Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore
PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / Name of the Candidate and Address / SUNESH GEORGE1ST YEAR M.Sc NURSING,
ROYAL COLLEGE OF NURSING,
7TH MAIN , 1ST BLOCK,
UTTARAHALLI, BANGALORE-61
2 / Name of the Institution / Royal College of Nursing
3 / Course of study and subject / 1st year M.Sc. nursing,
Medical And Surgical Nursing
4 / Date of admission to Course / 30 .06.2008
5. / Title of the Topic / A Quasi Experimental Study to Assess the Effectiveness of a Planned Teaching Program Regarding AIDS and Sexually Transmitted Diseases among Female Sex Workers Who are Members of Sangama Organization. J.C Nagar, Bangalore-06.
6. / Brief resume of the intended work
6.1. Need for the study
6.2. Review of literature
6.3. Objectives of the study
6.4. Operational definitions
6.5. Hypothesis of the study
6.6. Assumptions
6.7. Delimitations of the study
6.8. Pilot study
6.9. Variables / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7. / Material and Methods:
7.1. Source of data-Data will be collected from female sex workers who are the members of
Sangama Organization JC Nagar Bangalore.
7.2. Methods of collection of data: Structured questionnaire method.
7.3. Does the study require any investigation or interventions to be conducted on patients or
other humans or animals? – No
7.4. Has ethical clearance been obtained from our institutions?
YES, Ethical committee’s report is here with enclosed
8. / List of Reference / Enclosed
Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore
PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / Name of the Candidate and Address / SUNESH GEORGE1ST YEAR M.Sc NURSING
ROYAL COLLEGE OF NURSING
7TH MAIN , 1ST BLOCK
UTTARAHALLI, BANGALORE-61
2 / Name of the Institution / Royal College of Nursing
3 / Course of study and subject / 1st year M.Sc. nursing
Medical And Surgical Nursing
4 / Date of admission to Course / 30 .06.2008
5. / Title of the Topic
A Quasi Experimental Study to Assess the Effectiveness of a Planned Teaching Program Regarding AIDS and Sexually Transmitted Diseases among Female Sex Workers Who are Members of Sangama Organization. J.C Nagar, Bangalore-06.
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION:
“We say that slavery has vanished from European civilization, but this is not true. Slavery still exists, but now it applies only to women and its name is prostitution”.
Victor Hugo
Sex work as a profession has a long history in India. Kautilya's Arthashastra written in circa 300 BC and Vatsayana's Kama Sutra written between the first and fourth centuries AD. Vedic texts give account of a mythic empire builder, Bharata, and prove that people were acquainted with prostitution through references to "loose women", female "vagabonds" and sexually active unmarried girls. The Vedic word sadbarani refers to a woman who offers sex for payment.
Commercial sex work is central to an epidemic that is primarily spread by unprotected heterosexual intercourse. It is also a feature of all countries and cultures, encompassing a wide range of people and behaviours. Sex work can involve men and transgender people, as well as women. People who are engaged in selling sex obviously have multiple sex partners and are therefore highly vulnerable to several Sexual Transmission Diseases (STDs/STI) and HIV/AIDS infection. Because they have many sexual partners, they are also more likely to transmit the virus to other people unless condoms are always used.1
The sexually transmitted diseases are a group of communicable diseases that are transmitted predominantly by sexual contact and caused by a wide range of bacterial, viral, protozoval and fungal agent and ectoparasites. The sexually transmitted diseases include syphilis, gonorrhoea, chancroid, lymphogranuloma venereum and donovanosis. The term AIDS refers only to the last stage of the HIV infection. AIDS can be called our modern pandemic, affecting both industrialized and developing countries.
STDs affect men and women of all backgrounds and economic levels. They are most prevalent among teenagers and young adults. Nearly two-thirds of all STDs occur in people younger than 25 years of age. The incidence of STDs is rising, in part because in the last few decades, young people have become sexually active earlier yet are marrying later. In addition, divorce is more common. The net result is that sexually active people today are more likely to have multiple sex partners during their lives and are potentially at risk for developing Sexually Transmitted Diseases. Some Sexually transmitted Diseases can spread into the uterus (womb) and fallopian tubes to cause pelvic inflammatory disease (PID), which in turn is a major cause of both infertility and ectopic (tubal) pregnancy. The latter can be fatal. STDs in women also may be associated with cervical cancer. One STD, human papillomavirus infection (HPV), causes genital warts and cervical and other genital cancers.
