Factors Associated with Risky Sexual Practices among Female Sex Workers in Karnataka, India

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Abstract

Introduction

The objectives of this study are to develop a summary measure of risky sexual practice and examine the factors associated with this among female sex workers (FSWs) in Karnataka, India.

Materials and Methods

Data were drawn from special behavioral surveys (SBS) conducted in 2007 among 577 FSWs in two districts of Karnataka, India: Belgaum and Bangalore. FSWs were recruited using the two-stage probability sampling design. FSWs' sexual practice was considered risky if they reported inconsistent condom use with any sexual partner and reported experience of one of the following vulnerabilities to HIV risk: anal sex, alcohol consumption prior to sex and concurrent sexual relationships.

Results

About 51% of FSWs had engaged in risky sexual practice. The odds of engaging in risky sex were higher among FSWs who were older (35+ years) than younger (18–25 years) (58% vs. 45%, Adjusted Odds Ratio (AOR): 2.0, 95% confidence interval (CI): 1.2–3.4), who were currently married than never married (61% vs. 51%, AOR: 4.8, 95% CI: 2.5–9.3), who were in sex work for 10+ years than those who were in sex work for less than five years (66% vs. 39%, AOR: 2.6, 95% CI: 1.6–4.2), and who had sex with 3+ clients/day than those who had sex with fewer clients (67% vs. 38%, AOR: 3.7, 95% CI:2.5–5.5).

Conclusion

FSWs who are older, currently married, practicing sex work for longer duration and with higher clientele were more likely to engage in risky sexual practices. HIV prevention programs should develop strategies to reach these most-at risk group of FSWs to optimize the effectiveness of such programs.

Related collections

Most cited references 33

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Review of sampling hard-to-reach and hidden populations for HIV surveillance.

Robert Magnani, Keith Sabin, Tobi Saidel … (2005)

Adequate surveillance of hard-to-reach and 'hidden' subpopulations is crucial to containing the HIV epidemic in low prevalence settings and in slowing the rate of transmission in high prevalence settings. For a variety of reasons, however, conventional facility and survey-based surveillance data collection strategies are ineffective for a number of key subpopulations, particularly those whose behaviors are illegal or illicit. This paper critically reviews alternative sampling strategies for undertaking behavioral or biological surveillance surveys of such groups. Non-probability sampling approaches such as facility-based sentinel surveillance and snowball sampling are the simplest to carry out, but are subject to a high risk of sampling/selection bias. Most of the probability sampling methods considered are limited in that they are adequate only under certain circumstances and for some groups. One relatively new method, respondent-driven sampling, an adaptation of chain-referral sampling, appears to be the most promising for general applications. However, as its applicability to HIV surveillance in resource-poor settings has yet to be established, further field trials are needed before a firm conclusion can be reached.

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The association between HIV infection and alcohol use: a systematic review and meta-analysis of African studies.

Joseph C. Fisher, Heejung Bang, Saidi H Kapiga (2007)

To summarize the association between alcohol use and human immunodeficiency virus (HIV) infection based on studies conducted in Africa, EMBASE and PubMed were searched for African studies that related alcohol use to HIV infection. Meta-analyses were conducted to obtain pooled univariate and multivariate relative risk estimates. Subgroup analyses were performed for studies having different sample types: males or females and population-based or high-risk, and ones that differentiated between problem and asymptomatic drinkers. Alcohol drinkers were more apt to be HIV+ than nondrinkers. The pooled unadjusted odds ratio (OR) from 20 studies was 1.70 (95% confidence interval, CI = 1.45-1.99). Results from 11 studies that adjusted for other risk factors produced a pooled risk estimate of 1.57 (95% CI = 1.42-1.72). Males and females had similar risk estimates, while studies involving high-risk samples tended to report larger pooled odds ratios than studies of the general population. When compared with nondrinkers, the pooled estimates of HIV risk were 1.57 (95% CI = 1.33-1.86) for non-problem drinkers versus 2.04 (95% CI = 1.61-2.58) for problem drinkers, a statistically significant difference (z = 2.08, P <0.04). Alcohol use was associated with HIV infection in Africa and alcohol-related interventions might help reduce further expansion of the epidemic.

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Concurrent partnerships and the spread of HIV.

Taylor Morris, M. E. E. KRETZSCHMAR (1997)

To examine how concurrent partnerships amplify the rate of HIV spread, using methods that can be supported by feasible data collection. A fully stochastic simulation is used to represent a population of individuals, the sexual partnerships that they form and dissolve over time, and the spread of an infectious disease. Sequential monogamy is compared with various levels of concurrency, holding all other features of the infection process constant. Effective summary measures of concurrency are developed that can be estimated on the basis of simple local network data. Concurrent partnerships exponentially increase the number of infected individuals and the growth rate of the epidemic during its initial phase. For example, when one-half of the partnerships in a population are concurrent, the size of the epidemic after 5 years is 10 times as large as under sequential monogamy. The primary cause of this amplification is the growth in the number of people connected in the network at any point in time: the size of the largest "component'. Concurrency increases the size of this component, and the result is that the infectious agent is no longer trapped in a monogamous partnership after transmission occurs, but can spread immediately beyond this partnership to infect others. The summary measure of concurrency developed here does a good job in predicting the size of the amplification effect, and may therefore be a useful and practical tool for evaluation and intervention at the beginning of an epidemic. Concurrent partnerships may be as important as multiple partners or cofactor infections in amplifying the spread of HIV. The public health implications are that data must be collected properly to measure the levels of concurrency in a population, and that messages promoting one partner at a time are as important as messages promoting fewer partners.

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Author and article information

Contributors

Claire Thorne: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2013

Publication date (Electronic): 18 April 2013

Volume: 8

Issue: 4

Electronic Location Identifier: e62167

Affiliations

[1 ]Population Council, New Delhi, India

[2 ]Health Protection Services–Colindale, Health Protection Agency, London, United Kingdom

[3 ]International Institute for Population Sciences, Mumbai, India

[4 ]Karnataka Health Promotion Trust, Bengaluru, India

[5 ]Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada

[6 ]Departments of Medical Microbiology and Medicine, University of Manitoba, Winnipeg, Canada

[7 ]St. John's Medical College and Hospital, Bengaluru, India

[8 ]Department of Preventive and Social Medicine, Laval University, Québec City, Canada

UCL Institute of Child Health, University College London, United Kingdom of America

Author notes

* E-mail: bbmahapatra@ 123456gmail.com

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: BM CL. Performed the experiments: BM CL KG BR MA. Analyzed the data: BM SKM. Contributed reagents/materials/analysis tools: CL KG BR RW SM MA. Wrote the paper: BM SKM.

Article

Publisher ID: PONE-D-13-01062

DOI: 10.1371/journal.pone.0062167

PMC ID: 3630134

PubMed ID: 23637991

SO-VID: bc1970a3-01da-4bee-af2b-f9d6b9ced749

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 3 January 2013

Date accepted : 18 March 2013

Page count

Pages: 8

Funding

The overall research grant was funded by Bill & Melinda Gates Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Factors Associated with Risky Sexual Practices among Female Sex Workers in Karnataka, India

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Abstract

Introduction

Materials and Methods

Results

Conclusion

Related collections

PLOS Climate

Most cited references 33

Review of sampling hard-to-reach and hidden populations for HIV surveillance.

The association between HIV infection and alcohol use: a systematic review and meta-analysis of African studies.

Concurrent partnerships and the spread of HIV.

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Contributors

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History

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