Male Use of Female Sex Work in India: A Nationally Representative Behavioural Survey

Michelle F Gaffey,Rajesh Kumar,Srinivasan Venkatesh,Neeraj Dhingra,Nico Nagelkerke,Paul Arora,Ajay Khera,Prabhat Jha,Landon Myer

doi:10.1371/journal.pone.0022704

Abstract

Heterosexual transmission of HIV in India is driven by the male use of female sex workers (FSW), but few studies have examined the factors associated with using FSW. This nationally representative study examined the prevalence and correlates of FSW use among 31,040 men aged 15–49 years in India in 2006. Nationally, about 4% of men used FSW in the previous year, representing about 8.5 million FSW clients. Unmarried men were far more likely than married men to use FSW overall (PR = 8.0), but less likely than married men to use FSW among those reporting at least one non-regular partner (PR = 0.8). More than half of all FSW clients were married. FSW use was higher among men in the high-HIV states than in the low-HIV states (PR = 2.7), and half of all FSW clients lived in the high-HIV states. The risk of FSW use rose sharply with increasing number of non-regular partners in the past year. Given the large number of men using FSW, interventions for the much smaller number of FSW remains the most efficient strategy for curbing heterosexual HIV transmission in India.

Highlights

India had about 1.4 to 1.6 million people living with HIV in 2006 [1]
Stratified by marital status, prevalences of non-regular sex partners (NRP) and of female sex workers (FSW) use in the high-HIV states were 1.5 to 3.5 times as high as in the low-HIV states
The observed patterns of reported FSW use confirm that most HIV transmission in India likely arises from male use of FSW [4,5,6], with onward transmission to typically monogamous wives [18]

Summary

Introduction

India had about 1.4 to 1.6 million people living with HIV in 2006 [1]. National HIV prevalence at ages 15–49 years is about 0.25–0.28% [1], but varies by region. HIV transmission in India occurs primarily through heterosexual contact [3], with most of it driven by the male use of female sex work [4,5,6]. Prior research on factors associated with FSW use in India has been limited to high-risk male subpopulations, such as urban homeless men [13], urban sexually transmitted infection (STI) clinic attendees [14], or rural voluntary counselling and testing (VCT) clinic attendees [15], and to general populationbased studies in small geographical areas [16,17]. We report a nationally representative study on the prevalence and correlates of having any non-regular sex partners (NRP) and of using FSW among men aged 15–49 years in the Indian general population. We estimate the absolute number of men who used FSW in India in 2006

Methods

Results

Conclusion