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

This 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 (SWs); 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 SWs 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 SWs. 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 SWs whose main NPPs agreed to enrol in the study and the main NPP enroled were linked; these responses by couples (pairs of SWs and NPPs) were examined to assess sexual risk for HIV/STIs. Overall, this study included 257 SWs 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 (versus by the SWs herself). 

Our study highlights the potential risk for HIV/STI acquisition and transmission between NPPs and SWs, and between NPPs and their non-SWs 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 SWs in the context of their relationships with NPPs.

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By: Deering KN1,2, Shaw SY3, Thompson LH3, Ramanaik S4, Raghavendra T4, Doddamane M4, Bhattacharjee P4, Moses S3,5, Lorway R3.

• 1Faculty of Medicine, Division of AIDS , University of British Columbia, Vancouver , Canada.
• 2BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.
• 3Faculty of Medicine, Community Health Sciences , University of Manitoba , Winnipeg , Canada.
• 4Karnataka Health Promotion Trust , Bangalore , India.
• 5Faculty of Medicine, Medical Microbiology , University of Manitoba , Winnipeg , Canada.  

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