HIV risks vary according to type of sex work in a cross-sectional survey from Nagaland, India.

Anna Bz O’Halloran,Michelle Kermode,Collins Z Sono,Gregory Armstrong,Gajendra K Medhi,Jagadish Mahanta

doi:10.1186/s12905-014-0133-6

Abstract

BackgroundHuman immunodeficiency virus (HIV) infection is a significant problem among female sex workers (FSWs) in Nagaland, India. Place of solicitation and sex vary considerably in this context. The aim of this study was to investigate the relationship between categories of sex work and HIV risks.MethodsIn 2009 a survey was undertaken among 417 FSWs in Dimapur, Nagaland using an interviewer-administered questionnaire and blood and urine samples. Using this data, we constructed a typology of sex work by combining usual place of solicitation and place of sex, and examined variations in demographics, sex work patterns, sexually transmitted infections (STIs) and HIV prevalence across typology categories. Binary logistic regression analyses were done to examine the association between category of sex work and HIV, STIs, and condom use.ResultsBy combining place of solicitation with place of sex, seven distinct categories of sex work emerged. The largest category were women who usually solicited in a public place and had sex in a rented room or lodge (31.7%, n = 132). One-tenth of participants were HIV positive (10.3%) and 35.4% had at least one STI (reactive syphilis serology, gonorrhoea or chlamydia). FSWs who both solicited and entertained in a rented room or lodge (OR = 13.3; 95% CI 2.2, 81.5) and those who solicited by phone and had sex in a rented room or lodge (OR = 6.3; 95% CI 1.0, 38.0) were more likely to be HIV positive compared to home-based FSWs. Women who both solicited and entertained in public (OR = 6.7; 95% CI 1.6, 28.0) and who solicited in public and entertained in a rented room or lodge (OR = 2.5; 95% CI 1.1, 6.0) were more likely to test positive for an STI compared to home-based FSWs.ConclusionThe results indicate that different categories of sex work are associated with different HIV and STI risk profiles. Local contextual understanding of the different types of sex work and the associated levels of risk assist NGOs to target their interventions more effectively and efficiently in order to reduce STI and HIV prevalence among FSWs and their clients.

Highlights

Human immunodeficiency virus (HIV) infection is a significant problem among female sex workers (FSWs) in Nagaland, India
FSWs who solicited in public and entertained in a rented room/lodge (RRL) were more likely (OR = 2.5) to test positive for an Sexually transmitted infection (STI)
The results suggest that a combination of usual place of solicitation and usual place of sex provides more detailed information about HIV risks compared to place of solicitation or place of sex alone

Summary

Introduction

Human immunodeficiency virus (HIV) infection is a significant problem among female sex workers (FSWs) in Nagaland, India. Human immunodeficiency virus (HIV) is a major public health challenge in India, which is experiencing a concentrated epidemic affecting high-risk groups including female sex workers (FSWs) [1,2]. A geographically isolated state in the northeast of India, consistently reports a relatively high HIV prevalence; in 2009, the adult prevalence of HIV infection in Nagaland was estimated to be 0.8% compared with 0.3% nationally [3]. Geographical isolation, fear of discrimination and concerns regarding lack of confidentiality are some of the barriers that inhibit access to standard health care services for groups at high risk for HIV infection such as FSWs [5].

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