Sex Workers In Chennai Research Articles

General Health Care Utilization in the Past 3 Months Increased Recent and Routine HIV and STI Testing Among Male Sex Workers in Chennai, India.

In India, male sex workers (MSW) are among the most vulnerable populations at higher risk for HIV and other sexually transmitted infections (STIs) and may seek health care services less frequently. A community-based sample of 100 MSW in Chennai, India, completed a baseline assessment as part of a behavioral intervention to reduce the acquisition and transmission of HIV. MSW reported an average of 12.2 (SD = 17.7) condomless anal sex acts with male clients in the past month, yet only 48% accessed health care services in the past 3 months. In a multivariable model adjusted for relevant covariates, MSW who accessed health care services in the past 3 months were more likely to be tested for HIV/STIs and report routine HIV testing over the past 12 months. Future HIV prevention efforts among MSW in India should incorporate referrals for accessing general health care services and identify specific barriers to health care engagement among this group.

Violence against HIV positive women: A study on female HIV patients

India has a sharp increase in the number of its people living with HIV, from a few thousand in the early 1990s to around 2.47 million persons in India living with HIV (equivalent to 0.36 percent of the adult population) in 2007. With a population of over one billion, the HIV epidemic in India will have a major impact on overall spread of HIV in Asia and the Pacific and indeed worldwide. The first AIDS case in India was detected in 1986 among few sex workers in Chennai, Tamil Nadu, and since then HIV infection has been reported in all States and Union Territories. The spread of HIV within the country is as diverse as the societal patterns between its different regions, states and metropolitan areas. In fact, HIV in India exists in a number of epidemics, and in some places they occur within the states. The epidemics vary, from states with mainly heterosexuals transmission of HIV, to some states where injecting drugs use is the main route of HIV transmission.

A Pilot Randomized Controlled Trial of an Integrated In-person and Mobile Phone Delivered Counseling and Text Messaging Intervention to Reduce HIV Transmission Risk among Male Sex Workers in Chennai, India.

Men who have sex with men (MSM) are at increased risk for HIV infection in India, particularly those who engage in transactional sex with other men (i.e., male sex workers; MSW). Despite the need, HIV prevention efforts for Indian MSW are lacking. As in other settings, MSW in India increasingly rely on the use of mobile phones for sex work solicitation. Integrating mobile phone technology into an HIV prevention intervention for Indian MSW may mitigate some of the challenges associated with face-to face approaches, such as implementation, lack of anonymity, and time consumption, while at the same time proving to be both feasible and useful. This is a pilot randomized controlled trial to examine participant acceptability, feasibility of study procedures, and preliminary efficacy for reducing sexual risk for HIV. MSW (N=100) were equally randomized to: (1) a behavioral HIV prevention intervention integrating in-person and mobile phone delivered HIV risk reduction counseling, and daily, personalized text or voice messages as motivating "cognitive restructuring" cues for reducing condomless anal sex (CAS); or (2) a standard of care (SOC) comparison condition. Both groups received HIV counseling and testing at baseline and 6-months, and completed ACASI-based, behavioral and psychosocial assessments at baseline, 3, and 6months. Mixed-effects regression procedures specifying a Poisson distribution and log link with a random intercept and slope for month of follow-up was estimated to assess the intervention effect on the primary outcomes: (1) CAS acts with male clients who paid them for sex, and (2) CAS acts with male non-paying sexual partners-both outcomes assessed over the past month. The intervention was both feasible (98% retention at 6-months) and acceptable (>96% of all intervention sessions attended); all intervention participants rated the intervention as "acceptable" or "very acceptable." A reduction in the reported number of CAS acts with male clients who paid them for sex in the past month was seen in both study conditions. MSW in the intervention condition reported a faster rate of decline in the number of CAS acts with male clients in the past month from the baseline to both the 3-month (B=-1.20; 95% CI -1.68, -0.73; p<0.0001) and 6-month (B=-2.44; 95% CI -3.35, -1.53; p<0.00001) assessment visits compared to the SOC condition. Post-hoc contrasts indicated that, at 3months, participants in the intervention condition reported 1.43 (SD=0.29) CAS acts with male clients in the past month compared to 4.85 (SD=0.87) in the control condition (p=0.0003). Furthermore, at 6months, the intervention condition participants reported 0.24 (SD=0.09) CAS acts with male clients in the past month compared to 2.79 (SD=0.79) in the control condition (p<0.0001). Findings are encouraging and provide evidence of feasibility and acceptability, and demonstrate initial efficacy (for reducing sexual risk for HIV) of a behavioral HIV prevention intervention for Indian MSW that combines daily, personalized text or voice messages with mobile phone-delivered sexual risk reduction counseling and skills building. Future testing of the intervention in a fully powered randomized controlled efficacy trial is warranted.

Transactional sex and the challenges to safer sexual behaviors: a study among male sex workers in Chennai, India

ABSTRACTMale sex workers (MSW) are a significant but invisible population in India who are at risk for HIV/sexually transmitted infections (STIs). Few studies from India have documented HIV risk factors and motivations for sex work in this population. Between 2013 and 2014, a community-based convenience sample of 100 MSW in Chennai (south India) completed a baseline risk assessment as part of a behavioral intervention. Participants were ≥18 years, and reported current sex work. We report medians and proportions, and Wilcoxon–Mann–Whitney and chi-square tests are used to examine differences between sex work and sexual behavior measures by income source. Participants were engaged in sex work for 5.0 years (IQR = 2.3–10.0), and earned 3000 (IQR = 2000–8000) Rupees (<50 USD) per month from sex work. Sixty-four percent reported ever testing for HIV and 20.2% for any STI. The most common reasons for starting sex work were money (83.0%) and pleasure (56.0%). Compared to participants with an additional source of income, those whose only source of income was sex work reported more male clients in the past month (10.0 vs. 6.0, p = .017), as well as more condomless anal sex acts with male clients (8.0 vs. 5.0, p = .008). Nearly 70.0% were offered more money not to use a condom during sex with a client, and 74.2% reported accepting more money not to use a condom. Three-quarters reported having experienced difficulty using condoms with clients. MSW in India engage in high levels of sexual risk for HIV/STIs. Money appears to be a driving factor for engaging in sex work and condomless sex with clients. HIV prevention interventions with MSW should focus on facilitating skills that will support their ability to negotiate sexual safety in the context of monetary disincentives.

HIV/AIDS in India: an overview of the Indian epidemic.

The first cases of HIV infection in India were detected in 1986 among female sex workers in Chennai. A rapid increase followed in many states. The current national prevalence is about 0.26% compared with a global average of 0.2%, but the figure in most high-risk groups including female sex workers is much higher (up to 7%). New HIV infections reached a peak in 1998 and have since declined by 60%, although the total number of HIV-positive persons remains stable at 2.1million, largely probably due to the increased life expectancy following antiretroviral therapy. The Indian epidemic is characterized by low levels in the general population and elevated concentrations among high-risk groups. Transmission is mainly heterosexually driven, with differential burdens across the states. The four main drivers of HIV infection in India differ in order from those elsewhere in the world and are commercial sex work, general heterosexual intercourse, injecting drug use and unprotected anal sex between men who have sex with men. There are distinct differences from state to state in the prevalence of HIV, with some around the national norm of 0.21% but others with over 1% infected. India has embarked on a targeted HIV prevention strategy in recent years which is strongly associated with a fall in infection rate in both low- and high-risk groups.

Development and Open Pilot Trial of an HIV-Prevention Intervention Integrating Mobile-Phone Technology for Male Sex Workers in Chennai, India.

In India men who have sex with men and engage in sex work (i.e., male sex workers; MSW) have a high risk of transmitting HIV. Globally, sex workers have become more spatially mobile due to advances in mobile-phone technology. In 2012 in-depth qualitative feedback was garnered from 40 interviews with MSW and four focus groups with 35 key informants (KIs) who had expert knowledge of the local MSW community to inform the design of an HIV-prevention intervention among MSW in Chennai, India. All MSW were recruited during outreach by employees of a Chennai-based organization for MSM (men who have sex with men). The data were analyzed using a descriptive qualitative approach. MSW and KIs discussed the need for intervention content that went beyond basic HIV psychoeducation. They emphasized the importance of addressing psychological distress, alcohol-related risk, and sexual communication skills. Concerns were raised about confidentiality, privacy, and scheduling. Participants endorsed a combination of in-person and mobile-phone-delivered sessions as well as the integration of mobile-phone messaging. These findings served as the basis for the development of a theoretically driven, manual-based intervention incorporating mobile phones. An open pilot assessed the feasibility and acceptability of the intervention with eight MSW. Assessments and HIV testing were administered at baseline, 3, and 6months post-baseline. Exit interviews were conducted at the conclusion of the intervention. Retention for session attendance and assessment follow-up was 100%. There was a high level of acceptability for the format, structure, and content. These data show initial promise, feasibility, and acceptability of the intervention.

