Client-Perpetrated & Husband-Perpetrated Violence among Female Sex Workers in Andhra Pradesh, India: HIV/STI Risk Across Personal & Work Contexts

OBJECTIVES:

This study examines violence experienced in work and personal contexts and relation to HIV risk factors in these contexts among female sex workers (FSW) in Andhra Pradesh, India.

METHODS:

FSW at least 18 years of age (n=2335) were recruited through three rounds of respondent-driven sampling between 2006 and 2010 for a survey on HIV risk. Using crude and adjusted logistic regression models, any sexual/physical violence (last 6 months) perpetrated by clients and husbands were separately assessed in association with accepting more money for sex without a condom (last 30 days), consistent condom use with clients and husbands (last 30 days), and sexually transmitted infection (STI) symptoms (last 6 months).

RESULTS:

The mean age among participants was 32, 22% reported being currently married, and 22% and 21% reported physical/sexual violence by clients and husbands, respectively. In adjusted logistic regression models, FSW who experienced client violence were more likely to report accepting more money for unprotected sex trades (adjusted OR (AOR)=1.7; 95% CI 1.4 to 2.2), less likely to report consistent condom use with clients (AOR=0.6; 95% CI 0.5 to 0.7) and more likely to report STI symptoms (AOR=3.5; 95% CI 2.6 to 4.6). Women who reported husband violence were more likely to report accepting more money for unprotected sex trades (AOR=2.1; 95% CI 1.2 to 3.7), less likely to report consistent condom use with clients (AOR=0.5; 95% CI 0.3 to 0.8) and more likely to report STI symptoms (AOR=2.6; 95% CI 1.6 to 4.1).

CONCLUSIONS:

Among FSW, experiences of violence in work and personal contexts are associated with sexual HIV risk behaviours with clients as well as STI symptoms.

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By:  Reed E1, Erausquin JT2, Groves AK3, Salazar M1, Biradavolu M3, Blankenship KM3.

• 1Division of Global Public Health, School of Medicine: La Jolla, University of California, San Diego, CA, USA.
• 2Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA.
• 3Department of Sociology, American University, Washington DC, USA. 
• Sex Transm Infect. 2016 Feb 23. pii: sextrans-2015-052162. doi: 10.1136/sextrans-2015-052162.

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Non-Barrier Contraceptive Use & Relation to Condom Use Behavior by Partner Type among Female Sex Workers in Andhra Pradesh, India

OBJECTIVE:

The study assessed non-barrier contraceptive use among female sex workers (FSW) in Andhra Pradesh, India and relation to inconsistent condom use among commercial and non-commercial male sexual partners.

METHODS:

FSW at least 18 years of age (n=2338) were recruited through respondent-driven sampling for an HIV risk survey. Analysis was restricted to women of childbearing age (n=2197). Crude and adjusted logistic regression models were used to assess non-barrier contraceptive use and relation to inconsistent condom use with husbands or regular male partners (i.e. non-clients), regular clients and occasional clients.

RESULTS:

Non-barrier methods of contraception included contraceptive pills (3.8%) and sterilisation (68.4%). In logistic regression models adjusted for relevant demographics, FSW using contraceptive pills were more likely to report inconsistent condom use with a regular client (past week) and with an occasional client (past week), as well as accepting more money for sex without a condom (past 30 days). No significant associations were found between pill use and inconsistent condom use among women's non-client partners, potentially related to small sample sizes within these subgroups. Reporting sterilisation, which was more common among FSW who were older in age, was not associated with inconsistent condom use with client or non-client sexual partners.

CONCLUSIONS:

Findings document potential unmet need for modern, spacing contraceptives (i.e. pill, intrauterine device), but also indicate the importance for family planning services, particularly those promoting modern contraceptive methods to be provided alongside HIV prevention among FSW in Andhra Pradesh, India.

Full article at:   http://goo.gl/jiQFHl

By:  Reed E1, Erausquin JT2, Biradavolu M3, Servin AE4, Blankenship KM5.

• 1Assistant Professor, Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA.
• 2Assistant Professor, Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC, USA.
• 3Scholar in Residence, Department of Sociology, American University, Washington, DC, USA.
• 4Postdoctoral Fellow, Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA.
• 5Professor and Chair, Department of Sociology, American University, Washington, DC, USA. 
• J Fam Plann Reprod Health Care. 2015 Dec 23. pii: jfprhc-2014-100918. doi: 10.1136/jfprhc-2014-100918.