Globally unprotected heterosexual route is the predominant route of transmission of the virus. The other modes of transmission include unprotected penetrative sex between men, injecting drug use and unsafe blood transfusions and injections. AIDS has rapidly established itself through out the world, and is likely to endure and persist well into the 21st century. AIDS has evolved from a mysterious illness to a global pandemic which has infected tens of millions in less than 20 years. Sexually transmitted diseases are becoming a major public health problem in India.
6.1 NEED FOR STUDY
“Whether our reformers admit it or not, the economic and social inferiority of women is responsible for prostitution”
Emma Goldman
In the 6th century prostitution would remain legal through out the Greek and Roman emperors strongly discouraged it. In AD 590 Banned prostitution as a part of an effort to bring the country into alignment with Christian ideology. In 1161 King Henry 11 regulates but does not ban prostitution. In 1586 Pope Sixtus decided that all the women who participate in the prostitution should put to death. In 1956 Indian Anti-prostitutional Laws are generally enforced. In 1971 some countries ban brothels and some allow them to operate legally. In 1999 Anti-prostitution. Law has historically focused on the arrest and punishment of prostitutes themselves. In 2007 South Africa has a serious domestic prostitution problem of its own- in a nation where an estimated 25% of prostitutes are children. Criminal Law Amendment Act 32 of 2007 targets human trafficking, and a team of legal scholars has been commissioned by the government to draft new regulations governing prostitution.
By the end of 2007, about 3 million people living with HIV have been receiving ART (Anti Retroviral Therapy), one million increases since 2006. However this represents 31% only of the estimated need Countries are expanding client initiated and provider initiated testing and counseling to expand knowledge of HIV status. New successful examples of HIV prevention among most at risk groups have been implemented. More effort is needed to scale up, monitor and evaluate those programs. Despite improvement, most countries are still far from achieving their universal access targets.
Today, an estimated 34 to 46 million people are living with HIV/ AIDS. More than 20 million people have died from AIDS, 3 million in 2003 alone. AIDS is affecting mainly the young people in sexually active age groups. Majority of the HIV infections (87.7%) are in the age group of 15-44 years, out of which 35% are in the age group of 15-24 years. The majority are infected through unprotected sex. According to HIV Sentinel Surveillance 2003, males account for 73.5% of AIDS cases and females 26.5%, the ratio being 3:1.2
A cross- sectional study conducted to assess the epidemiology of HIV infection among brothel-based sex workers. The setting were National Institute of Cholera and Enteric Diseases, Kolkata ,India. The samples were 622 sex workers. The result shows that HIV infection was 9.6% but was much higher among younger sex workers aged 20 years or less (27.7%) compared to older age group (8.4%).The study concluded that there was a big gap between the reported and the evaluated condom use by sex workers. There is a need to develop suitable HIV intervention strategies, considering the socioeconomic and cultural aspects of city sex workers, with a provision for continuous monitoring and evaluation.3
A study conducted to determine HIV prevalence in injection drug users and their regular sex partners. The settings were SAHAI Trust, Chennai, India. The samples were 226 injection drug users and their regular sex partners. Semi structured questionnaire was administered to collect the data. The result revealed that the HIV seroprevalence was 30% in injection drug users and 5% in their regular sex partners. While 25% couples only the male partner was HIV positive, and 70% was HIV negative. The study concluded that reducing sharing of injection equipment and unsafe tattoing through targeted and environmental interventions, increasing HIV risk perception, promoting safer sex practices among injection drug users and their sex partners are urgent program needs.4
Since the investigator was worked as a staff nurse in a hospital, many cases of HIV infected clients reported in the casualty and the majority of them belongs to commercial sex workers. While taking the detail history of them, the researcher found to know that the basic reason behind that is lack of knowledge regarding AIDS and poverty. So the researcher thought to provide a teaching program and assess the knowledge regarding HIV and sexually transmitted diseases to improve the awareness about AIDS and sexually transmitted diseases among sex workers.
