Abstract
Background and objective: Varying degrees of sexual mixing in an intimate partner relationship which provides emotional support and social security, in addition to the economic benefits to female sex workers (FSWs)—often results in risky sexual behaviour (for example, unprotected sex), hence increasing the vulnerability of FSWs to sexually transmitted infections (STIs). This paper analyses the pattern of sexual mixing and the major covariates of STIs in intimate partner sexual relationships among FSWs in Nepal. Method: The findings are based on information collected from 2901 FSWs, selected by using the modified timelocation cluster sampling as part of mapping and size estimation of MARPs across different districts of Nepal in year 2010-11. Results: Findings reveal that almost 40 percent or two-fifths of FSWs in Nepal have commercial as well as noncommercial sexual partners. Further, 5.2 percent of the FSWs reported having more than one non-commercial partner along with commercial partners. Half of the FSWs in intimate partner relationships reported their last sexual encounter as unprotected, which was further lower among those currently married. Adjusted effects of socio-demographic and behavioural correlates portray that being married (p<0.01) and having a higher client load—a proxy of poverty and powerlessness (p<0.05)—are significant determinants of unprotected sex, which may also be attributed to a lack of risk perception in intimate relationships. A higher incidence of unprotected sex further leads to substantially higher prevalence of STIs (35%), which is disproportionately higher among those aged 30 and above, and among those having no formal education. Conclusion: Findings of this study highlight the requirement of strategies to address sexual rights of FSWs within intimate partner relationships, in addition to the need for occupational empowerment of FSWs in order to combat prevalence of STIs and improving their quality of life.
Highlights
Background and objectiveVarying degrees of sexual mixing in an intimate partner relationship which provides emotional support and social security, in addition to the economic benefits to female sex workers (FSWs)—often results in risky sexual behaviour, increasing the vulnerability of FSWs to sexually transmitted infections (STIs)
An examination of the background characteristics of FSWs who reported to have intimate partners showed that the majority of these women were above the age of 20 years
A little more than two fifths belonged to the age group of 20–29 years, while the rest were aged 30 years or more This clearly shows that younger women did not have any regular long term intimate partner
Summary
Background and objectiveVarying degrees of sexual mixing in an intimate partner relationship which provides emotional support and social security, in addition to the economic benefits to female sex workers (FSWs)—often results in risky sexual behaviour (for example, unprotected sex), increasing the vulnerability of FSWs to sexually transmitted infections (STIs). An estimated 75 million men in Asia visit sex workers and 10 million women cater to them. Add to these figures male Intravenous Drug Users (IDUs) and Men who have Sex with Men (MSM)—approximately 20 million—and we have a very large number of people who are at high risk of getting infected and, in turn, can potentially infect their partners [1]. Evidence from several Asian countries shows that these women are either married or in long-term relationships with men who engage in high-risk sexual behaviours [3]. In India alone, approximately 90 percent of the 1.7 million women living with HIV were infected by their husbands or partners of long- term relationships [4].
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