title: Understanding out-migration among female sex workers in South India.
abstract: BACKGROUND
  Migrant sex workers are known to be vulnerable to HIV. There is substantial female sex worker (FSW) mobility between the borders of Maharashtra and Karnataka, but little programming emphasis on migrant FSWs in India. We sought to understand the individual/cultural, structural, and contextual determinants of migration among FSWs from Karnataka.
  
  
  METHODS
  A cross-sectional face-to-face interview of 1567 FSWs from 142 villages in 3 districts of northern Karnataka, India was conducted from January to June 2008. Villages having 10+ FSWs, a large number of whom were migrant, were selected following mapping of FSWs. Multinomial logistic regression was conducted to identify characteristics associated with migrant (travelled for ≥ 2 weeks outside the district past year) and mobile (travelled for <2 weeks outside the district past year) FSWs; adjusting for age and district.
  
  
  RESULTS
  Compared with nonmigrants, migrant FSWs were more likely to be brothel than street based (Adjusted Odds Ratio (AOR): 5.7; 95% confidence interval: 1.6-20.0), have higher income from sex work (Adjusted Odds Ratio (AOR): 42.2; 12.6-142.1), speak >2 languages (AOR: 5.6; 2.6-12.0), have more clients (AOR per client: 2.9; 1.2-7.2), and have more sex acts per day (AOR per sex act: 3.5; 1.3-9.3). Mobile FSWs had higher income from sex work (AOR: 13.2; 3.9-44.6) relative to nonmigrants, but not as strongly as for migrant FSWs.
  
  
  CONCLUSIONS
  Out-migration of FSWs in Karnataka was strongly tied to sex work characteristics; thus, the structure inherent in sex work should be capitalized on when developing HIV preventive interventions. The important role of FSWs in HIV epidemics, coupled with the potential for rapid spread of HIV with migration, requires the most effective interventions possible for mobile and migrant FSWs.
authors.affiliation: Karnataka Health Promotion Trust, Bangalore, India. doctorpradeepbs@gmail.com
authors.forename: Pradeep
authors.initials: P
authors.lastname: Banandur
authors.forename: Satyanarayana
authors.initials: S
authors.lastname: Ramanaik
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Manhart
authors.forename: Raluca
authors.initials: R
authors.lastname: Buzdugan
authors.forename: Bidhubhushan
authors.initials: B
authors.lastname: Mahapatra
authors.forename: Shajy
authors.initials: S
authors.lastname: Isac
authors.forename: Shiva S
authors.initials: SS
authors.lastname: Halli
authors.forename: Reynold G
authors.initials: RG
authors.lastname: Washington
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.forename: James F
authors.initials: JF
authors.lastname: Blanchard
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D004641:Emigration and Immigration; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007194:India / Q000453:epidemiology; D007407:Interviews as Topic; D008875:Middle Aged; D021841:Safe Sex; D011477:Sex Work / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D014171:Transients and Migrants / Q000706:statistics & numerical data; D055815:Young Adult