Relationship between reported prior condom use and current self-perceived risk of acquiring HIV among mobile female sex workers in southern India

Anrudh K Jain,Bidhubhusan Mahapatra,Shiva S Halli,Hanimi Reddy Modugu,Mary Philip Sebastian,Niranjan Saggurti,Ravi K Verma

doi:10.1186/1471-2458-11-s6-s5

Abstract

BackgroundWith the evolution of Health Belief Model, risk perception has been identified as one of several core components of public health interventions. While female sex workers (FSWs) in India continue to be at most risk of acquiring and transmitting HIV, little is known about their perception towards risk of acquiring HIV and how this perception depends upon their history of consistent condom use behavior with different type of partners. The objective of this study is to fill this gap in the literature by examining this relationship among mobile FSWs in southern India.MethodsWe analyzed data for 5,413 mobile FSWs from a cross-sectional behavioral survey conducted in 22 districts from four states in southern India. This survey assessed participants’ demographics, condom use in sex with different types of partners, continuation of sex while experiencing STI symptoms, alcohol use before having sex, and self-perceived risk of acquiring HIV. Descriptive analyses and multilevel logistic regression models were used to examine the associations between risky sexual behaviors and self-perceived risk of acquiring HIV; and to understand the geographical differences in HIV risk perception.ResultsOf the total mobile FSWs, only two-fifths (40%) perceived themselves to be at high risk of acquiring HIV; more so in the state of Andhra Pradesh (56%) and less in Maharashtra (17%). FSWs seem to assess their current risk of acquiring HIV primarily on the basis of their past condom use behavior with occasional clients and less on the basis of their past condom use behaviors with regular clients and non-paying partners. Prior inconsistent condom use with occasional clients was independently associated with current perception of high HIV risk (adjusted odds ratio [aOR)] = 2.1, 95% confidence interval [CI]: 1.7-2.6). In contrast, prior inconsistent condom use with non-paying partners was associated with current perception of low HIV risk (aOR= 0.7, 95% CI: 0.5-0.9). The congruence between HIV risk perception and condom use with occasional clients was high: only 12% of FSWs reported inconsistent condom use with occasional clients but perceived themselves to be at low risk of acquiring HIV.ConclusionThe association between high risk perception of acquiring HIV and inconsistent condom use, especially with regular clients and non-paying partners, has not been completely internalized by this high risk group of mobile FSWs in India. Motivational efforts to prevent HIV should emphasize the importance of accurately assessing an individual’s risk of acquiring HIV based on condom use behavior with all types of partners: occasional and regular clients as well as non-paying partners; and encourage behavior change based on an accurate self-assessment of HIV risk.

Highlights

With the evolution of Health Belief Model, risk perception has been identified as one of several core components of public health interventions
Of the sample of 5,413 mobile female sex workers (FSWs) who were included in this study, 40% currently perceived themselves to be at high risk of HIV
Association between prior condom use behavior and current perceived high HIV risk Results presented in Table 1 indicate that the large majority of FSWs who engaged in risky sexual behaviors in last one week currently perceived themselves to be at a higher risk of acquiring HIV, and that FSWs assessed their HIV risk mainly based on consistency of condom use with occasional clients rather than on consistency of condom use with regular clients or non-paying partners

Summary

Introduction

With the evolution of Health Belief Model, risk perception has been identified as one of several core components of public health interventions. With the evolution of Health Belief Model (HBM) in 1950, risk perception has been identified as one of the several core components of public health interventions, but it is an important marker to promote safe sex behavior in the context of HIV prevention programs [1]. In order to support the adoption of safe sex practices, interventions have ensured the availability of condoms [15,16,17,18], communicated with sex workers using peers [19,20,21,22,23], made attempts to empower sex workers [18,24,25,26,27,28], provided care for sexually transmitted infections (STIs) and HIV [29,30], and developed collectives and community groups [18,23,27,31,32] These factors either independently or together have increased the self esteem of sex workers to insist on condom use with their clients [22,24,28,32]. The longterm success of such interventions, will depend on the extent to which they bring about sustained change in risky sexual behavior [33,34]

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