title: Condom use within non-commercial partnerships of female sex workers in southern India.
abstract: BACKGROUND
  Although female sex workers (FSWs) report high levels of condom use with commercial sex clients, particularly after targeted HIV preventive interventions have been implemented, condom use is often low with non-commercial partners. There is limited understanding regarding the factors that influence condom use with FSWs' non-commercial partners, and of how programs can be designed to increase condom use with these partners. The main objectives of this study were therefore to describe FSWs' self-reported non-commercial partners, along with interpersonal factors characterizing their non-commercial partnerships, and to examine the factors associated with consistent condom use (CCU) within non-commercial partnerships.
  
  
  METHODS
  This study used data collected from cross-sectional questionnaires administered to 988 FSWs in four districts in Karnataka state in 2006-07. We used bivariate and multivariable logistic regression analysis to examine the relationship between CCU (i.e., 'always' compared to 'never', 'sometimes' or 'frequently') with non-commercial partners of FSWs (including the respondents' husband or main cohabiting partner [if not married] and their most recent non-paying partner [who is neither a husband nor the main cohabiting partner, and with whom the FSW had sex within the previous year]) and interpersonal factors describing these partnerships, as well as social and environmental factors. Weighting and survey methods were used to account for the cluster sampling design.
  
  
  RESULTS
  Overall, 511 (51.8%) FSWs reported having a husband or cohabiting partner and 247 (23.7%) reported having a non-paying partner. CCU with these partners was low (22.6% and 40.3% respectively). In multivariable analysis, the odds of CCU with FSWs' husband or cohabiting partner were 1.8-fold higher for FSWs whose partner knew she was a sex worker (adjusted odds ratio [AOR]: 1.84, 95% confidence intervals[CI]: 1.02-3.32) and almost 6-fold higher if the FSW was unmarried (AOR: 5.73, 95%CI: 2.79-11.76]. CCU with FSWs' non-paying partner decreased by 18% for each one-year increase in the duration of the relationship (AOR: 0.82, 95%CI: 0.68-0.97).
  
  
  CONCLUSIONS
  This study revealed important patterns and interpersonal determinants of condom use within non-commercial partnerships of FSWs. Integrated structural and community-driven HIV/STI prevention programs that focus on gender and reduce sex work stigma should be investigated to increase condom use in non-commercial partnerships.
authors.affiliation: Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada. kdeering@cfenet.ubc.ca
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Deering
authors.forename: Paranita
authors.initials: P
authors.lastname: Bhattacharjee
authors.forename: Janet
authors.initials: J
authors.lastname: Bradley
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Moses
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
authors.forename: Souradet Y
authors.initials: SY
authors.lastname: Shaw
authors.forename: Reynold
authors.initials: R
authors.lastname: Washington
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Lowndes
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Boily
authors.forename: Banadakoppa M
authors.initials: BM
authors.lastname: Ramesh
authors.forename: S
authors.initials: S
authors.lastname: Rajaram
authors.forename: Kaveri
authors.initials: K
authors.lastname: Gurav
authors.forename: Michel
authors.initials: M
authors.lastname: Alary
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007398:Interpersonal Relations; D008297:Male; D021841:Safe Sex / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000706:statistics & numerical data*; D012747:Sexual Partners; D018454:Spouses / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires