title: Exploring dynamics of anal sex among female sex workers in Andhra Pradesh.
abstract: OBJECTIVE
  The anal sex among heterosexual couples is on the rise as reported in many scientific studies. Considering that unprotected anal sex has higher risk of human immunodeficiency virus (HIV) transmission than the vaginal sex, we undertook a study to understand the anal sex practices among Female Sex Workers (FSW).
  
  
  METHODS
  The study was conducted among FSW attending 11 randomly selected sexually transmitted infection (STI) clinics in Bill and Melinda Gates supported targeted interventions in Andhra Pradesh. A structured questionnaire was administered to the 555 FSW attending these clinics by project clinic counselors. Informed consent was obtained from all the study participants.
  
  
  RESULTS
  Engaging in anal sex was self reported by 22% of sex workers, though demand from clients was reported to be much higher (40%). The reasons for anal sex practices included more money (61%), clout/influence of the client (45%), risk of losing client (27%), and forced sex (1.2%). Factors associated with anal sex were higher number of clients, higher duration of sex work, higher income, and older age group. Associated risks perceived by FSW were bleeding and injury to anal canal (98%) while only 28% associated it with higher HIV transmission risk. Reported Condom and lubricant use was about 88% and 39% respectively.
  
  
  CONCLUSIONS
  The study shows that there is frequent anal sex, inconsistent condom and infrequent lubricant usage, economic and physical coercion, and low awareness of STI/HIV transmission risk among FSW, which have serious implications for HIV prevention programmes. There is a need to focus on anal sex education and use of lubricants along with condoms during anal sex in FSW-targeted interventions in AP.
authors.affiliation: India HIV/AIDS Alliance, Sarovar Center, Secretariat Road, Hyderabad, Andhra Pradesh, India.
authors.forename: Saroj
authors.initials: S
authors.lastname: Tucker
authors.forename: Rama
authors.initials: R
authors.lastname: Krishna
authors.forename: Parimi
authors.initials: P
authors.lastname: Prabhakar
authors.forename: Swarup
authors.initials: S
authors.lastname: Panyam
authors.forename: Pankaj
authors.initials: P
authors.lastname: Anand