Are Female Sex Workers Able to Negotiate Condom Use with Male Clients? The Case of Mobile FSWs in Four High HIV Prevalence States of India

Shalini Bharat,Bidhubhusan Mahapatra,Niranjan Saggurti,Suchismita Roy,Paula Braitstein

doi:10.1371/journal.pone.0068043

Shalini Bharat, Bidhubhusan Mahapatra + Show 3 more

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https://doi.org/10.1371/journal.pone.0068043

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Journal: PloS one	Publication Date: Jun 28, 2013
Citations: 85	License type: CC BY 4.0

Affiliation: Tata Institute of Social Sciences, Population Council

Abstract

IntroductionCondom promotion among female sex workers (FSWs) is a key intervention in India’s National AIDS Control Program. However, there is limited understanding of how FSWs negotiate condom use with male clients, particularly in the context of their mobility for sex work. The objective of this study is to examine the factors associated with the mobile FSWs’ ability to refuse unsafe sex and successfully negotiate condom use with unwilling male clients.MethodsData for 5498 mobile FSWs from a cross-sectional survey conducted in 22 districts of four states in southern India were analyzed. Questions assessed FSWs’ ability to refuse clients unprotected sex, convince unwilling clients for condom use and negotiate condom use in a new location. Logistic regression models were constructed to examine the association between socio-demographics, economic vulnerability, sex work practice, and program exposure and condom negotiation ability.ResultsA majority of FSWs (60%) reported the ability to refuse clients for unprotected sex, but less than one-fifth reported the ability to successfully convince an unwilling client to use a condom or to negotiate condom use in a new site. Younger and older mobile FSWs compared to those who were in the middle age group, those with longer sex work experience, with an income source other than sex work, with program exposure and who purchased condoms for use, reported the ability to refuse unprotected sex, to successfully negotiate condom use with unwilling clients and to do so at new sites.ConclusionFSWs need to be empowered to not only refuse unprotected sex but also to be able to motivate and convince unwilling clients for condom use, including those in new locations. In addition to focusing on condom promotion, interventions must address the factors that impact FSWs’ ability to negotiate condom use.

Highlights

Condom promotion among female sex workers (FSWs) is a key intervention in India’s National AIDS Control Program
Contemporary sex work is a mix of the traditional devadasi system practiced in some parts of Karnataka [2,3], largely brothel based as reported in West Bengal [4], predominantly street, lodge and home based in states of Tamil Nadu, and Andhra Pradesh [5,6], and a combination of brothel, street, bars and home based in Maharashtra [7]
These four states were identified as high HIV prevalence states by the National AIDS Control Organization (NACO) in 2005, while the districts were identified using independent mapping and enumeration data on FSWs collected by the State AIDS Control Societies (SACS) as well as Avahan

Summary

Introduction

Condom promotion among female sex workers (FSWs) is a key intervention in India’s National AIDS Control Program. There is limited understanding of how FSWs negotiate condom use with male clients, in the context of their mobility for sex work. The objective of this study is to examine the factors associated with the mobile FSWs’ ability to refuse unsafe sex and successfully negotiate condom use with unwilling male clients. A majority of FSWs enter the profession at young age, are illiterate, from rural areas, and support young children, aged parents, and non-earning partners [8]. Recent studies suggest a complex typology of FSWs in terms of the sites of solicitation (street, brothel, bars) and sites of sex work (brothel, lodge, home), and mobility patterns, with important implications for HIV interventions [11].

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