Saturday, June 18, 2016

Micro-level social and structural factors act synergistically to increase HIV risk among Nepalese female sex workers

Sex workers face stigma, discrimination and violence across the globe and are almost 14 times more likely to be HIV infected than other women in low-and middle income countries. In Asia, condom campaigns at brothels have been effective in some settings, but for preventive interventions it is important to understand micro-level social and structural factors that influence sexual behaviors of sex workers to be sustainable. This study assesses the syndemic effects of micro-level social and structural factors of unprotected sex and the prevalence of HIV among female sex workers in Nepal.

This quantitative study included 610 female sex workers that were recruited using two-stage cluster sampling from September to November 2012 in 22 Terai highway districts of Nepal. Rapid HIV tests and face-to-face interviews were conducted to collect biological and behavioral information. A count of physical (sexual violence and other undesirable events), social (poor social support and condom negotiation skills) and economic (unprotected sex to make more money) factors that operate at the micro-level was calculated to test the additive relationship to unprotected sex.

The HIV prevalence was 1% and this is presumably representative with a large sample of female sex workers in Nepal. The prevalence of unprotected sex with client was high (24%). For each additional adverse physical, social and economic condition, the probability of non-use of condoms with clients increased substantially: 1 problem=12%, p-value 0.005; 2 problems=19%, p-value <0.001; 3-5 problems= 38%, p-value <0.001.

Interactions between two or more adverse conditions linked to physical, social and economic environment increased the risk of unprotected sex among Nepalese female sex workers.

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1Public Health and Environment Research Center, Kathmandu, Nepal; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Electronic address:
2Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
3Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
4FHI360, Kathmandu, Nepal.
5Centre for International Health, University of Bergen, Bergen, Norway.
6Department of Public Health, Nobel College, Pokhara University, Kathmandu, Nepal.
Int J Infect Dis. 2016 Jun 13. pii: S1201-9712(16)31091-8. doi: 10.1016/j.ijid.2016.06.007. [Epub ahead of print]

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