Association Between System Reach and Exposure to Interventions and Characteristics of Mobile Female Sex Workers in Four High HIV Prevalence States in India.

Shalini Bharat,Varun Sharma,Niranjan Saggurti

doi:10.5539/gjhs.v7n4p83

Abstract

Mobility among Female Sex Workers (FSWs) interrupts their demand for, and utilization of, health services under any intervention. Various strategic interventions are meant to provide access to care and reduce the incidence of HIV and other STIs among FSWs. This paper applies a bivariate probit regression analysis to explain the probability of mobile FSWs being reached by the system and being exposed to interventions jointly with a wide variety of characteristics of mobile FSWs in India. The data used are based on a cross-section survey among 5,498 mobile FSWs in 22 districts of four high HIV prevalence states in southern India. A majority of mobile FSWs (59%) were street-based and about 70 percent of them were members of SW organization and nearly half (46%) were highly mobile. The majority of them (90%) had been contacted by outreach workers from any system in the last two years in their current location and 94 percent were exposed to interventions in terms of getting free or subsidized condoms. Bivariate probit analysis revealed that comprehensive interventions are able to reach more vulnerable mobile FSWs effectively, e.g. new entrants, highly mobile, reported STIs, tested for HIV ever and serving a high volume of clients. The results complement the efforts of government and other agencies in response to HIV. However, the results highlight that specific issues related to various subgroups of this highly vulnerable population remain unaddressed calling for tailoring the response to the specific needs of the sub-groups.

Highlights

Female sex workers (FSWs) are most vulnerable to infection with HIV (Chattopadhyay & McKaig, 2004; Morris, Morris, & Ferguson, 2009)
Description of variables System reach Exposure to interventions Typology of sex workers Street based Female Sex Workers (FSWs) (SBS) Home based FSWs (HBS) Brothel based FSWs (BBS) Educational status Non-literate Up to primary Above primary Duration into sex work New entrants [FSWs in sex work less than equal to 2 years] FSWs who have ever been tested for HIV infection Living arrangementsa
The analysis shows that highly mobile FSWs are more likely to be contacted by systems’ agents and accessing free or socially marketed condoms

Summary

Introduction

Female sex workers (FSWs) are most vulnerable to infection with HIV (Chattopadhyay & McKaig, 2004; Morris, Morris, & Ferguson, 2009). High prevalence of HIV and other STIs among them is the result of their inconsistent or no use of condom with clients, non-paying clients (Chattopadhyay & McKaig, 2004; Dandona et al, 2005; Ministry of Public Health and Sanitation, 2010; Morris et al, 2009; Munoz et al, 2010; Saggurti et al, 2011), frequency and number of clients (Morris et al, 2009), unprotected anal sexual practice (Alexander et al, 2014; Dandona et al, 2005; Ministry of Public Health and Sanitation, 2010) and substance use before or during sexual intercourse (Saggurti et al, 2012) They are ‘difficult to trace population’ given the nature of their work and associated stigma (Ministry of Public Health and Sanitation, 2010). Mobility of FSWs, driven by work uncertainties, further enhances their risk to HIV and interrupts access to health care and services under any intervention

Methods

Results

Discussion

Conclusion