title: Trends in risk behaviors among female sex workers in south India: priorities for sustaining the reversal of HIV epidemic.
abstract: HIV epidemic in India is predominantly concentrated in subgroups of population, such as female sex workers (FSWs) and their clients, whose behavior exposes them to a higher risk of acquiring HIV infection. This paper aims to present the changing patterns of socio-demographic characteristics, behaviors, reported sexually transmitted infections (STIs), and associated factors among FSWs over 11 years. Multistage cluster sampling with probability-proportional-to-size (PPS) method was used in the surveys. A sample of 400 FSWs was studied every year. The mean age and literacy at the baseline level increased significantly over the years. House-based sex increased by 40% from 43.3% in 1997 to 83% in 2008 (p<0.001). Condom use at last sex with one-time clients; consistent condom use (CCU) with one-time and regular clients indicated increasing trends. FSWs reported low levels of condom use at last sex (14.5% in 1997 to 5% in 2008; p<0.001) and CCU (12.6% in 2004 to 3.6% in 2008; p<0.01) with regular partners. FSWs who used condom with one-time clients at last sex reported significantly less STI symptoms. A two-third reduction in genital ulcers was found from 13.1% in 1997 to 4.5% in 2008 (p<0.001). Nonliterate and hotel-based sex workers were 1.6 (1.0-2.5; 95% CI) and 2.2(1.3-3.7; 95% CI) times more likely to have reported STI symptoms. The percentage of FSWs who underwent HIV testing increased (p<0.001); similarly, a 20% increase was found in FSWs who availed counseling services from 65.2% in 1997 to 85.4% in 2008 (p<0.001). Poor, illiterate, and marginalized were more likely to get involved in risky behaviors which suggest the need for structural interventions as part of HIV prevention strategy.
authors: a AIDS Prevention and Control Project, Voluntary Health Services , Chennai , India.
authors: Bimal
authors: B
authors: Charles
authors: Lakshmanan
authors: L
authors: Jeyaseelan
authors: Asirvatham
authors: A
authors: Edwin Sam
authors: Arvind
authors: A
authors: Kumar Pandian
authors: Mani
authors: M
authors: Thenmozhi
authors: Visalakshi
authors: V
authors: Jeyaseelan
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data* / Q000639:trends; D003430:Cross-Sectional Studies; D058872:Epidemics / Q000517:prevention & control; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India / Q000453:epidemiology; D015995:Prevalence; D012309:Risk-Taking; D021841:Safe Sex / Q000706:statistics & numerical data; D011477:Sex Work / Q000706:statistics & numerical data*; D060386:Sex Workers; D012747:Sexual Partners; D012959:Socioeconomic Factors; D047568:Unsafe Sex / Q000706:statistics & numerical data; D055815:Young Adult