title: Consistent Condom Use by Female Sex Workers in Kolkata, India: Testing Theories of Economic Insecurity, Behavior Change, Life Course Vulnerability and Empowerment.
abstract: Consistent condom use (CCU) is the primary HIV/STI prevention option available to sex workers globally but may be undermined by economic insecurity, life-course vulnerabilities, behavioral factors, disempowerment, or lack of effective interventions. This study examines predictors of CCU in a random household survey of brothel-based female sex workers (n = 200) in two neighborhoods served by Durbar (the Sonagachi Project) in Kolkata, India. Multivariate logistic regression analyses indicated that CCU was significantly associated with perceived HIV risk, community mobilization participation, working more days in sex work, and higher proportion of occasional clients to regular clients. Exploratory analyses stratifying by economic insecurity indicators (i.e., debt, savings, income, housing security) indicate that perceived HIV risk and community mobilization were only associated with CCU for economically secure FSW. Interventions with FSW must prioritize economic security and access to social protections as economic insecurity may undermine the efficacy of more direct condom use intervention strategies.
authors.affiliation: Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Drive South, Los Angeles, CA, 90095, USA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Fehrenbacher
authors.affiliation: Public Health Foundation of India (PHFI), Sector-44, Plot No-47, Gurgaon, 122003, India.
authors.forename: Debasish
authors.initials: D
authors.lastname: Chowdhury
authors.affiliation: School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Caster D17, Philadelphia, 19104, USA.
authors.forename: Toorjo
authors.initials: T
authors.lastname: Ghose
authors.affiliation: Center for HIV Identification, Prevention and Treatment Services (CHIPTS), Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA. dswendeman@mednet.ucla.edu.|Department of Epidemiology, Fielding School of Public Health, 10920 Wilshire Blvd., Suite 350, Los Angeles, 90024, USA. dswendeman@mednet.ucla.edu.
authors.forename: Dallas
authors.initials: D
authors.lastname: Swendeman
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007194:India; D008297:Male; D011209:Power, Psychological; D011322:Primary Prevention; D040242:Risk Reduction Behavior; D021841:Safe Sex / Q000706:statistics & numerical data; D011477:Sex Work / Q000208:ethnology / Q000523:psychology*; D060386:Sex Workers / Q000706:statistics & numerical data*; D035862:Vulnerable Populations; D055815:Young Adult
keywords: Community mobilization; Economic insecurity; Empowerment; Sex work; Structural interventions