Knowledge and risk perception regarding HIV among healthcare workers in a medical college hospital

Background: Ever since HIV was first identified in India among sex workers in Chennai during 1986, HIV infections have been reported in all states and territories. The knowledge and attitudes of healthcare workers (HCWs) in relation to HIV infection is an important factor influencing the willingness and ability of people with HIV to access care, and the quality of the care they receive. Aims & Objective: To assess HIV-related knowledge and risk perception among a group of north Indian health care workers (HCW), and to identify predictors of willingness to provide care for patients with HIV infection. Material and Methods: A cross-sectional survey of 450 HCWs from tertiary health care centre was undertaken in March 2011. The information was collected on a semi structured, self-administered questionnaire. Information was gathered regarding demographic details, HIV-related knowledge, risk perception and previous experience caring for HIV-positive patients. Results: Most (95.7%) were aware of the routes of transmission. 4.1% HCWs wished that they should be allowed to refuse to care for people with HIV/AIDS. HCWs willingness to provide care for patients with HIV was strongly associated with having previously cared for patients with HIV (P = 0.001). Knowledge of HIV transmission and perception of risk were not associated with willingness to provide care (p

Condom nonuse among female sex workers in Chennai, India

Commercial sex is uniquely implicated in the HIV epidemic in India and has been confronted with extensive HIV prevention and condom promotion efforts among female sex workers (FSWs). However given the widespread condom availability and HIV knowledge among FSWs motivations for condom nonuse are unclear. This study explored reasons for condom nonuse among FSWs in Chennai India. Clarification is vital for refining HIV prevention efforts because programmatic approaches vary widely according to the reasons for condom nonuse. A confluence of trust client suggestion and economic coercion and fear of violence are influential factors in condom nonuse among FSWs. The findings demonstrate the importance of relationship dynamics and the active role of male clients indicating the need for expansion beyond FSW-centered approaches and improved access to encourage condom use. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Measuring perceived stigma in female sex workers in Chennai, India

Although sex work is highly stigmatized throughout the world, a limited body of research has examined stigma among female sex workers (FSWs). We developed a Sex Worker Stigma (SWS) Index to measure perceived stigma among 150 FSWs in Chennai, India. These women were at a median age of 35 years and reported, on average, having engaged in sex work for nine out of the previous 12 months. The two-factor structure of the index was verified in both exploratory and confirmatory factor analyses with acceptable goodness of fit. The final 10-item index comprises of two domains of perceived stigma from the community and perceived stigma from one's family. Cronbach's α coefficients were 0.87 and 0.88 for each domain, respectively. In regression analysis, we found that income from jobs other than sex work was correlated with decreased levels of perceived stigma from both the community (β = − 0.16; 95% CI: −0.30 and −0.02) and the family (β = − 0.24; 95% CI: −0.40 and −0.07); prior experience of accessing health care system increased perceived stigma from the community while heavier financial responsibility for the family was associated with lower perceived stigma from women's family. With the proposed SWS Index, we have a valid and reliable metric to document and track levels of perceived stigma among FSWs to assess the impact of stigma reduction interventions.

High prevalence of forced sex among non-brothel based, wine shop centered sex workers in Chennai, India.

Sexual violence has been shown to increase women's risk of HIV infection. India is a country where the HIV epidemic is growing among women and intimate partner violence (IPV) is pervasive. This study examined prevalence of and factors associated with forced sex among female sex workers (FSWs) in Chennai, India. We conducted a probability survey among FSWs in 24 slum venues and identified predictive factors for recent forced sex using univariate and multivariable proportional odds models. Among 522 FSWs, 28% reported having forced sex with one partner and 35% with 2+ partners. In the final multivariable model, women who had a high number of partners who had a strong tendency to drink alcohol before sex were more likely to have experienced forced sex, and women who had both unprotected sex with a nonspousal partner and > 20 days of alcohol consumption in the last 30 days were more likely to have experienced forced sex. Discussion about family violence with larger social networks was independently associated with lower odds of forced sex among FSWs. HIV interventions for FSWs and their clients aimed at reducing alcohol consumption and encouraging condom use could be enhanced by violence prevention interventions to facilitate discourse about sexual violence.

