High-risk sex among mobile female sex workers in the context of jatras (religious festivals) in Karnataka, India

Jatras (religious festivals) represent venues for female sex workers (FSWs) to meet potential clients in an environment of anonymity. Data from a survey conducted among 1499 mobile FSWs in Karnataka, India were analysed using bivariate and multivariate analysis. Overall, 31% of mobile FSWs reported attending jatras in the previous year. Women who sold sex at jatras tended to practice sex work in public places, in their own homes or on highways. Jatra attendees reported lower condom use with their last commercial sexual partners at their usual places of sex work. Jatra-related mobility was a significant predictor of non-condom use at their usual place of residence, after controlling for sociodemographic, sex work-related, HIV vulnerability and programme exposure variables. Moreover, only 13% of FSWs used condoms consistently at jatras. Condom availability and accessibility at jatras should be a priority for HIV prevention programmes, and such programmes should make efforts to introduce outreach activities at jatras.     

The role of collectives in STI and HIV/AIDS prevention among female sex workers in Karnataka, India

This paper evaluates the role of female sex worker (FSW) collectives in the state of Karnataka, India, regarding their facilitating effect in increasing knowledge and promoting change towards safer sexual behaviour. In 2002 a state-wide survey of FSWs was administered to a stratified sample of 1,512 women. Following the survey, a collectivization index was developed to measure the degree of involvement of FSWs in collective-related activities. The results indicate that a higher degree of collectivization was associated with increased knowledge and higher reported condom use. Reported condom use was higher with commercial clients than with regular partners or husbands among all women and a gradient was observed in most outcome variables between women with low, medium and high collectivization index scores. Collectivization seems to have a positive impact in increasing knowledge and in empowering FSWs in Karnataka to adopt safer sex practices, particularly with commercial clients. While these results are encouraging, they may be confounded by social desirability, selection and other biases. More longitudinal and qualitative studies are required to better understand the nature of sex worker collectives and the benefits that they can provide.     

HIV testing among female sex workers in Andhra Pradesh, India

Of 6648 female sex workers (FSW) in 13 districts of Andhra Pradesh state in India, only 7.9% reported having undergone HIV testing, and three-quarters of the rest were unwilling to undergo HIV testing in the future. The risk of HIV infection as a result of the non-use of condoms was higher among FSW who reported not having been tested and were also unwilling to get tested, and they also held significantly more negative beliefs about HIV/AIDS.     

Measuring perceived stigma in female sex workers in Chennai, India

Although sex work is highly stigmatized throughout the world, a limited body of research has examined stigma among female sex workers (FSWs). We developed a Sex Worker Stigma (SWS) Index to measure perceived stigma among 150 FSWs in Chennai, India. These women were at a median age of 35 years and reported, on average, having engaged in sex work for nine out of the previous 12 months. The two-factor structure of the index was verified in both exploratory and confirmatory factor analyses with acceptable goodness of fit. The final 10-item index comprises of two domains of perceived stigma from the community and perceived stigma from one's family. Cronbach's α coefficients were 0.87 and 0.88 for each domain, respectively. In regression analysis, we found that income from jobs other than sex work was correlated with decreased levels of perceived stigma from both the community (β = - 0.16; 95% CI: -0.30 and -0.02) and the family (β = - 0.24; 95% CI: -0.40 and -0.07); prior experience of accessing health care system increased perceived stigma from the community while heavier financial responsibility for the family was associated with lower perceived stigma from women's family. With the proposed SWS Index, we have a valid and reliable metric to document and track levels of perceived stigma among FSWs to assess the impact of stigma reduction interventions.     

Transactional sex risk and STI among HIV-infected female sex workers and HIV-infected male clients of FSWs in India

