Differing HIV vulnerability among female sex workers in a high HIV burden Indian state

Abstract

IntroductionThe HIV sentinel surveillance [HSS] conducted in 2010–11 among female sex workers [FSW] in the state of Maharashtra, India provided an opportunity to assess characteristics of different types of FSWs and their HIV risk. It is important for India’s National AIDS Control Program, to understand the differences in vulnerability among these FSW, in order to define more specific and effective risk reduction intervention strategies. Therefore, we analyzed data from HSS with the objective of understanding the HIV vulnerability among different types of FSW in Maharashtra.Material and methodsCross sectional data collected as a part of HSS among FSWs in year 2010–11 from 21 sentinel sites in the state of Maharashtra were analyzed to understand the vulnerability and characteristics of different types of female sex workers based on their place of solicitation using multinomial logistic regression.ResultsWhile the HIV prevalence was 6.6% among all FSWs, it was 9.9% among brothel based [BB], 9% among street based [SB] and 3.1% and 3.7% among home based [HB], and bar based [Bar-B] sex workers respectively. SB FSWs were least likely to be located in HIV low burden districts [ANC] [ARRR: 0.61[95% CI: 0.49, 0.77]], but were 6 times more likely to be recently [<1 year] involved in sex work [ARRR: 6.15 [95% CI: 3.15, 12.0]]. The number of clients of SB FSWs in the preceding week were lower than 11% [ARRR: 0.89 [95%CI: 0.87, 0.90]] as compared to the BB FSWs denoting lesser client load. The duration since last paid sex was shorter [ARRR: 0.94[95%CI: 0.91, 0.96]] as compared to the BB FSWs.ConclusionStreet based FSWs have emerged as one of the most vulnerable types of FSW with a high HIV prevalence similar to BB FSWs. Our study reveals that they have more frequent sex acts despite lower client loads, and are more likely to be located in districts highly affected by HIV (ANC prevalence >1%). We identify them as a group to be focused on for prevention interventions and it is likely that they would be easily amenable to novel interventions due to their higher literacy rate as compared to other typologies.

Prevalence and genotype distribution of genital human papillomavirus infection in female sex workers in the world: a systematic review and meta-analysis

“…Another group is indoor-based sex workers who are employed to work in brothels, hotels, massage parlors, saunas, and lodges. In some cases, they might solicit clients independently based on both on-street and off-street, by online advertising in newspapers or by phone or text, or might work for a pimp or manager [ 15 – 17 ]. FSWs are at greatly elevated risk of acquiring sexually transmitted infections (STIs), including HPV, and their clients can act as a bridging population toward the general population.…”

Does fear for infection affect condom use and HIV testing? A study of female sex workers in Pune city

“…Information about a number of brothels and FSWs was not available, which challenged the calculation of sample size. 12 To resolve it, an approach specifically designed for such population was applied 6 the red light area was mapped for a number of brothels and FSWs. It was found that the area has 2000 FSWs in 330 brothels.…”

“…9,17,18 In India, the National AIDS Control Organization (NACO) report documents risk perception in the range of 4%-77% in India and 27%-47% in the study area, higher than the present study's finding. 6 Similarly, a survey in four states of southern India found that 40% FSWs perceived to be at high risk; more so in the state of Andhra Pradesh (56%) and less in Maharashtra (18%). 1 With the implementation of the HIV prevention interventions in the study area for more than two decades, this finding is significant.…”

“…study area respectively, as compared to the national percentage of 2.2%. 6,7 The figures are a concern with the policymakers. At this background, it is essential to understand the pathways of risk perception influencing condom use and HIV testing in this specific population, 9,10 besides the role of knowledge in transferring the perception to action.…”

Factors associated with non-adherence to antiretroviral therapy among female sex workers living with HIV in Hyderabad, India

“…8 FSWs also have the lowest levels of adherence to ART. 9,10 Other factors that may complicate the lives of FSWs include poverty, 11 illiteracy, 12 human trafficking, 13 violence, 14 arrest, 15 food insecurity, [16][17][18] stigma 19,20 and mental health struggles such as depression, 21,22 alcohol 23,24 and/or substance abuse. [25][26][27] Several of these factors, including food insecurity and depression, have been shown in some studies to be associated with ART adherence.…”