Fertility Intentions, Power Relations & Condom Use within Intimate & Other Non-Paying Partnerships of Women in Sex Work in Bagalkot District, South India

Study aimed to: (1) examine the relationship between interpersonal as well as social-demographic, cultural and structural factors, and condom non-use by sex workers' main intimate or other non-paying male sex partners (NPPs), as reported by a sample of sex workers; and (2) understand HIV/sexually transmitted infections (STIs) risk (e.g., numbers of sexual partners; condom use with different partners) among couples comprised of a sub-set of sex workers and their NPPs. 

Bivariate and multivariable logistic regression was used to identify factors associated with condom non-use at last sex by the main NPP, as reported by sex workers. Adjusted odds ratios and 95% confidence intervals are reported (AOR[95%CIs]). Data were drawn from cross-sectional surveys in Bagalkot District, Karnataka State, South India. Responses by sex workers whose main NPPs agreed to enrol in the study and the main NPP enroled were linked; these responses by couples (pairs of sex workers and NPPs) were examined for responses to sexual risk for HIV/STIs. 

Overall, this study included 257 sex workers and 76 NPPs. The data from 67 couples (88.2%) could be linked. In over a quarter of partnerships, at least one (SW or NPP) partner reported having another type of partner besides each other (and clients of SWs). In multivariable analysis, significantly increased odds of condom non-use at last sex with the main NPP were found for the following key factors: planning to have a child with their main NPP; and having decisions about condom use made by their main NPP or both equally (instead of by the sex workers herself). 

The study highlights the potential risk for HIV/STI acquisition and transmission between NPPs and sex workers, and between NPPs and their non-sex workers wives and other sex partners. Study results underscore the need for HIV/STI prevention approaches that incorporate informed decision-making about childbearing and parenting, and empowerment strategies for sex workers within the context of NPPs.

Via:  http://ht.ly/Rj9MS HT https://twitter.com/UBCMedicine/