title: Pornography, Sexual Enhancement Products, and Sexual Risk of Female Sex Workers and their Clients in Southern India.
abstract: Despite their large numbers, and important role in the HIV epidemic in India, male clients of female sex workers (FSWs) are a difficult to reach population and little is known about their sexual behaviors. Using data from an integrated behavioral and biological assessment of 684 clients in Bangalore in 2012, we examined factors associated with their reports of having sex with three or more different female sex workers in the last month, and anal sex with sex workers. We included sociodemographic and sexual behavior factors and, for the first time in client studies in India, included data on the use of pornography and sexual enhancement products (SEPs) such as pills, oils, and sprays, in our multivariable analyses of client risk. Seventy-eight percent of clients had seen pornographic material and 8% reported ever having used SEPs. The profiles of men practicing the two risk behaviors examined were quite different. Travel in the past year, drunkenness in the past month, young age at first commercial sex, non-use of condoms at last sex, and finding sex workers in public places (but not use of pornography and SEPs) were independently associated with multiple partnering. Sex with a man or transsexual, being a white collar worker, seeking out FSWs at home, pornography and SEP use, and condom use at last FSW sex, were all independently associated with anal sex with an FSW. More research is needed to better understand the links between pornography and SEPs, and HIV risk behaviors, and HIV prevention programs need to be cognizant of the importance of ensuring that condom use is adequately promoted and supported in the context of anal sex in female sex worker-client interactions.
authors.affiliation: Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Quebec City, PQ, Canada. jbradley360@shaw.ca.|Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 McDermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB, R3E 0T6, Canada. jbradley360@shaw.ca.
authors.forename: Janet
authors.initials: J
authors.lastname: Bradley
authors.affiliation: Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Quebec City, PQ, Canada.|CHARME-India Project, Bangalore, India.|India KHPT Office, Bangalore, India.
authors.forename: Subramanian Potty
authors.initials: SP
authors.lastname: Rajaram
authors.affiliation: India KHPT Office, Bangalore, India.
authors.forename: Shajy
authors.initials: S
authors.lastname: Isac
authors.affiliation: India KHPT Office, Bangalore, India.
authors.forename: Kaveri
authors.initials: K
authors.lastname: Gurav
authors.affiliation: India KHPT Office, Bangalore, India.
authors.forename: B M
authors.initials: BM
authors.lastname: Ramesh
authors.affiliation: Swasti-Health Resource Centre, Bangalore, India.
authors.forename: Chandrashekhar
authors.initials: C
authors.lastname: Gowda
authors.affiliation: Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 McDermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB, R3E 0T6, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.affiliation: Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, Quebec City, PQ, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Alary
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D058872:Epidemics; D004882:Erotica; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012306:Risk; D012309:Risk-Taking; D021841:Safe Sex; D011477:Sex Work; D060386:Sex Workers / Q000523:psychology* / Q000706:statistics & numerical data; D012725:Sexual Behavior; D012747:Sexual Partners / Q000523:psychology*; D014195:Travel
keywords: Anal sex; Clients of female sex workers; Female sex workers; HIV risk behaviors; India; Pornography; Sexual enhancement products