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Non-paying partnerships and its association with HIV risk behavior, program exposure and service utilization among female sex workers in India.
BMC Public Health. 2014 Mar 13; 14:248.BP

Abstract

BACKGROUND

In India, HIV prevention programs have focused on female sex workers' (FSWs') sexual practices vis-à-vis commercial partners leading to important gains in HIV prevention. However, it has become apparent that further progress is contingent on a better understanding of FSWs' sexual risks in the context of their relationships with non-paying partners. In this paper, we explored the association between FSWs' non-paying partner status, including cohabitation and HIV risk behaviors, program exposure and utilization of program services.

METHODS

We used data from the cross-sectional Integrated Behavioral and Biological Assessment (IBBA) survey (2009-2010) conducted among 8,107 FSWs in three high priority states of India- Maharashtra, Andhra Pradesh and Tamil Nadu. Multiple logistic regression was used to examine the association between non-paying partner and cohabitation status of FSWs with HIV risk behaviors, program exposure and utilization of program services.

RESULTS

FSWs reporting a non-paying partner were more likely to be exposed to and utilize HIV prevention resources than those who did not have a non-paying partner. Analyses revealed that FSWs reporting a non-cohabiting non-paying partner were more likely to be exposed to HIV prevention programs (adjusted OR: 1.7, 95% CI: 1.3-2.1), attend meetings (adjusted OR: 1.5, 95% CI: 1.2-1.8), and visit a sexually transmitted infections clinic at least twice in the last six months (adjusted OR: 1.6, 95% CI: 1.3-1.9) as compared to those reporting no non-paying partner. That said, FSWs with a non-paying partner rarely used condoms consistently and were more vulnerable to HIV infection because of being street-based (p<0.001) and in debt (p<0.001).

CONCLUSION

FSWs with cohabiting partners were more likely to be exposed to HIV prevention program and utilize services, suggesting that this program was successful in reaching vulnerable groups. However, this subgroup was unlikely to use condoms consistently with their non-paying partners and was more vulnerable, being street based and in debt. The next generation of HIV prevention interventions in India should focus on addressing relationship factors like risk communication and condom negotiation, including specific vulnerabilities like indebtedness and street based solicitation among women in sex work.

Authors+Show Affiliations

No affiliation info availableNo affiliation info availableNo affiliation info availableDivision of Epidemiology, St John's Research Institute, St John's National Academy of Health Sciences, Bangalore 560034, India. skrishnan@rti.org.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24621082

Citation

Travasso, Sandra Mary, et al. "Non-paying Partnerships and Its Association With HIV Risk Behavior, Program Exposure and Service Utilization Among Female Sex Workers in India." BMC Public Health, vol. 14, 2014, p. 248.
Travasso SM, Mahapatra B, Saggurti N, et al. Non-paying partnerships and its association with HIV risk behavior, program exposure and service utilization among female sex workers in India. BMC Public Health. 2014;14:248.
Travasso, S. M., Mahapatra, B., Saggurti, N., & Krishnan, S. (2014). Non-paying partnerships and its association with HIV risk behavior, program exposure and service utilization among female sex workers in India. BMC Public Health, 14, 248. https://doi.org/10.1186/1471-2458-14-248
Travasso SM, et al. Non-paying Partnerships and Its Association With HIV Risk Behavior, Program Exposure and Service Utilization Among Female Sex Workers in India. BMC Public Health. 2014 Mar 13;14:248. PubMed PMID: 24621082.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-paying partnerships and its association with HIV risk behavior, program exposure and service utilization among female sex workers in India. AU - Travasso,Sandra Mary, AU - Mahapatra,Bidhubhusan, AU - Saggurti,Niranjan, AU - Krishnan,Suneeta, Y1 - 2014/03/13/ PY - 2013/08/29/received PY - 2014/03/06/accepted PY - 2014/3/14/entrez PY - 2014/3/14/pubmed PY - 2015/9/8/medline SP - 248 EP - 248 JF - BMC public health JO - BMC Public Health VL - 14 N2 - BACKGROUND: In India, HIV prevention programs have focused on female sex workers' (FSWs') sexual practices vis-à-vis commercial partners leading to important gains in HIV prevention. However, it has become apparent that further progress is contingent on a better understanding of FSWs' sexual risks in the context of their relationships with non-paying partners. In this paper, we explored the association between FSWs' non-paying partner status, including cohabitation and HIV risk behaviors, program exposure and utilization of program services. METHODS: We used data from the cross-sectional Integrated Behavioral and Biological Assessment (IBBA) survey (2009-2010) conducted among 8,107 FSWs in three high priority states of India- Maharashtra, Andhra Pradesh and Tamil Nadu. Multiple logistic regression was used to examine the association between non-paying partner and cohabitation status of FSWs with HIV risk behaviors, program exposure and utilization of program services. RESULTS: FSWs reporting a non-paying partner were more likely to be exposed to and utilize HIV prevention resources than those who did not have a non-paying partner. Analyses revealed that FSWs reporting a non-cohabiting non-paying partner were more likely to be exposed to HIV prevention programs (adjusted OR: 1.7, 95% CI: 1.3-2.1), attend meetings (adjusted OR: 1.5, 95% CI: 1.2-1.8), and visit a sexually transmitted infections clinic at least twice in the last six months (adjusted OR: 1.6, 95% CI: 1.3-1.9) as compared to those reporting no non-paying partner. That said, FSWs with a non-paying partner rarely used condoms consistently and were more vulnerable to HIV infection because of being street-based (p<0.001) and in debt (p<0.001). CONCLUSION: FSWs with cohabiting partners were more likely to be exposed to HIV prevention program and utilize services, suggesting that this program was successful in reaching vulnerable groups. However, this subgroup was unlikely to use condoms consistently with their non-paying partners and was more vulnerable, being street based and in debt. The next generation of HIV prevention interventions in India should focus on addressing relationship factors like risk communication and condom negotiation, including specific vulnerabilities like indebtedness and street based solicitation among women in sex work. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/24621082/Non_paying_partnerships_and_its_association_with_HIV_risk_behavior_program_exposure_and_service_utilization_among_female_sex_workers_in_India_ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-248 DB - PRIME DP - Unbound Medicine ER -