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Mobile Phones & Sex Work in South India: The Emerging Role of Mobile Phones in Condom Use by Female Sex Workers in Two Indian States

The aim of this study was to examine female sex workers' solicitation of clients using mobile phones and the association between this and condom use with clients. Cross-sectional data were utilised to address the study's aim, drawing on data collected from female sex workers in Calicut, Kerala, and Chirala, Andhra Pradesh. 

Use of mobile phone solicitation was reported by 46.3% (n = 255) of Kerala participants and 78.7% (n = 464) of those in Andhra Pradesh. Kerala participants reporting exclusive solicitation using mobile phones demonstrated 1.67 times higher odds (95% CI: 1.01-2.79) of inconsistent condom use than those reporting non-use of mobile phones for solicitation. 

However, those reporting exclusive solicitation through mobile phones in Andhra Pradesh reported lower odds of inconsistent condom use (OR: 0.03; 95% CI: 0.01-0.26) than those not using mobile phones for solicitation. 

Findings indicate that solicitation of clients using mobile phones facilitates or hampers consistency in condom use with clients depending on the context, and how mobile phones are incorporated into solicitation practices. 

Variations in sex work environments, including economic dependence on sex work or lack thereof may partially account for the different effects found.

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By:  Navani-Vazirani S1, Solomon D, Gopalakrishnan, Heylen E, Srikrishnan AK, Vasudevan CK, Ekstrand ML.

• 1 School of Public Health, University of California , Berkeley , USA.
• Cult Health Sex. 2015;17(2):252-65. doi: 10.1080/13691058.2014.960002. Epub 2014 Oct 10. 

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Change Over Time in Police Interactions and HIV Risk Behavior Among Female Sex Workers in Andhra Pradesh, India

Little is known about the effectiveness of intervening to change interactions between female sex workers (FSWs) and police in order to reduce HIV risk. Using data collected in the context of a HIV prevention intervention that included components to change policing practices (n = 1,680), we examine the association of FSWs' reports of negative police interactions and HIV risk behaviors and whether these associations varied over time. 

Results show negative police interactions declined significantly over time. FSWs who had more than one negative police interaction were more likely to experience STI symptoms, inconsistently use condoms with their clients, and accept more money for condomless sex. Over time, these associations were stable or increased. 

Even where interventions have reduced the number of police incidents experienced by FSWs, stakeholders in HIV prevention must remain vigilant in challenging these incidents.

Via:  http://ht.ly/RMa9S HT https://twitter.com/UNCG_PHE

Correlates of Mental Depression among Female Sex Workers in Southern India

Mental health is an integral part of overall health status but has been a largely neglected issue in the developing world especially among female sex workers (FSWs). This study examines the prevalence and correlates of major depression among FSWs in southern India. Major depression was assessed using Patient Health Questionnaire-2 depression scale data from a cross-sectional Behavioral Tracking Survey, 2010-2011 conducted among FSWs (n = 1986) in Andhra Pradesh, a state in southern India. 

Almost two-fifths of FSWs (39%) reported major depression. Multivariate logistic regression analysis shows a significant association between major depression and the following characteristics for FSWs: low autonomy, alcohol use, experience of violence, police arrest, inconsistent condom use with clients, mobility for sex work, and being HIV positive or not wanting to disclose HIV status. 

Research and advocacy efforts are needed to ensure that the mental health issues of marginalized groups are appropriately addressed in HIV prevention programs.

Via:  http://ht.ly/RM3Sg HT https://twitter.com/Pop_Council

“From Me to HIV”: A Case Study of the Community Experience of Donor Transition of Health Programs

Below:  Avahan and the National AIDS Control Program (NACP)

Below:  Stakeholders involved in transition of Avahan program to Government of India

We find that communication about transition was difficult at first but improved over time, while issues related to employment of peer educators were challenging throughout the transition. Clinical services were shifted to government providers resulting in mixed experiences depending on the population being targeted. Lastly, the loss of activities aimed at community ownership and mobilization negatively affected the beneficiaries’ view of transition.

While some programmatic changes resulted in improvements, additional opportunity costs for beneficiaries may pose barriers to accessing HIV prevention services. Communicating and engaging community stakeholders early on in future such transitions may mitigate negative feelings and lead to more constructive relationships and dialogue.

Read more at:   http://ht.ly/R60vH HT @JohnsHopkinsSPH