6.2 REVIEW OF LITERATURE
Review of literature provides basis for future investigations, justifies the need for replication, throws light up on feasibility of the study, and indicates constraints of data collection and help to relate findings of one another.5
A cross- sectional study conducted to determine the prevalence of sexually transmitted infections and associated risk factors among female commercial sex workers in Mexico. The samples were 100 female commercial sex workers. The data were collected by using questionnaire. The result shows that sexually transmitted prevalence was of 11%, reproductive system infection prevalence was 39%. The study concluded that the regular use of condom during intercourse is the most important preventive measures to avoid the control of sexually transmitted diseases. The intervention measures directed at these factors should strengthen preventive and educational programs to improve medical care for this infection.6
A cross-sectional survey conducted to assess the beliefs, sexual behavior and preventive practices with respect to HIV or Aids among commercial sex workers. The setting was Gono University, Daulatdia. Bangladesh. The face-to-face interview and structured questionnaire were used to collect the data. The sample sizes were 300 commercial sex workers. The study concluded that Bangladesh needs a comprehensive HIV program that combines clinical and screening measures with behavior change and communication, interventions along with change in social norms and attention to the rights of commercial sex workers in order to avert a wide spread epidermic.7
A cross-sectional survey conducted to investigate the alcohol use by men is a risk factor for the acquisition of sexually transmitted infections and HIV virus from female sex workers. The study settings were School of Public Health, Mumbai, India. The sample size was 1741 men. The data is collected by randomized controlled trial of HIV prevention, intervention. The study revealed that men who drink alcohol when visiting female sex workers engaged in riskier behavior and are more likely to have HIV and STDs. Prevention program in India need to raise awareness of this relationship.8
A study conducted to assess the risk of HIV in non-brothel based female sex workers in India. The settings were Centre for Human Development, Administrative Staff College, Hyderabad, India. The samples were 6648 female sex workers in 13 districts in the state of Andhra Pradesh. The confidential interview method was used for collection of data. The study concluded that the Non- brothel based Female Sex Workers, who form the majority of sex work in India, were at a significant higher risk of HIV infection as compared with brothel – based Female Sex Workers with their high vulnerability, the success of expansion of HIV prevention efforts will depends on achieving and sustaining an environment that enables HIV prevention with the non-brothel based Female Sex Workers.9
A cross-sectional study done to measure the prevalence of sexually transmitted infection and performance STI syndromes against etiological diagnosis, in female sex workers of red light area. The setting was on the Department of Community Medicine, Government Medical College, Surat, India. The behavioral questionnaire were administered to collect the data. The samples were 124 out of an estimated total of 500 sex workers. The study revealed that the prevalence of different STIs and HIV among female sex workers in the Surat red light area is high despite, high reported condom use with clients, therefore, it is necessary to explore alternative strategies for control of STIs in female sex workers, STI services need to be improved.10
A study conducted to develop and test an HIV intervention targeting sex workers and madams in the brothel of Bombay. The setting was AIDS surveillance centre, Department of Microbiology, Seth G.S, Medical College Bombay, India. The samples were 334 sex workers and 20 madams. The method of data collection by interviewer administered questionnaire. The result revealed that the baseline level of knowledge about HIV’s experience with condoms was extremely low among both sex workers and madams. The study concluded that both HIV prevalence and incidence are alarmingly high among female sex workers in Bombay.11
A study conducted with the aim to assess the prevalence of Human Immunodeficiency virus-1 infection among patient with sexually transmitted disease in Bombay, India. The samples were the HIV-1 persons belonging to various high risk groups in Bombay from 1987 to 1989. The result shows that the increase in HIV-1 antibody sero positively among both male and female patients with sexually transmitted disease was detected from 1987 to 1989. The study concluded that HIV-1 established in this population and need to be controlled vigorously.12
A study conducted to assess the burden and determinants of HIV and STIs in a population based samples of female sex workers in Goa, India. The sample size was 326 female sex workers. A completed interviewer administered questionnaires were used to collect the data. The result revealed that knowledge about HIV and access to free STI services was associated with a lower likelihood of STIs. Sex workers working in medium prevalence states of India are highly vulnerable to HIV and STIs and need to be rapidly incorporated into existing interventions. Structural and gender based determinants of HIV and STIs are integral to HIV prevention strategies.13