Consistent Condom Use by Married and Cohabiting Female Sex Workers in India: Investigating Relational Norms with Commercial Versus Intimate Partners

Abstract

This study examines determinants of consistent condom use (CCU) among married and cohabiting female sex workers (FSW) in India. Although CCU with clients is normative in the study area, most FSW do not consistently use condoms with intimate partners. Multiple logistic regression models indicated that condom use with intimate partners was associated with relationship status, cohabitation, HIV knowledge, STI symptoms, and being offered more money for sex without a condom by clients. Additionally, more days of sex work in the last week, serving as a peer educator, and participating in community mobilization activities were associated with higher odds of CCU across all partner types. Although improving economic security may increase CCU with clients, mobilization to reduce stigma and promote disclosure of sex work to non-cohabiting partners may be necessary to increase CCU overall.

Female Sex Work Dynamics: Empowerment, Mobilization, Mobility

“…Since risk perception depends on the intimacy gradient, female sex workers may not use condoms with intimate clients and husbands [47,48]. This may also happen if they are offered more money [49]. Newer methods such as pre-exposure prophylaxis (PrEP) are not as yet widely available to female sex workers and have not shown the same community-level impact as constant condom use [50].…”

Successful integration of HIV pre-exposure prophylaxis into a community-based HIV prevention program for female sex workers in Kolkata, India

“… 2 Condom use prevents HIV and other sexually transmitted infections (STIs), but not all FSWs are able to use condoms consistently and correctly, particularly with regular partners. 3 In India, it is estimated that at least 20% of FSWs remain at high risk of acquiring HIV infection for this reason, despite the best efforts of HIV prevention programs. 4 , 5 Other approaches are therefore needed to close this significant prevention gap.…”

The Ashodaya PrEP project: Lessons and implications for scaling up PrEP from a community-led demonstration project among female sex workers in Mysore, India

“…These TIs have largely focused on promoting consistent condom use among sex workers and their clients, with 90% of female sex workers reporting using condoms with new clients (Mitchell et al, 2016;Reza-Paul et al, 2008). However, condom use continues to remain low with regular partners, such as husbands and boyfriends (Deering et al, 2011;Fehrenbacher et al, 2018;Isac et al, 2017). The results from various surveys in Mysore show that while reported condom use is high in the last sex act with occasional clients, consistent condom use with all clients and partners continues to be a challenge (Reza-Paul et al, 2008;Reza-Paul et al, 2019).…”