title: Relationship between mobility, violence and HIV/STI among female sex workers in Andhra Pradesh, India.
abstract: BACKGROUND
  Violence and mobility have been identified as critical factors contributing to the spread of HIV worldwide. This study aimed to assess the independent and combined associations of mobility and violence with sexual risk behaviors and HIV, STI prevalence among female sex workers (FSWs) in India.
  
  
  METHODS
  Data were drawn from a cross-sectional, bio-behavioral survey conducted among 2042 FSWs across five districts of southern India in 2005-06. Regression models were used to estimate odds ratios and 95% confidence intervals (CIs) for sexual risk behaviors and HIV infection based on experience of violence and mobility after adjusting for socio-demographic and sex work related characteristics.
  
  
  RESULTS
  One-fifth of FSWs (19%) reported experiencing violence; 68% reported travelling outside their current place of residence at least once in the past year and practicing sex work during their visit. Mobile FSWs were more likely to report violence compared to their counterparts (23% vs. 10%, p < 0.001). Approximately 1 in 5 tested positive for HIV. In adjusted models, FSWs reporting both mobility and violence as compared to their counterparts were more likely to be infected with HIV (Adjusted odds ratio (adjusted OR): 2.07, 95% CI: 1.42-3.03) and to report unprotected sex with occasional (adjusted OR: 2.86, 95% CI: 1.76-4.65) and regular clients (adjusted OR: 2.07, 95% CI: 1.40-3.06).
  
  
  CONCLUSIONS
  The findings indicate that mobility and violence were independently associated with HIV infection. Notably, the combined effect of mobility and violence posed greater HIV risk than their independent effect. These results point to the need for the provision of an enabling environment and safe spaces for FSWs who are mobile, to augment existing efforts to reduce the spread of HIV/AIDS.
authors.affiliation: Population Council, 1st Floor, 142 Golf Links, New Delhi, 110003, India. sramesh@popcouncil.org
authors.forename: Sowmya
authors.initials: S
authors.lastname: Ramesh
authors.forename: Deepika
authors.initials: D
authors.lastname: Ganju
authors.forename: Bidhubhusan
authors.initials: B
authors.lastname: Mahapatra
authors.forename: Ram Manohar
authors.initials: RM
authors.lastname: Mishra
authors.forename: Niranjan
authors.initials: N
authors.lastname: Saggurti
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D016017:Odds Ratio; D060386:Sex Workers; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000635:transmission; D014195:Travel / Q000706:statistics & numerical data; D047568:Unsafe Sex / Q000706:statistics & numerical data; D014754:Violence