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      Indicators of Mobility, Socio-Economic Vulnerabilities and HIV Risk Behaviours Among Mobile Female Sex Workers in India

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          Abstract

          This paper examines the relationship between indicators of mobility, socio-economic vulnerabilities, and HIV risk behaviours among 5,498 mobile female sex workers (FSWs) living in the four high HIV prevalence states in India. Female sex workers with greater degree of mobility reported significantly more often than the FSWs with lesser degree of mobility that they experienced physical violence, and consumed alcohol prior to sex. Further, FSWs with greater degree of mobility reported significantly more often than the FSWs with lesser degree of mobility that they had inconsistent condom use in sex with clients, even after controlling for several demographic characteristics and socio-economic vulnerabilities including experiences of violence. Additionally, short duration visits and visit to the Jatra (religious fairs) places found to have significant association with their inconsistent condom use in sex with clients as well as continuation of sex despite having STI symptoms. These findings suggest the need for screening FSWs for higher degree of mobility and to mobilize them to form community networks so as to deal with violence, reduce alcohol use and promote consistent condom use along the routes of mobility. HIV prevention interventions aimed at FSWs require an increased attention to address the socio-economic vulnerabilities including alcohol use, with particular emphasis on those FSWs who are on the move in India and elsewhere.

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          Most cited references30

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          Containing HIV/AIDS in India: the unfinished agenda.

          India's HIV epidemic is not yet contained and prevention in populations most at risk (high-risk groups) needs to be enhanced and expanded. HIV prevalence as measured through surveillance of antenatal and sexually transmitted disease clinics is the chief source of information on HIV in India, but these data cannot provide real insight into where transmission is occurring or guide programme strategy. The factors that influence the Indian epidemic are the size, behaviours, and disease burdens of high-risk groups, their interaction with bridge populations and general population sexual networks, and migration and mobility of both bridge populations and high-risk groups. The interplay of these forces has resulted in substantial epidemics in several pockets of many Indian states that could potentially ignite subepidemics in other, currently low prevalence, parts of the country. The growth of HIV, unless contained, could have serious consequences for India's development. India's national response to HIV began in 1992 and has shown early success in some states. The priority is to build on those successes by increasing prevention coverage of high-risk groups to saturation level, enhancing access and uptake of care and treatment services, ensuring systems and capacity for evidence-based programming, and building in-country technical and managerial capacity.
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            Intimate partner violence is as important as client violence in increasing street-based female sex workers' vulnerability to HIV in India.

            There are no studies that examine street-based female sex workers' vulnerability to HIV from both clients and intimate partners. This study documents street-based female sex workers' experiences of client and intimate partners, examines the intersections of violence, alcohol use in condom use, and highlights survival strategies used to avert harm. Ethnographic data were collected from 49 female sex workers through focus group discussions and in-depth interviews. Female sex workers experienced multifarious forms of severe client and intimate partner violence. Sexual coercion and forced group sex in the context of alcohol use posed formidable barriers for condom use negotiation. Further, traditional gender norms dictated women's inabilities to negotiate condom-use with intimate partners. However, there was evidence of adoption of successful survival strategies in the face of danger and women's positive evaluations of the benefits of sex work and their contributions to family well-being. Harm reduction efforts with female sex workers need to account for their vulnerability to HIV from intimate partners in addition to clients. HIV prevention programmes need to include male clients in order to reduce harm among street-based female sex workers. There is an urgent need to build on sex workers' strengths and involve them in designing individual level, community, and structural interventions that could help in reducing women's vulnerability to intimate partner violence and HIV in India.
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              Determinants of HIV prevalence among female sex workers in four south Indian states: analysis of cross-sectional surveys in twenty-three districts.

              In four states in southern India we explored the determinants of HIV prevalence among female sex workers (FSW), as well as factors associated with district-level variations in HIV prevalence among FSW. Data from cross-sectional surveys in 23 districts were analysed, with HIV prevalence as the outcome variable, and sociodemographic and sex work characteristics as predictor variables. Multilevel logistic regression was applied to identify factors that could explain variations in HIV prevalence among districts. HIV prevalence among the 10 096 FSW surveyed was 14.5% (95% confidence interval 14.0-15.4), with a large interdistrict variation, ranging from 2% to 38%. Current marital status and the usual place of solicitation emerged as important factors that determine individual probability of being HIV positive, as well as the HIV prevalence within districts. In multivariate analysis, compared with home-based FSW, the odds of being HIV positive was greater for brothel-based FSW [adjusted odds ratio (AOR) 2.17, P
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                Author and article information

                Contributors
                +91-11-41743410 , +91-11-41743412 , nsaggurti@popcouncil.org , nsaggurti@yahoo.co.in
                Journal
                AIDS Behav
                AIDS Behav
                AIDS and Behavior
                Springer US (Boston )
                1090-7165
                1573-3254
                29 March 2011
                29 March 2011
                May 2012
                : 16
                : 4
                : 952-959
                Affiliations
                [ ]Population Council, 142, Golf Links, 1st Floor, New Delhi, 110 003 India
                [ ]International Center for Research on Women, New Delhi, India
                [ ]Public Health Foundation of India, New Delhi, India
                [ ]University of Manitoba, Winnipeg, MB Canada
                Article
                9937
                10.1007/s10461-011-9937-7
                3618410
                22186960
                62640366-5b13-4e60-87e6-38f590089edc
                © Springer Science+Business Media, LLC 2011
                History
                Categories
                Original Paper
                Custom metadata
                © Springer Science+Business Media, LLC 2012

                Infectious disease & Microbiology
                mobility,hiv,stis,condom use,fsws,violence,alcohol use,india,sex workers
                Infectious disease & Microbiology
                mobility, hiv, stis, condom use, fsws, violence, alcohol use, india, sex workers

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