To describe sex risk behaviors of HIV-infected female sex workers (FSWs) and HIV-infected male clients of FSWs, to evaluate associations between risky transactional sex and number of unprotected transactional sex episodes, and to assess the association between unprotected transactional sex and self-reported sexually transmitted infection (STI). Adult HIV-infected FSWs (n = 211) and HIV-infected male clients (n = 205) were surveyed in Mumbai about demographics, STI, and past 90-day and past year sex and substance use histories. Gender-stratified Poisson regression models were used to evaluate associations between four risky transactional sex behaviors (number of transactional sex partners; alcohol use before transactional sex; anal transactional sex; and transactional sex with a known HIV-infected partner) and number of unprotected transactional sex episodes; logistic regression was used to assess the association between unprotected transactional sex and self-reported STI. Twenty-nine percent of females and 7% of males reported any unprotected transactional sex episodes in the past 90 days. Thirty-nine percent of females and 12% of males reported past year STI. Among males, a greater number of transactional sex partners was associated with more unprotected transactional sex episodes (adjusted incidence rate ratio [IRR] = 8.2, 95% confidence interval [CI] = 1.8-38.4 highest vs. lowest tertile), and any unprotected transactional sex was associated with a higher odds of self-reported STI in the past year (adjusted odds ratio [AOR] = 5.6, 95% CI = 1.4-22.4). For women, risky transactional sex behaviors were not associated with condom non-use, and unprotected sex was negatively associated with STI (AOR = 0.4, 95% CI = 0.2-0.9). Reports of condom use during transactional sex were high for these samples. However, standard predictors of unprotected transactional sex (i.e., greater number of partners) and STI (i.e., unprotected sex) only held true for males. Further research is needed to guide an understanding of sex risk and STI among HIV-infected FSWs in India.     

Commercial sex venues, syphilis and methamphetamine use among female sex workers

The objective of this study was to assess the factors associated with methamphetamine (MA) use, syphilis, and unprotected sex among female sex workers from different type of venues in Qingdao City, Shandong Province of China. Three consecutive cross-sectional surveys provided information on demographics, sexual and drug use behaviors, and HIV-related services. Of 1187 participants, 3.0% were infected with syphilis; 30.2% ever used MA; 58.3% ever had unprotected commercial sex in the past month. The prevalence rates of syphilis and MA use were 2.5% and 33.0% for participants recruited from saunas, night clubs, bars or hotels; 2.7% and 28.3% for hair/beauty salon-based participants; and 4.5% and 15.8% for street-based participants. Street-based MA users were more likely to be single, non-Shandong residents, have first lifetime sex act at younger age, and recruited in 2008 (vs. 2006). Saunas, night clubs, bars, or hotels-based MA users were more likely to be younger, sex debut at younger age, have longer duration of sex work, have unprotected commercial sex, and be syphilis-infected. Hair/beauty salon-based MA users were more likely to be non-Shandong residents, younger, and to have unprotected commercial sex. Syphilis among the sauna-, night club-, bar-, or hotel-based participants was associated with MA use and ever receipt of HIV testing. Syphilis among the hair/beauty salon-based participants was associated with longer duration of sex work. MA users who frequent commercial sex venues are engaging in high-risk behaviors and are at risk for syphilis/other sexually transmitted diseases. Better-targeted intervention efforts to curtail the epidemics of MA use and HIV/syphilis should therefore take cognizance of the role of commercial sex venues as focal points of MA use and syphilis/sexually transmitted disease transmission.     

The prevalence of HIV in female sex workers in Manipur, India

Data on STDs and sexual practices in commercial sex workers (CSWs) is in general limited in India. Manipur in north-east Indian has a high prevalence of HIV in injecting drug users but the rate in CSWs is not known. The site selected for the study was Moreh, on the Myanmar border of Manipur. One hundred blood samples were collected, 7 from migrants from Myanmar, the remainder from Manipuri women. The HIV seropositivity rate was 12% (95% CI = 5.6-18.4). The age of the women ranged from 15 to 42 (mean = 24.5 years, median 23.7 years). The proportion of HIV positives increased significantly with number of customers per day and number of years in the profession. The HIV prevalence among Injecting drug using CSWs was 9.4 times higher that among non-IDU CSWs. Vaginal discharge was strongly associated with HIV positivity. Effective intervention programmes among CSWs in Manipur to prevent further spread of HIV are strongly indicated by the results of this study.     

Social and behavioral determinants of consistent condom use among female commercial sex workers in Ghana.

This study investigated the social and behavioral predictors of consistent condom use among female commercial sex workers (FCSWs) in Ghana. Four hundred fifty street commercial sex workers were interviewed in Accra, Kumasi and Techiman. The level of condom education was very low (14%); however consistent condom use (all the time) with clients was relatively high (49.6%). Two hundred seventy-seven of the participants did not use condoms all the time.     

