Measuring vulnerability among female sex workers in India using a multidimensional framework.

Bidhubhusan Mahapatra,Niranjan Saggurti,Yamini Atmavilas,Ruchira Bhattacharya,Geng-Feng Fu

doi:10.1371/journal.pone.0204055

Bidhubhusan Mahapatra, Niranjan Saggurti + Show 3 more

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https://doi.org/10.1371/journal.pone.0204055

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Abstract

Measuring vulnerability and identifying determinants of vulnerability are key to designing interventions for marginalized groups like sex workers. The current study introduces a new approach of measuring vulnerability among female sex workers (FSWs) by adopting a multidimensional poverty measurement framework. A multidimensional vulnerability index was created from four dimensions and 16 indicators using a dual cut-off approach. The study found that 55% of FSWs were multidimensionally vulnerable with 48% of intensity in vulnerability. The overall value of multidimensional vulnerability index was 0.265. FSWs in Maharashtra were most vulnerable (82%). Lack of financial security contributed mostly to FSWs’ vulnerability. Further, compared to less vulnerable FSWs, multidimensionally vulnerable ones were more to engage in behaviors that put them at risk such as inconsistent use of condoms with clients, alcohol consumption, engaging in anal sex with clients and experiencing sexually transmitted infections. Findings suggest that structural, social and financial vulnerabilities of FSWs need to be addressed concurrently.

Highlights

Vulnerability among female sex workers (FSWs) is a widely researched area [1,2,3,4,5]; the definition and use of the term “vulnerability” vary considerably with a clear agreement that HIV vulnerability is different from HIV risk [6, 7]
The proportion of FSWs multidimensionally vulnerable was highest in Maharashtra (82%) and least in Karnataka (35%)
The intensity of vulnerability was 48%, which suggests that multidimensionally FSWs were vulnerable in nearly half of the weighted vulnerable indicators

Summary

Introduction

Vulnerability among female sex workers (FSWs) is a widely researched area [1,2,3,4,5]; the definition and use of the term “vulnerability” vary considerably with a clear agreement that HIV vulnerability is different from HIV risk [6, 7]. While HIV risk refers to behaviors or situations that directly increase the probability of HIV transmission, HIV vulnerability refers to the context governing individual’s ability to prevent oneself from getting HIV infection [7]. These vulnerabilities can be in various forms ranging from personal attributes to financial, environmental and cultural norms including stigma and discrimination at various levels. Empirical research has shown that vulnerabilities increase FSWs’ HIV risk-taking behaviors including experience of violence, poor negotiation skills to use condom, inability to refuse clients for sex and lack of access to HIV prevention services [8,9,10,11]. Given the HIV epidemic in India is a concentrated one and FSWs remain as one of core source of transmission, the current HIV

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