Acceptability of a Microenterprise Intervention Among Female Sex Workers in Chennai, India

Female sex workers have been central in India's HIV epidemic since it was first diagnosed among them in 1989. Female sex workers' risk of HIV is primarily economically motivated. The Pi pilot study examined the feasibility and association of a microenterprise intervention, the tailoring of canvas bags, on sexual risk behaviors among female sex workers (N = 100) in Chennai. Women were randomized to an intervention or control arm. Between-group comparisons at baseline and at six-month follow-up were performed. Multivariate linear regression with bootstrapping was conducted to estimate the intervention effect. At baseline, women were a median of 35 years old, 61% were married and they had an average of two children. Intervention participants reported a significantly lower number of sex partners and significant increases in income at the 6-month follow-up compared to control participants. In a multivariate model, intervention participants had a significantly lower number of paying clients per month at follow-up compared to control participants. By graduation, 75% of intervention arm participants had made at least one sellable canvas bag and 6 months after the study's end, 60% have continued involvement in bag production. The pilot study demonstrated that microenterprise interventions are successful in both providing FSWs with licit income opportunities and was associated with reductions in HIV risk behaviors.

Barriers to free antiretroviral treatment access for female sex workers in Chennai, India.

India's National AIDS Control Organization (NACO) provides free first-line antiretroviral treatment (ART) at government centers for people living with HIV. To assist in developing policies and programs to ensure equity in ART access, we explored barriers to ART access among female sex workers (FSWs) living with HIV in Chennai. Between August and November 2007, we conducted three focus group discussions and two key informant interviews. Data were explored using framework analysis to identify categories and derive themes. We found interrelated barriers at the family/social, health care system/programmatic, and individual levels. Major barriers included fear of adverse consequences of disclosure of HIV status due to stigma and discrimination associated with HIV and sex work, lack of family support, negative experiences with health care providers, lack of adequate counseling services at government centers and by outreach workers employed by nongovernmental organizations (NGOs), perceived biased treatment of FSWs who are not referred by NGOs, lack of adequate knowledge about ART, and fatalism. Barriers can be addressed by: creating effective measures to reduce stigma associated with HIV/AIDS and sex work at the familial, societal, and health care system levels; incorporating information about ART into targeted interventions among FSWs; training counselors at government hospitals and NGO outreach workers on treatment issues; improving infrastructure and staffing levels at government centers to allow adequate time and privacy for counseling; and implementing government mass media campaigns on ART availability. Finally, it is crucial that NACO begin monitoring ART coverage of FSWs and other marginalized populations to ensure equitable ART access.

An Assessment of the Mental Health of Street-Based Sex Workers in Chennai, India

Prostitution, which is considered a public-order crime in India, is a way of life and employment for a large number of Indian women. Most choose prostitution for a living, in the absence of other opportunities for employment. The psychological costs of prostitution, however, are high. Violence against sex workers is common and is believed to affect their psychological well-being in general and affective disorders in particular. To date, little empirical research on this subject exists. This cross-sectional study attempts to fill this gap in the literature by investigating the relationship between workplace violence and mental health among sex workers in Chennai (formerly Madras), India. The study analyzes the social pathways to depression and suicidal ideations and found that workplace violence was the key variable that predicted higher depression scores. The article concludes that this group of marginalized women has major mental health needs that are currently unidentified and unmet.

Bacterial vaginosis in female sex workers in Chennai, India

Bacterial vaginosis (BV) causes obstetric and gynaecological complications and non-chlamydial/non-gonococcal pelvic inflammatory disease and has been shown to be associated with the risk of acquiring HIV and herpes simplex (HSV)-2 infections. This study investigated both the prevalence of BV and its association with STDs among 582 female sex workers living in Chennai, South India. Blood, vaginal and endocervical swabs were tested for HSV-2, HIV, Treponema pallidum, BV, Chlamydia trachomatis, Neisseria gonorrhoea and Trichomonas vaginalis. The vaginal swabs collected were Gram's stained and analysed for BV by Nugent's scoring criteria. Of the women studied, 45% (95% CI, 40.6-48.7) were positive, 39.5% (95% CI, 35.5-43.5) were negative and 16% (95% CI, 12.8-18.7) were intermediate for BV. Bacterial vaginosis positivity was directly related to concurrent infection with HSV-2 (RR 1.3, AR 12, P = 0.00), T vaginalis (RR 1.5, AR 10, P = 0.01) T. pallidum (RR 2.8, AR 16, P = 0.00) and HIV (RR 4.1, AR 52, P = 0.01). Future studies are needed to focus on the risk factors for BV.