title: Suicidal behavior among female sex workers in Goa, India: the silent epidemic.
abstract: OBJECTIVE
  We sought to study suicidal behavior prevalence and its association with social and gender disadvantage, sex work, and health factors among female sex workers in Goa, India.
  
  
  METHODS
  Using respondent-driven sampling, we recruited 326 sex workers in Goa for an interviewer-administered questionnaire regarding self-harming behaviors, sociodemographics, sex work, gender disadvantage, and health. Participants were tested for sexually transmitted infections. We used multivariate analysis to define suicide attempt determinants.
  
  
  RESULTS
  Nineteen percent of sex workers in the sample reported attempted suicide in the past 3 months. Attempts were independently associated with intimate partner violence (adjusted odds ratio [AOR] = 2.70; 95% confidence interval [CI] = 1.38, 5.28), violence from others (AOR = 2.26; 95% CI = 1.15, 4.45), entrapment (AOR = 2.76; 95% CI = 1.11, 6.83), regular customers (AOR = 3.20; 95% CI = 1.61, 6.35), and worsening mental health (AOR = 1.05; 95% CI = 1.01, 1.11). Lower suicide attempt likelihood was associated with Kannad ethnicity, HIV prevention services, and having a child.
  
  
  CONCLUSIONS
  Suicidal behaviors among sex workers were common and associated with gender disadvantage and poor mental health. India's widespread HIV-prevention programs for sex workers provide an opportunity for community-based interventions against gender-based violence and for mental health services delivery.
authors.affiliation: Centre for Sexual Health and HIV Research, University College London, 3rd floor Mortimer Market Centre, off Caper St, London WC1E 6AU UK. bamaryjoon@yahoo.co.uk
authors.forename: Maryam
authors.initials: M
authors.lastname: Shahmanesh
authors.forename: Sonali
authors.initials: S
authors.lastname: Wayal
authors.forename: Frances
authors.initials: F
authors.lastname: Cowan
authors.forename: David
authors.initials: D
authors.lastname: Mabey
authors.forename: Andrew
authors.initials: A
authors.lastname: Copas
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D001523:Mental Disorders / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D011477:Sex Work; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014754:Violence / Q000706:statistics & numerical data