BackgroundAlthough female sex workers (FSWs) report high levels of condom use with commercial sex clients, particularly after targeted HIV preventive interventions have been implemented, condom use is often low with non-commercial partners. There is limited understanding regarding the factors that influence condom use with FSWs’ non-commercial partners, and of how programs can be designed to increase condom use with these partners. The main objectives of this study were therefore to describe FSWs’ self-reported non-commercial partners, along with interpersonal factors characterizing their non-commercial partnerships, and to examine the factors associated with consistent condom use (CCU) within non-commercial partnerships.MethodsThis study used data collected from cross-sectional questionnaires administered to 988 FSWs in four districts in Karnataka state in 2006-07. We used bivariate and multivariable logistic regression analysis to examine the relationship between CCU (i.e., ‘always’ compared to ‘never’, ‘sometimes’ or ‘frequently’) with non-commercial partners of FSWs (including the respondents’ husband or main cohabiting partner [if not married] and their most recent non-paying partner [who is neither a husband nor the main cohabiting partner, and with whom the FSW had sex within the previous year]) and interpersonal factors describing these partnerships, as well as social and environmental factors. Weighting and survey methods were used to account for the cluster sampling design.ResultsOverall, 511 (51.8%) FSWs reported having a husband or cohabiting partner and 247 (23.7%) reported having a non-paying partner. CCU with these partners was low (22.6% and 40.3% respectively). In multivariable analysis, the odds of CCU with FSWs’ husband or cohabiting partner were 1.8-fold higher for FSWs whose partner knew she was a sex worker (adjusted odds ratio [AOR]: 1.84, 95% confidence intervals[CI]: 1.02-3.32) and almost 6-fold higher if the FSW was unmarried (AOR: 5.73, 95%CI: 2.79-11.76]. CCU with FSWs’ non-paying partner decreased by 18% for each one-year increase in the duration of the relationship (AOR: 0.82, 95%CI: 0.68-0.97).ConclusionsThis study revealed important patterns and interpersonal determinants of condom use within non-commercial partnerships of FSWs. Integrated structural and community-driven HIV/STI prevention programs that focus on gender and reduce sex work stigma should be investigated to increase condom use in non-commercial partnerships.

A strategy that involves geographically defined coverage and micro-level outreach planning can rapidly and effectively provide outreach and services to large dispersed FSW populations.

heterosexual populations are not well understood. Objective was to describe female clients and partners of MSM sex workers (MSM-SW) in Lagos and to determine risk factors for unprotected sex between women and MSM-SW. Methods MSM were recruited through respondent driven sampling, a novel methodology designed to access hidden populations. MSM-SW were identified through self-reporting and consent was obtained. Participants completed a pre-tested questionnaire and a behaviour diary. The questionnaire included questions on details of each sexual partner for 4 weeks; each sexual encounter with each partner; and the three most recent partnerships. Data were summarised as proportions and compared using chi square test. Results 62 MSM-SW participated in the study and concluded the selfreported questionnaire and behaviour diary. MSM-SW recorded 311 partners, out of which 66(21.2%) were female and aged between 16 and 38 years. Thirty-two (10.3%) were recent female partners. Of the recent female partners, 17 (53.1%) were unmarried, 14 (43.8%) married and one was a spouse of MSM-SW. 60 (90.1%) of female partners of MSM-SW paid or were paid for sex (39/60,65% paid MSM-SW while 21/60, 35% were paid by them). There were 52 single episode sexual contacts and 14 regular partnerships. Of the 50 new transactional contacts, more than half (56%) met in the bars, restaurants, clubs, motels and beaches. All the sexual encounters between MSM-SW and their female partners involved penetrative sexdvaginal sex (VS)(53, 80%); anal sex (AS)(39, 59%); and both (31, 47%). Unprotected sex was significantly more frequently associated with sex with regular partner than with single episode sexual contact (79% vs 52%; p¼0.02, OR¼3.0) and non-transactional sex than sex paid for by the female partners (71% vs 46%; p¼0.029,OR¼2.8).Conclusion MSM-SW in Nigeria have a lot of female clients and partners and frequently engage in transactional and unprotected sex with them. Majority of these female partners are in heterosexual married relationships. Understanding these interactions between MSM and heterosexual populations is very crucial to any HIV intervention targeted on MSM and by extension the general population. Background Little is known about the epidemiology and burden of sexually transmitted infections (STI) in male commercial sex workers who have sex with men (MSM-CSWs) in the Netherlands and other Western countries. MSM-CSWs are often hard to reach for prevention and STI testing. This feasibility study aimed to reach MSM-CSWs, assess their socio-demographics and prevalence of HIV and other STI, and their risk profile. Methods Retrospective, cross sectional study. Demographic and STI diagnosis data were retrieved from standardised medical records of MSM-CSWs consulted during outreach activities by a public health service in Southern Limburg, The Netherlands (2009 and 2010). Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) were diagnosed by NAAT and serology was performed for HIV (HIV-Ag/ Ab), syphilis (TPPA, FTA-ABS, VDRL) and hepatitis B...

Methods In-depth interviews were conducted with sixteen purposively selected (based on HIV status, ethnicity, age, area, and type of sex work) female sex workers in Goa, India (December 2004eDecember 2005. We interrogated the life narratives to explore the nexus between the social context/risk environment and selfefficacy/agency. Results The narratives showed a dynamic interplay between underlying vulnerabilities, precipitating factors, and the route through which women gain entry into the sex trade: The ubiquitous mitigating theme that emerged was violence in childhood and youth. This ranged from dysfunctional and violent family life, sexual violence, and violence from intimate male partners. The other underlying vulnerabilities that emerged from the narratives were also manifestations of gender disadvantage, namely being unwanted; sexual naïveté and young marriage/sexual initiation; repression of sexuality, desire and entrapment in loveless marriages; and lack of life skills and low self-esteem. The loss of social support through bereavement, abandonment or financial need, were the commonest events that precipitated entry into sex work. Becoming a sex worker was frequently an expression of agency in a context with few other economically viable choices for women. The clearest division in the route into sex work was between traditional castebased sex workers (devadasi) and those who were either introduced by peers, or sold through a broker; however the underlying and precipitating factors for both routes were remarkably similar. Mostly, initiation was described as a complex process that was mediated through peers. Conclusion The interplay between caste, economy, gender, and violence drives the initiation into sex work, which is one of the few viable choices for the women. HIV prevention interventions therefore need to work upstream to impact upon the context within which women enter sex work and downstream to strengthen their agency. The peers who introduce women into sex work are potentially important vehicles to deliver "HIV prevention services and reduce the adverse health outcomes of sex work." Background Studies among high-risk groups (HRGs) have shown that the presence of STIs is associated with certain demographic and behavioural characteristics as well as exposure to HIV/STI prevention interventions. The objective of this study was to understand the correlates of STIs in female sex workers (FSWs) in India in order to improve STI programming for HRGs. Methods During 2008e2009, 417 female sex workers were recruited from three STI clinics in two cities of India as part of an operations research to evaluate the effectiveness of STI prevention service package for sex workers under Avahan, the India AIDS Initiative of the Bill & Melinda Gates Foundation. Behavioural and clinical information along with biological samples were collected. Bivariate analysis of demographic and behavioural characteristics associated with the prevalence of common bacterial STIs-Neisseria gonorrhoeae, Chlamydia trachomatis, Treponem...