Power, community mobilization, and condom use practices among female sex workers in Andhra Pradesh, India.
OBJECTIVE
We used a structural interventions framework to analyse the associations between power and condom use among a sample of female sex workers (FSW), and how exposure to a local community mobilization intervention (CMI) affects these associations.


METHODS
Data came from a cross-sectional survey of 812 FSW in the East Godavari district of Andhra Pradesh, India, recruited through respondent-driven sampling.


METHODS
We identified three types of power - collective power, control over work, and economic power, and three dimensions of collective power - collective identity, efficacy, and agency. Multivariate logistic regression analysis was used to analyse the relationship of these three types of power and exposure to a CMI with consistent condom use with clients.


RESULTS
A total of 803 respondents exchanged sex with an occasional or regular client in the 7 days before the interview. Multivariate logistic regression shows that control over both the type of sex [adjusted odds ratio (AOR) 1.70, 95% confidence interval (CI) 1.23-2.34] and the amount charged (AOR 1.56, 95% CI 1.12-2.16), and economic dependence (AOR 0.54, 95% CI 0.35-0.83) are associated with consistent condom use as is programme exposure (AOR 2.09, 95% CI 1.48-2.94). The interaction between programme exposure and collective agency was also significant (chi-square 6.62, P = 0.01). Among respondents who reported both programme exposure and high levels of collective agency, the odds ratio of consistent condom use was 2.5 times that of other FSW.


CONCLUSIONS
A structural interventions framework is useful for understanding HIV risk among FSW. More needs to be done to promote FSW control over work and access to economic resources.
Blankenship
Kim M
KM
Department of Sociology, Duke Global Health Institute, Duke University, Durham, North Carolina 27708, USA. kim.blankenship@duke.edu
West
Brooke S
BS
Kershaw
Trace S
TS
Biradavolu
Monica R
MR
D000328:Adult; D017677:Age Distribution; D019058:Community Networks / Q000458:organization & administration*; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology / Q000635:transmission; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007194:India / Q000453:epidemiology; D007389:Internal-External Control; D008875:Middle Aged; D011209:Power, Psychological; D021841:Safe Sex / Q000523:psychology / Q000706:statistics & numerical data; D011477:Sex Work / Q000523:psychology* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult