title: Mobilising community collectivisation among female sex workers to promote STI service utilisation from the government healthcare system in Andhra Pradesh, India.
abstract: BACKGROUND
  To assess the association between female sex workers' (FSWs) degree of community collectivisation and self-efficacy, utilisation of sexually transmitted infection (STI) services from government-run health centres in Andhra Pradesh, India.
  
  
  METHODS
  Cross-sectional analyses of 1986 FSWs recruited using a probability-based sampling from five districts of Andhra Pradesh during 2010-2011. Multiple logistic regression models were constructed to assess associations. The independent variables included-collective efficacy, collective agency and collective action-measured using a series of items that assessed the grouping of the community on issues that concern most sex workers. An additional independent variable included FSWs belonging to an area where there was a project partnership with government health centres to provide STI treatment services to FSWs. The outcome indicators included self-efficacy for service utilisation from government health facilities and the treatment for STIs from government health facilities at least once in the past year experience of STI symptoms.
  
  
  RESULTS
  Of the 1986 FSWs, nearly two-fifths (39.5%) reported a high level of overall collectivisation (collective efficacy: 89%, collective agency: 50.7%; collective action: 12.7%). Sex workers with a high degree compared with low degree of overall collectivisation were significantly more likely to report high self-efficacy to use government health facilities (75.0% vs 57.3%, adjusted OR 2.5, 95% CI 2.0 to 3.1) and to use government health centres for STI treatment in past 1 year (78.1% vs 63.2%, adjusted OR 2.1, 95% CI 1.6 to 2.8), irrespective of project partnership with government centres.
  
  
  CONCLUSIONS
  The current research findings reinforce the need for stronger community mobilisation for better utilisation of government health facilities for STI and HIV prevention interventions.
authors.affiliation: Regional Office, India HIV AIDS Alliance, Sarovar Centre, 5-9-22, Secretariat Road, Hyderabad-500063, Andhra Pradesh, India. pprabhakar@allianceindia.org
authors.forename: Prabhakar
authors.initials: P
authors.lastname: Parimi
authors.forename: Ram Manohar
authors.initials: RM
authors.lastname: Mishra
authors.forename: Saroj
authors.initials: S
authors.lastname: Tucker
authors.forename: Niranjan
authors.initials: N
authors.lastname: Saggurti
mesh_terms: D000328:Adult; D003098:Collective Bargaining; D019058:Community Networks; D003159:Community-Institutional Relations; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D015438:Health Behavior; D006297:Health Services Accessibility; D006779:Hospitals, Public; D006801:Humans; D007194:India; D016015:Logistic Models; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D034121:Reproductive Health Services / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D020377:Self Efficacy; D011477:Sex Work; D060386:Sex Workers / Q000523:psychology* / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000628:therapy*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult