HIV risks vary according to type of sex work in a cross-sectional survey from Nagaland, India

Abstract

BackgroundHuman immunodeficiency virus (HIV) infection is a significant problem among female sex workers (FSWs) in Nagaland, India. Place of solicitation and sex vary considerably in this context. The aim of this study was to investigate the relationship between categories of sex work and HIV risks.MethodsIn 2009 a survey was undertaken among 417 FSWs in Dimapur, Nagaland using an interviewer-administered questionnaire and blood and urine samples. Using this data, we constructed a typology of sex work by combining usual place of solicitation and place of sex, and examined variations in demographics, sex work patterns, sexually transmitted infections (STIs) and HIV prevalence across typology categories. Binary logistic regression analyses were done to examine the association between category of sex work and HIV, STIs, and condom use.ResultsBy combining place of solicitation with place of sex, seven distinct categories of sex work emerged. The largest category were women who usually solicited in a public place and had sex in a rented room or lodge (31.7%, n = 132). One-tenth of participants were HIV positive (10.3%) and 35.4% had at least one STI (reactive syphilis serology, gonorrhoea or chlamydia). FSWs who both solicited and entertained in a rented room or lodge (OR = 13.3; 95% CI 2.2, 81.5) and those who solicited by phone and had sex in a rented room or lodge (OR = 6.3; 95% CI 1.0, 38.0) were more likely to be HIV positive compared to home-based FSWs. Women who both solicited and entertained in public (OR = 6.7; 95% CI 1.6, 28.0) and who solicited in public and entertained in a rented room or lodge (OR = 2.5; 95% CI 1.1, 6.0) were more likely to test positive for an STI compared to home-based FSWs.ConclusionThe results indicate that different categories of sex work are associated with different HIV and STI risk profiles. Local contextual understanding of the different types of sex work and the associated levels of risk assist NGOs to target their interventions more effectively and efficiently in order to reduce STI and HIV prevalence among FSWs and their clients.

Correlates of HIV prevalence among female sex workers in four north and east Indian states: findings of a national bio-behavioural survey

“…[39][40][41][42][43][44][45][46] The study finding linking client solicitation in rented rooms to increased HIV risk is consistent to a study conducted in Nagaland, which reported that low levels of condom use by such FSWs, who may rely on lodge managers as client intermediaries, could be a reason for such high prevalence in this typology group. 23 The significant association of HIV positivity with mobile phone use in the study points towards need to integrate this aspect of sex work into HIV/AIDS interventions for FSWs. [47][48][49] Studies conducted in South India found that while the invisibility offered by mobile phone use to FSWs, through the establishment of a direct communication with their clients and reduction in their reliance on traditional sex work intermediaries (pimps and brothel managers), benefits them, it also prevents health and social services from reaching them.…”

“…The study finding linking client solicitation in rented rooms to increased HIV risk is consistent to a study conducted in Nagaland, which reported that low levels of condom use by such FSWs, who may rely on lodge managers as client intermediaries, could be a reason for such high prevalence in this typology group. 23…”

“…The FSW typologies analysed in this study (home-, rented room-, lodge/hotel-, brothels-, public places-, bar-, night club- and highway-based) are based on the places where FSWs usually solicit clients. These typologies have been adapted from the ones formulated by the National AIDS Control Organization (NACO), 22 a study conducted among FSWs in the north-east 23 and from a study that reviewed different FSW typologies in the country. 24…”

HIV decline associated with changes in risk behaviours among young key populations in Nepal: analysis of population-based HIV prevalence surveys between 2001 and 2012

“…The prevalence of HIV and STIs varies widely among sex workers depending on where they work, such as in the street, at home or in a commercial establishment such as a bar and massage parlor. 46,47 The 2011 surveillance survey in Kathmandu valley found that the HIV prevalence was four times higher among FSW who worked on the street as compared to establishment-based sex workers. 42 Reducing police harassment of sex workers and understanding changes in the typical place of solicitation over time are thus also vital for adapting HIV prevention efforts to the needs of sex workers.…”

Syphilis of prevalence in women sex professionals: integrative review / Prevalência de sífilis em mulheres profissionais do sexo: revisão integrativa / La prevalencia de sífilis en las mujeres profesionales del sexo: revisión integradora

“…Para essa elevada prevalência destacam-se os principais fatores: multiplicidade de parcerias sexuais, estado civil solteira ou separada, baixa escolaridade, capacidade reduzida para negociar práticas sexuais segura, ser trabalhadora sexual migrante, o uso de drogas estimulantes (cocaína, carck, metanfetamina) e de álcool, o compartilhamento de drogas injetáveis, vítimas de violência física (9,15) . MPS que possuem clientes constantes e regulares apresentaram sorologia negativa para HIV/IST (12) .…”