title: Understanding the role of peer group membership in reducing HIV-related risk and vulnerability among female sex workers in Karnataka, India.
abstract: In Karnataka state, South India, we analyzed the role of membership in peer groups in reducing HIV-related risk and vulnerability among female sex workers (FSWs). Data from three surveys conducted in Karnataka, a behavioral tracking survey and two rounds of integrated biological and behavioral assessments (IBBAs), were analyzed. Using propensity score matching, we examined the impact of group membership on selected outcomes, including condom use, experience of violence, access to entitlements, and the prevalence of sexually transmitted infections, including HIV infection. Focus group discussions were conducted with the FSWs to better understand their perceptions regarding membership in peer groups. Peer group members participating in the IBBAs had a lower prevalence of gonorrhea and/or chlamydia (5.2 vs 9.6%, p<0.001), and of syphilis (8.2 vs 10.3%, p<0.05), compared to non-members. The average treatment effect for selected outcome measures, from the propensity score matching, showed that FSWs who were members of any peer group reported significantly less experience of violence in the past six months, were less likely to have bribed police to avoid trouble in the past six months, and were more likely to have obtained at least one formal identification document in the past five years, compared to non-members. In focus group discussions, group members indicated that they had more confidence in dealing with situations of forced sex and violence. Including community mobilization and peer group formation in the context of HIV prevention programing can reduce HIV-related risk and vulnerability among FSWs.
authors.affiliation: Karnataka Health Promotion Trust, Bangalore, India. parinita@khpt.org
authors.forename: Parinita
authors.initials: P
authors.lastname: Bhattacharjee
authors.forename: Ravi
authors.initials: R
authors.lastname: Prakash
authors.forename: Priya
authors.initials: P
authors.lastname: Pillai
authors.forename: Shajy
authors.initials: S
authors.lastname: Isac
authors.forename: Mohan
authors.initials: M
authors.lastname: Haranahalli
authors.forename: Andrea
authors.initials: A
authors.lastname: Blanchard
authors.forename: Maryam
authors.initials: M
authors.lastname: Shahmanesh
authors.forename: James
authors.initials: J
authors.lastname: Blanchard
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
mesh_terms: D000328:Adult; D003256:Community Participation; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007194:India; D007407:Interviews as Topic; D008297:Male; D010379:Peer Group; D010465:Perception; D057216:Propensity Score; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D021841:Safe Sex; D060386:Sex Workers / Q000523:psychology*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D012959:Socioeconomic Factors; D035862:Vulnerable Populations / Q000523:psychology*; D055815:Young Adult