Abstract
BackgroundAlthough female sex workers (FSWs) report high levels of condom use with commercial sex clients, particularly after targeted HIV preventive interventions have been implemented, condom use is often low with non-commercial partners. There is limited understanding regarding the factors that influence condom use with FSWs’ non-commercial partners, and of how programs can be designed to increase condom use with these partners. The main objectives of this study were therefore to describe FSWs’ self-reported non-commercial partners, along with interpersonal factors characterizing their non-commercial partnerships, and to examine the factors associated with consistent condom use (CCU) within non-commercial partnerships.MethodsThis study used data collected from cross-sectional questionnaires administered to 988 FSWs in four districts in Karnataka state in 2006-07. We used bivariate and multivariable logistic regression analysis to examine the relationship between CCU (i.e., ‘always’ compared to ‘never’, ‘sometimes’ or ‘frequently’) with non-commercial partners of FSWs (including the respondents’ husband or main cohabiting partner [if not married] and their most recent non-paying partner [who is neither a husband nor the main cohabiting partner, and with whom the FSW had sex within the previous year]) and interpersonal factors describing these partnerships, as well as social and environmental factors. Weighting and survey methods were used to account for the cluster sampling design.ResultsOverall, 511 (51.8%) FSWs reported having a husband or cohabiting partner and 247 (23.7%) reported having a non-paying partner. CCU with these partners was low (22.6% and 40.3% respectively). In multivariable analysis, the odds of CCU with FSWs’ husband or cohabiting partner were 1.8-fold higher for FSWs whose partner knew she was a sex worker (adjusted odds ratio [AOR]: 1.84, 95% confidence intervals[CI]: 1.02-3.32) and almost 6-fold higher if the FSW was unmarried (AOR: 5.73, 95%CI: 2.79-11.76]. CCU with FSWs’ non-paying partner decreased by 18% for each one-year increase in the duration of the relationship (AOR: 0.82, 95%CI: 0.68-0.97).ConclusionsThis study revealed important patterns and interpersonal determinants of condom use within non-commercial partnerships of FSWs. Integrated structural and community-driven HIV/STI prevention programs that focus on gender and reduce sex work stigma should be investigated to increase condom use in non-commercial partnerships.
Highlights
Female sex workers (FSWs) report high levels of condom use with commercial sex clients, after targeted HIV preventive interventions have been implemented, condom use is often low with non-commercial partners
As suggested in a systematic review of studies in sub-Saharan Africa and Asia, HIV preventive interventions focusing on behaviour change are more effective at increasing condom use within commercial compared to non-commercial partnerships of female sex workers (FSWs) [10]
Sample characteristics Of the total sample of 988 FSWs, 208, 198, 369 and 213 women were recruited in Belgaum, Bellary, Bangalore and Mysore, respectively
Summary
Female sex workers (FSWs) report high levels of condom use with commercial sex clients, after targeted HIV preventive interventions have been implemented, condom use is often low with non-commercial partners. There is limited understanding regarding the factors that influence condom use with FSWs’ non-commercial partners, and of how programs can be designed to increase condom use with these partners. As suggested in a systematic review of studies in sub-Saharan Africa and Asia, HIV preventive interventions focusing on behaviour change are more effective at increasing condom use within commercial compared to non-commercial partnerships of FSWs [10]. The evidence for increased condom use with non-commercial partners after interventions have been implemented is not conclusive. Limited research has been conducted to elucidate the reasons for low condom use within non-commercial partnerships of FSWs and how this can be addressed by HIV programming. Fertility desires or the use of other types of contraceptives, including female sterilization may impact whether or not condoms are used in noncommercial partnerships
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