Variability in the sexual structure in a rural Indian setting: implications for HIV prevention strategies.
OBJECTIVE
To describe the sexual structure, including numbers and distribution of female sex workers (FSWs) and male sexual behaviours in the Bagalkot district of the state of Karnataka in south India.


METHODS
Village health workers and peer educators enumerated FSWs in each village by interviewing key informants and FSWs. Urban FSW populations were estimated using systematic interviews with key informants to identify sex work sites and then validating FSW populations at each sex work site. Male sexual behaviours were measured through confidential polling booth surveys in randomly selected villages. HIV prevalence was estimated through a community-based survey using randomised cluster sampling. Lorenz curves and Gini coefficients were used to describe the degree of clustering of FSW populations.


RESULTS
Of an estimated 7280 FSWs in Bagalkot district (17.1/1000 adult males), 87% live and work in rural areas. The relative size of the FSW population varies from 9.6 to 30.5/1000 adult males in the six subdistrict administrative areas (talukas). The FSW population was highest in the three talukas with more irrigated land and fewer and larger villages. FSW populations are highly clustered; 93 (15%) of the villages accounted for 54% of all rural FSWs. There is a high degree of FSW clustering in all talukas, and talukas with fewer and larger villages have larger clusters and more FSWs overall. General population HIV prevalence is highest in the taluka with the highest relative FSW population.


CONCLUSIONS
Prevention programmes in India should be scaled up to reach FSWs in rural areas. These programmes should be focused on those districts and subdistrict areas with large concentrations of FSWs. More research is required to determine the distribution of FSWs in rural areas in other regions of India.
Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W3, Canada. blanchard@umanitoba.ca
James F
JF
Blanchard
Shiva
S
Halli
B M
BM
Ramesh
Parinita
P
Bhattacharjee
Reynold G
RG
Washington
John
J
O'Neil
Stephen
S
Moses
D000293:Adolescent; D000328:Adult; D017280:Condoms; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006306:Health Surveys; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data; D011477:Sex Work / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012931:Social Environment