HIV and AIDS risk perception among sex workers in semi-urban Blantyre, Malawi

Background: Several health behaviour theories propose that risk perception affects the likelihood of behaviour intentions and practice. The perception of risk to HIV and AIDS among female sex workers in Malawi has not been well described. Yet knowledge of how this most at risk population perceives contagion could help in informing the design, implementation and monitoring of interventions.
Methods: A cross sectional, qualitative study was conducted among female sex workers in Blantyre, Malawi between 2013 and 2014. Snowballing technique was used to recruit study participants. In depth interviews were done by six trained female research assistants among 45 female sex workers. Data were analysed using thematic content analysis.
Results: There were mixed perceptions of risk to HIV infection among the sampled sex workers. While some of the study participants perceived themselves as at higher risk of acquiring infection, some considered themselves to be at no higher risk than the general population. Some study participants suggested that married women in stable relationship were at higher risk of infection than the female sex workers. Prayer and belief in God were reported to be protective from HIV acquisition while predestination or mere talking about HIV was perceived to result in vulnerability to infection. In terms of overall knowledge about HIV, this was assessed as high. Several barriers to consistent condom use were reported: non-availability at all times, high cost and unacceptable instructions of the female condom, offers of higher pay for unprotected sex by male clients and harassment and forced unprotected sex by police.
Conclusions: We have reported expression of dissonance, fatalism and predestination among female sex workers in semi-urban Malawi is responses to the threat of HIV. There is need to develop context-specific safer sex programs among female sex worker in Malawi.