title: Transactional sex risk and STI among HIV-infected female sex workers and HIV-infected male clients of FSWs in India.
abstract: To describe sex risk behaviors of HIV-infected female sex workers (FSWs) and HIV-infected male clients of FSWs, to evaluate associations between risky transactional sex and number of unprotected transactional sex episodes, and to assess the association between unprotected transactional sex and self-reported sexually transmitted infection (STI). Adult HIV-infected FSWs (n = 211) and HIV-infected male clients (n = 205) were surveyed in Mumbai about demographics, STI, and past 90-day and past year sex and substance use histories. Gender-stratified Poisson regression models were used to evaluate associations between four risky transactional sex behaviors (number of transactional sex partners; alcohol use before transactional sex; anal transactional sex; and transactional sex with a known HIV-infected partner) and number of unprotected transactional sex episodes; logistic regression was used to assess the association between unprotected transactional sex and self-reported STI. Twenty-nine percent of females and 7% of males reported any unprotected transactional sex episodes in the past 90 days. Thirty-nine percent of females and 12% of males reported past year STI. Among males, a greater number of transactional sex partners was associated with more unprotected transactional sex episodes (adjusted incidence rate ratio [IRR] = 8.2, 95% confidence interval [CI] = 1.8-38.4 highest vs. lowest tertile), and any unprotected transactional sex was associated with a higher odds of self-reported STI in the past year (adjusted odds ratio [AOR] = 5.6, 95% CI = 1.4-22.4). For women, risky transactional sex behaviors were not associated with condom non-use, and unprotected sex was negatively associated with STI (AOR = 0.4, 95% CI = 0.2-0.9). Reports of condom use during transactional sex were high for these samples. However, standard predictors of unprotected transactional sex (i.e., greater number of partners) and STI (i.e., unprotected sex) only held true for males. Further research is needed to guide an understanding of sex risk and STI among HIV-infected FSWs in India.
authors.affiliation: Boston University School of Public Health, Community Health Sciences, MA, USA. anitaraj@bu.edu
authors.forename: Anita
authors.initials: A
authors.lastname: Raj
authors.forename: N
authors.initials: N
authors.lastname: Saggurti
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: Anindita
authors.initials: A
authors.lastname: Dasgupta
authors.forename: Carly
authors.initials: C
authors.lastname: Bridden
authors.forename: Manojkumar
authors.initials: M
authors.lastname: Pradeshi
authors.forename: J H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012309:Risk-Taking; D057566:Self Report; D011477:Sex Work / Q000706:statistics & numerical data*; D060386:Sex Workers; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000453:epidemiology*; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult