Abstract
Objectives: Understanding the role of Self-Help Group (SHG) in light of the evolving dynamics of sex work needs to be delved into to strategize HIV interventions among FSWs in India. This paper aims to study the HIV program outcome among the FSWs associated with SHGs and FSWs not associated with SHGs in Thane, Maharashtra. Study Design: This cross-sectional study was undertaken from the Behavioral Tracking Survey (BTS) conducted among 503 FSWs in Thane in 2015. Two-stage probability based conventional sampling was done for selection of brothel and bar based FSWs, while Time Location Cluster (TLC) sampling was done for home, lodge and street based sex workers. Methods: Bivariate and multivariate logistic regression were performed to compare and contrast between FSWs associated with SHG and those not associated with SHG with respect to the utilization of HIV related services by them. “Condom use”, “consistent condom use”, “contact with peer-educators”, “counseling sessions” and “HIV testing” were chosen as indicators on HIV service utilization. Results: 8% (38) of FSWs are registered with SHG; 92% aged ≥25 years, 47% illiterate, and 71% are currently married. The likelihood of utilizing HIV services including, knowledge on HIV/AIDS and its mode of transmission (OR: 5.54; CI: 1.87 - 16.60; p < 0.05), accessed drop-in Centre (OR: 6.53; CI: 2.15 - 19.88; p < 0.10), heard about joint health camps (OR: 4.71; CI: 2.12 - 10.46); p < 0.05), negotiated or stood up against police/broker/local goonda/clients (OR: 2.26; CI: 1.08 - 4.73; p < 0.05), turned away clients when they refused to use condom during sex (OR: 3.76; CI: 1.27 - 11.15; p < 0.05) and heard of ART (OR; 4.55; CI: 2.18 - 9.48; p < 0.01) were higher among FSWs associated with SHG in comparison to FSWs not associated with SHG. Conclusions: Considering the improved HIV program outcomes among FSWs associated with SHG, HIV interventions among FSWs could consider facilitating the formation of SHGs with FSWs as one of the key strategies to empower the community for ensuring better program outcomes.
Highlights
Poverty, gender inequalities and social marginalization continue to be a major challenge globally to HIV prevention efforts among key populations
This paper aims to study the HIV program outcome among the Female sex workers (FSWs) associated with SHGs and FSWs not associated with SHGs in Thane, Maharashtra
The mean age of the study participants is 30 (SD = 6.0) years, while FSWs associated with SHG was 32 (SD = 5.5) years significantly (p = 0.031) higher than the mean age of FSWs not associated with SHGs
Summary
Gender inequalities and social marginalization continue to be a major challenge globally to HIV prevention efforts among key populations. Women who join sex work for economic reasons belong to a particular social, caste and class groups. Studies that have profiled the socio-demographic characteristics of sex workers [3] [5] [6] [7] [8] document that the majority of women in sex work are illiterate, belong to lower castes, are destitute and/or are from poor economic backgrounds. Female sex workers (FSWs) are considered as one of the key populations for HIV transmission due to various occupational hazards such as sex with multiple partners, inconsistent condom use, and higher infection rates [9] [10]. HIV prevalence in India is estimated to be more than 20 times higher among sex workers as compared to the general population [11] [12] [13]. FSWs are not empowered, socio-economically marginalized and are highly vulnerable to HIV [14]
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