Context of Economic Insecurity, violence and HIV risk among Sex workers in AP

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The Context of Economic Insecurity and Its Relation to Violence and

Risk Factors for HIV Among Female Sex Workers in Andhra Pradesh, India

, ScDa,b Jhumka Gupta, ScDc Biradavolu, PhDb Vasavi

Devireddy, BSb Kim M. Blankenship, PhDb

a Washington University, School of Public Health and Health Services,

Washington, DC bDuke Global Health Institute, Duke University, Durham, NC cYale

University, School of Public Health, New Haven, CT

Address correspondence to: , ScD, Washington University,

School of Public Health and Health Services,

Department of Prevention and Community Health, 2175 K St. NW, Ste. 700,

Washington, DC 20037; tel. 202-994-7183;

fax 202-994-3601; e-mail <pchear@...>. ©2010 Association of Schools of

Public Health

Public Health Reports / 2010 Supplement 4 / Volume 125 & #57445; 81

SYNOPSIS

Objective. We examined the context of economic insecurity and debt among female

sex workers (FSWs), how this context varies among FSWs, and its association with

experiences of violence and sexual risk factors for human immunodeficiency virus

(HIV).

Methods. We recruited FSWs aged $18 years (n5673) through respondent driven

sampling for a survey on HIV risk in this region. Using logistic regression

models (adjusted for partner status, education, financial support, and

literacy), we assessed the relation between debt and sexual and physical

victimization as

well as sexual risk. We also conducted qualitative interviews with a subsample

of the survey participants and examined these for related themes.

Results. In adjusted logistic regression models, FSWs who reported debt were

more likely to report the following: recent physical violence (adjusted odds

ratio [AOR] 5 2.4, 95% confidence interval [CI] 1.5, 3.9), unprotected sex with

occasional clients in the past week (AOR52.3, 95% CI 1.2, 4.3), anal sex with

clients in the past 30 days (AOR52.0, 95% CI 1.1, 3.9), and at least one

sexually transmitted infection symptom in the past six months (AOR51.6, 95% CI

1.1, 2.4).

FSWs with debt were more likely to report current husbands or other male

partners, and less likely to report condom use with these partners, further

increasing their sexual risk. Qualitative data elaborated on these findings.

Conclusion. Findings indicate the violence- and HIV-related vulnerability of

FSWs who report debt and further highlight how male partners may contribute to

the debt and economic insecurity of FSWs.

A copy of the report is available at the following url

http://www.publichealthreports.org/archives/issueopen.cfm?articleID=2486