Data analysis was guided by a qualitative data analysis framework. The study results revealed several societal determinants that supported vulnerability to HIV infection among the participants. They included low education level and sexual health literacy including the lack of knowledge and information about HIV transmission and prevention. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Competing interests: The authors have declared that no competing interests exist. The prevalence of HIV infection among the clients of female commercial sex workers FCSWs and the sex workers themselves has been reported to be ranging from 5. However, this group does not seem to be considered as an HIV high-risk group and has not been the target group for HIV prevention programs and interventions in Indonesia even though the number of annual HIV cases transmitted through heterosexual contacts is higher than that of through other modes of transmission [ 11 ].
For instance, heterosexual contacts have been reported as the main route of HIV transmission as they contributed In the context of this paper, vulnerability determinants refer to a range of contextual, socio-environmental and cultural factors that contribute to the spread of HIV and are instrumental in enhancing the transmissibility of the HIV infection among clients of FCSWs and in other vulnerable populations.
Societal determinants on the other hand, refer to a much broader range of social factors distal factors that are supportive of HIV transmission in the current study group as well as in the general society: these may include factors such as education levels, socioeconomic status, the prevalence of HIV and poorly resourced health system that does not meet the needs of the population especially those at highest risk of HIV infections [ 16 — 19 ].
Globally, behavioural factors such as frequent unprotected sex with multiple sex workers, expectation of high sexual pleasure and sexual satisfaction have been reported to be the main contributors proximal factors to the transmission of the epidemic among a group of people who are the clients of FCSWs [ 1 , 3 , 4 , 6 , 7 , 19 — 27 ]. Lack of knowledge of how HIV transmission and prevention can occur, the practice of consuming prophylactic antibiotics prior to sexual engagement as an HIV prevention method and perceptions of good appearance as HIV safe sex partners, have also been identified as influencers of unsafe sexual practices among the clients of FCSWs [ 4 , 6 , 26 — 29 ].
