Role of vaginal sex in heterosexual transmission of HIV has
been investigated but that of heterosexual anal sex (HAS) is not fully
understood. This paper examines practice of HAS among Female Sex Workers (FSWs)
and its correlates in India where the HIV epidemic is being primarily driven by
core groups like FSWs.
Data for this paper are drawn from Round I survey of 9667
FSWs in the Integrated Biological and Behavioral Assessment (IBBA) from 23
districts of 4 high HIV prevalent states of India. Bivariate and multivariate
analysis identified factors associated with HAS.
Ever having anal sex was reported by 11.9% FSWs. Typology and literacy were positively associated with practice of HAS. Longer duration
in sex trade, entertaining larger number of
clients the previous week, alcohol consumption and inability to negotiate condom use (AOR 1.53, 95% CI
1.28–1.83) were also correlated with HAS. Self-risk perception for HIV (AOR
1.46, 95% CI 1.25–1.71) did not impede HAS. Although symptoms of sexually
transmitted infections (STIs) in the last 12 months were associated with anal
sex (AOR 1.39, 95% CI 1.13–1.72) there was no significant association between
laboratory confirmed HIV and other STIs with HAS.
Practice of HAS by FSWs might significantly contribute to
HIV transmission in India. This study also shows that despite self-risk
perception for HIV, even literate FSWs with longer duration in sex work report
HAS. General messages on condom use may not influence safe HAS. FSWs need to be
targeted with specific messages on HIV transmission during anal sex. Women
controlled prevention methods, such as rectal microbicides and vaginal
microbicides are needed.
Below: FSWs Heterosexual Anal Sex & condom used at last anal sex
Table 2
Socio demographic and sex work profile of FSWs.
| Characteristics | Total FSWs = 9667 |
| Age - median (min, max) | 30.0 (18, 60) |
| Age<25 years | 18.30% |
| Age≥25 years | 81.70% |
| No. of years of education, Median (min, max): | 7.0 (1, 15) |
| Cannot read/write | 60.30% |
| Can read only | 11.00% |
| Can read and write | 28.70% |
| Ever married | 84.50% |
| Have no other source of income | 47.80% |
| Age at initiation of sex <15 yrs | 24.40% |
| Age at initiation of sex ≥15 yrs | 75.60% |
| Age at first paid sex <20 yrs | 19.10% |
| Age at first paid sex ≥20 yrs | 80.90% |
| Solicits from brothel/lodge/dhabha | 17.00% |
| Solicits from home | 17.40% |
| Solicits from public places, others | 65.30% |
| No. of clients FSW had sex with the previous day, Median(min, max): | 2.0 (0, 25) |
| No. of clients FSW had sex with the previous week Median(min, max): | 7.0 (0, 85) |
| Have regular paying clients | 92.10% |
| Have occasional paying client | 90.30% |
| Have non-paying partner | 70.20% |
| Never used condom with non paying partners- last week | 70.40% |
| Condom non use at last sex with regular client | 29.00% |
| Have >2 types of partners | 61.30% |
| Alcohol consumption at least once a week in the last month | 34.80% |
| STI awareness | 82.70% |
| STI at least one symptom-past 12 months | 47.50% |
| STI at least one symptom-current | 28.70% |
Full article at:
By:
1Clinical Trials Unit, National AIDS Research Institute, Pune, Maharashtra, India
2Integrated Behavioural and Biological Assessment Project, National AIDS Research Institute, Pune, Maharashtra, India
3Department of Biostatistics and Epidemiology, National AIDS Research Institute, Pune, Maharashtra, India
4National Institute of Epidemiology, Chennai, Tamil Nadu, India
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