Role of Community Group Exposure in Reducing Sexually Transmitted Infection-Related Risk among Female Sex Workers in India

Diwakar Yadav,Bitra George,Shrabanti Sen,Niranjan Saggurti,Prabuddhagopal Goswami,Shreena Ramanathan,Lakshmi Ramakrishnan,Ramesh Paranjape

doi:10.1371/journal.pone.0078361

Diwakar Yadav, Bitra George + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0078361

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Abstract

BackgroundEmpowering female sex workers (FSWs) to address structural barriers and forming community groups (CGs) through community mobilization are seen as essential components of HIV prevention programs in India. Taking the membership of a CG as an exposure intervention, we hypothesized whether participation in a CG lead to reduced sexually transmitted infections (STIs) and increased treatment-seeking behavior among FSWs in three selected states of India — Andhra Pradesh, Maharashtra and Tamil Nadu.Methods and Findings The propensity score matching (PSM) approach examined the effect of CG membership, as against no membership, on STI-related risk, described as selected outcome measures — presence of any STI, self-reported STI symptoms, and treatment-seeking behavior among FSWs. A cross sectional bio-behavioral survey was administered in 2009–2010 and covered 7,806 FSWs through two-stage probability-based conventional and time location cluster sampling in 23 administrative districts of Andhra Pradesh, Maharashtra and Tamil Nadu. Only 2,939 FSWs were reported to be members of a CG and among them 4.5% had any STIs. A majority of FSWs were aged above 24 years (86.4%), had ever been married (73%), operated from a public place for solicitation (81.5%), and had ever received HIV test results (75.6%). The average effect of CG exposure was reduction in STI prevalence by 4%, while self-reported STI symptom treatment-seeking behavior increased by 13.7%.ConclusionFSWs who were exposed to a CG were at a substantially lower risk of STIs than those who were unexposed. The FSWs exposed to a CG had a higher chance of seeking STI treatment from public and private health facilities. Collectivization related challenges must be overcome to provide access to tailored STI prevention and care services.

Highlights

Formation of community groups (CGs) is a common output of community mobilization[1]
In HIV and AIDS programs, CGs and networks are seen as modes to strengthen demand for services, manage programmatic activities, and empower individuals and groups to reduce their vulnerability to HIV/ sexually transmitted infection (STI) among high-risk groups [2,3,4]
The integrated behavioral and biological assessment (IBBA) protocol and ethical clearances were obtained from Protection of Human Subjects Committee of FHI 360 and the Health Ministry Screening Committee of Indian Council of Medical Research (ICMR) institute and local ethical committees of the implementing institutes of ICMR [National AIDS Research Institute (NARI), Pune; National Institute of Medical Statistics (NIMS), New Delhi; National Institute of Nutrition (NIN), Hyderabad; and National Institute of Epidemiology (NIE), Chennai][42]

Summary

Introduction

Formation of community groups (CGs) is a common output of community mobilization[1]. In HIV and AIDS programs, CGs and networks are seen as modes to strengthen demand for services, manage programmatic activities, and empower individuals and groups to reduce their vulnerability to HIV/ sexually transmitted infection (STI) among high-risk groups [2,3,4]. Studies from developing countries have shown that community mobilization helps to empower sex workers, reduce vulnerability to HIV/STI and increase condom use [12,13,14,15,16,17,18,19,20,21]. Limited studies mentioned that community mobilization interventions help FSWs to use condoms and practice safe sex, access social entitlements, avail STI services from government health facilities and increase empowerment [30,33,34,35,36,37,38,39,40,41].

Ethical Statement

Results

Background community community and Student variables