The Role of Sex Work Pay in Moderating the Effect of Mobile Phone Solicitation on Condom Practices: An Analysis of Female Sex Workers in India

Abstract

Mobile phones remain a largely untapped resource in the ongoing challenge to address Female Sex Worker (FSW) health, including HIV prevention services, in India. An important step towards designing effective mobile phone-based initiatives for FSWs is clarifying the contextual influences of mobile phone solicitation on sexual risk behavior. In this paper, we extend previously identified associations between mobile phone solicitation and condom practices by examining whether this association is moderated by sex work pay and offer key considerations for future research and implementation. Specifically, we conducted an analysis among 589 Indian FSWs, where FSWs who did not use mobile phones to solicit clients had the lowest mean sex work pay (INR 394/ USD 6.54) compared to FSWs who used both mobile and traditional strategies (INR 563/ USD 9.34). Our analysis indicate low paid FSWs who used mobile phones concurrently with traditional strategies had 2.46 times higher odds of inconsistent condom use compared to low paid FSWs who did not use mobile phones for client solicitation. No such effect was identified among high paid FSWs. These findings also identified group level differences among FSWs reporting different mobile phone solicitation strategies, including violence, client condom use and HIV status. Our results indicate that low pay does moderate the association between mobile phone solicitation and condom practices, but only among a sub-set of low paid FSWs. These findings also demonstrate the utility of classification by different mobile phone solicitation strategies for accurate assessment of sexual risk among mobile phone soliciting FSWs. In turn, this paves the way for novel approaches to utilize mobile phones for FSW HIV prevention. We discuss one such example, a mobile phone-based rapid screening tool for acute HIV infection targeting Indian FSWs.

The Use of Information and Communication Technologies by Sex Workers to Manage Occupational Health and Safety: Scoping Review

“…Of the 41 studies selected for review, 7 were experimental (5 were randomized controlled trials) [17][18][19][20][21][22][23], 19 were observational studies [10,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] [55,56]. Each paper was a unique separate study, meaning that no two papers discussed the same data.…”

“…Of the included studies, 41% (17/41) pertained to cisgender women [18,19,21,[26][27][28][29][30]34,36,37,39,46,50,55,56,59].…”

“…Sex tourism was categorized as indoor based on the content of the study [46]. A total of 3 studies mentioned outdoor (street-based) sex work [9,17,40]; 2 were extrapolated to be outdoors [18,55]; and 8 studies addressed occupational health and safety for both indoor and outdoor (street-based) sex workers [10,[27][28][29][30]35,36,59], with 5 studies extrapolated to be as such [20,21,32,39,41]. Of the 41 studies, 23 (56%) addressed indoor sex work, 5 (12%) addressed outdoor sex work, and 13 (32%) addressed sex workers in both indoor and outdoor settings.…”

Female sex workers' use of mobile phones in India: Lessons in effective engagement

“…Mobile phones also may be a vital tool in helping sex workers to organize, mobilize, and advocate for change, as well as participate actively in local and regional political forums. Seamlessly integrating mobile phone-based tools into existing services for sex workers may be an urgent priority for NGOs (Navani-Vazirani et al, 2017). Most importantly, as underscored in prior research (e.g., Thomas et al, 2017), mobile phone-based interventions with FSWs need to outgrow merely addressing issues around HIV prevention and encompass domains such as digital literacy and building competencies around safety and privacy.…”

“…Mobile phones and the Internet have been underscored as important new pathways for soliciting new clients and enabling ongoing clientsex worker interactions in Estonia (Aral, St. Lawrence, & Uuskula, 2006) and Thailand (Veena, 2007) and for establishing and maintaining transactional sex practices in sub-Saharan Africa (Stark, 2013). Research evidence from India has stressed the association between mobile phone use by FSWs for client solicitation and risky sexual behaviors (Mahapatra, Saggurti, Halli, & Jain, 2012;Navani-Vazirani et al, 2015), especially in the case of FSWs belonging to the lower socioeconomic strata who solicited clients both over the phone and at traditional venues (Navani-Vazirani et al, 2017). In a recent study in India, Panchanadeswaran, Unnithan, Chacko, Brazda, and Kuruppu (2017) emphasized FSWs' heightened vulnerabilities, including risk for conflict and violence within intimate relationships resulting from mobile phone surveillance by their partners.…”