title: Diversity among clients of female sex workers in India: comparing risk profiles and intervention impact by site of solicitation. implications for the vulnerability of less visible female sex workers.
abstract: BACKGROUND
  It seems generally accepted that targeted interventions in India have been successful in raising condom use between female sex workers (FSWs) and their clients. Data from clients of FSWs have been under-utilised to analyse the risk environments and vulnerability of both partners.
  
  
  METHODS
  The 2009 Integrated Biological and Behavioural Assessment survey sampled clients of FSWs at hotspots in Andhra Pradesh, Maharashtra and Tamil Nadu (n=5040). The risk profile of clients in terms of sexual networking and condom use are compared across usual pick-up place. We used propensity score matching (PSM) to estimate the average treatment effect on treated (ATT) of intervention messages on clients' consistent condom use with FSW.
  
  
  RESULTS
  Clients of the more hidden sex workers who solicit from home or via phone or agents had more extensive sexual networks, reporting casual female partners as well as anal intercourse with male partners and FSW. Clients of brothel-based sex workers, who were the least educated, reported the fewest number/categories of partners, least anal sex, and lowest condom use (41%). Consistent condom use varied widely by state: 65% in Andhra Pradesh, 36% in Maharashtra and 29% in Tamil Nadu. Exposure to intervention messages on sexually transmitted infections was lowest among men frequenting brothels (58%), and highest among men soliciting less visible sex workers (70%). Exposure had significant impact on consistent condom use, including among clients of home-based sex workers (ATT 21%; p=0.001) and among men soliciting other more hidden FSW (ATT 17%; p=0.001). In Tamil Nadu no impact could be demonstrated.
  
  
  CONCLUSIONS
  Commercial sex happens between two partners and both need to be, and can be, reached by intervention messages. Commercial sex is still largely unprotected and as the sex industry gets more diffuse a greater focus on reaching clients of sex workers seems important given their extensive sexual networks.
authors.affiliation: Tata Institute of Social Sciences, Mumbai, India.
authors.forename: Dipak
authors.initials: D
authors.lastname: Suryawanshi
authors.forename: Tarun
authors.initials: T
authors.lastname: Bhatnagar
authors.forename: Sucheta
authors.initials: S
authors.lastname: Deshpande
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhou
authors.forename: Pankaj
authors.initials: P
authors.lastname: Singh
authors.forename: Martine
authors.initials: M
authors.lastname: Collumbien
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003710:Demography; D005260:Female; D006293:Health Promotion / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008297:Male; D012306:Risk; D011477:Sex Work / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000517:prevention & control
references.citation: BMC Public Health. 2011 Dec 29;11 Suppl 6:S2
references.pmid: 22375562
references.citation: Sex Transm Infect. 2006 Jun;82 Suppl 3:iii26-33
references.pmid: 16735289
references.citation: Sex Transm Infect. 2002 Apr;78 Suppl 1:i69-77
references.pmid: 12083450
references.citation: Sex Transm Infect. 2010 Feb;86 Suppl 1:i25-32
references.pmid: 20167727
references.citation: Int J Epidemiol. 2010 Apr;39(2):439-48
references.pmid: 19995861
references.citation: AIDS. 2008 Dec;22 Suppl 5:S127-36
references.pmid: 19098473
references.citation: Sex Transm Infect. 2005 Aug;81(4):342-4
references.pmid: 16061544
references.citation: J HIV AIDS Soc Serv. 2012 Apr;11(2):169-191
references.pmid: 22745597
references.citation: J Epidemiol Community Health. 2012 Oct;66 Suppl 2:ii49-54
references.pmid: 22495773
references.citation: Trop Med Int Health. 2009 Jun;14(6):673-87
references.pmid: 19392742
references.citation: Sex Transm Infect. 2013 Feb;89(1):5-10
references.pmid: 23196329
references.citation: AIDS Behav. 2008 Jul;12(4):613-22
references.pmid: 18080739
references.citation: BMJ Open. 2012 Sep 30;2(5):
references.pmid: 23028110
references.citation: J Infect Dis. 2005 Feb 1;191 Suppl 1:S139-46
references.pmid: 15627224
references.citation: AIDS. 2008 Dec;22 Suppl 5:S17-34
references.pmid: 19098477
references.citation: BMC Public Health. 2011 Dec 29;11 Suppl 6:S1
references.pmid: 22376071
references.citation: PLoS One. 2011;6(7):e22704
references.pmid: 21829486
references.citation: AIDS. 1996 Sep;10(11):1265-71
references.pmid: 8883589
references.citation: AIDS. 2008 Dec;22 Suppl 5:S81-90
references.pmid: 19098482
references.citation: AIDS Behav. 2013 Jul;17(6):2260-8
references.pmid: 23361948
references.citation: BMC Public Health. 2011 Dec 29;11 Suppl 6:S3
references.pmid: 22375609
references.citation: BMC Public Health. 2011 Dec 29;11 Suppl 6:S4
references.pmid: 22375691
references.citation: Sex Transm Infect. 2010 Feb;86 Suppl 1:i33-43
references.pmid: 20167728
references.citation: Lancet. 2004 Jul 3-9;364(9428):69-82
references.pmid: 15234860
references.citation: BMC Public Health. 2011 Dec 29;11 Suppl 6:S11
references.pmid: 22376171
references.citation: AIDS Care. 2005 Apr;17(3):377-85
references.pmid: 15832886
references.citation: AIDS Care. 2006 Oct;18(7):739-49
references.pmid: 16971283
references.citation: AIDS. 2008 Dec;22 Suppl 5:S69-79
references.pmid: 19098481
references.citation: Soc Sci Med. 2009 Oct;69(8):1157-66
references.pmid: 19716639
references.citation: AIDS. 1991;5 Suppl 1:S169-76
references.pmid: 1669915
references.citation: Sex Transm Dis. 2002 Aug;29(8):444-52
references.pmid: 12172528
references.citation: AIDS. 2008 Dec;22 Suppl 5:S91-100
references.pmid: 19098483
references.citation: AIDS. 2008 Dec;22 Suppl 5:S109-16
references.pmid: 19098471