Determination of gag subtypes of HIV type 1 detected among female sex workers in Calcutta, India

HIV-1 subtyping is important to study the changing scenario of genetic variation. The gag-based heteroduplex mobility assay (gag-HMA) was developed and evaluated as a powerful and reliable technique for identifying the HIV-1 group M subtypes A to H and the circulating recombinant forms (CRFs). To study the subtype distribution of HIV-1 strains from the eastern part of India, we used the gag-based HMA, followed by the sequencing and phylogenetic analysis. Blood samples from HIV-1-seropositive female sex workers in Calcutta were subjected to gag-HMA. The most prevalent subtype was found to be the C type, among which the C4 subsubtype was prevalent. However, a number of nontypable C strains were found in gag-HMA. Phylogenetic analysis revealed the discrete nature of the C strains and no monophyletic cluster was noticed. This result might indicate a growing tendency of variations among the HIV-1 type C strains circulating in eastern India.     

Drug use among female sex workers in Hanoi, Vietnam

AIMS: To describe the drug use practices among female sex workers (FSWs) in Hanoi and to identify factors associated with their drug injecting. DESIGN, SETTING AND PARTICIPANTS: A two-stage cluster survey of 400 FSWs was conducted from June to September, 2002. Participating FSWs were both establishment- (160) and street-based (240), who were practising in seven urban and one suburban districts of Hanoi. MEASUREMENTS: Subjects were interviewed face to face using a structured questionnaire. FINDINGS: Among the middle-class FSWs, 27% used drugs, of whom 79% injected. Among low-class FSWs, 46% used drugs and 85% injected. Among drug-using FSWs, 86% had started using drugs within the past 6 years. Among drug-injecting FSWs, 81% had started injecting within the past 4 years. Cleaning of injecting equipment was not common among those who shared. Having drug-injecting 'love mates', drug-using clients, longer residence in Hanoi, more clients and not currently cohabiting were found to be independently associated with drug injecting among FSWs. CONCLUSIONS: The high prevalence of injecting drug use among FSWs makes them susceptible to HIV infection, and is a threat to their clients. There is a strong relationship between drug-using FSWs and male drug-using clients and non-client partners. Intervention to prevent drug use initiation among non-drug-using FSWs and harm reduction among drug-using FSWs are urgently needed.     

岑溪市暗娼商业性性行为使用安全套情况及影响因素

目的了解岑溪市暗娼人群最近1个月商业性性行为安全套的使用情况及其影响因素。方法用分层随机抽样法,调查收集岑溪市高、中、低档场所暗娼商业性性行为相关信息。用非条件Logistic回归方法分析安全套使用的相关因素。结果共调查400名暗娼,最近1个月商业性性行为安全套坚持使用率为66.8%。经非条件Logistic回归分析发现,暗娼最近1个月的商业性性行为是否坚持使用安全套与娱乐场所档次、婚姻状况、艾滋病知识知晓等因素有关。结论应针对不同档次的娱乐场所,不同婚姻状况和不同艾滋病相关知识知晓程度的暗娼开展行为干预工作,特别是对低档场所、相关知识知晓程度较低的暗娼,要加大干预力度,并大力推广安全套的使用。     

女性性工作者对女用安全套的接受性研究进展

女用安全套（以下简称＂女套＂）是放入妇女阴道、通过屏障作用来避孕和预防性传播疾病的工具。现在世界上女套产品不止一种,但女套接受性研究目前主要针对世界第一个女套产品FC1/2。该文就女性性工作者（FSW）对女套的接受性、影响因素,以及在该人群中开展女套干预的方法进行综述。由于不同研究的干预设计和所选择的接受性指标的差异,文献报告FSW女套接受性结果变化较大。例如,国外研究中,干预后＂调查前1个月,使用女套＂的妇女在40%～76%之间,而国内研究中该比例为4%～15%。有研究报告,女套加入男套的干预可以减少FSW无保护性行为。例如国内研究中,干预12个月后,FSW最近1个月坚持使用安全套的比例增加了2～15个百分点。除了干预因素外,女套产品特点、年龄、性服务场所类型以及性伴态度,是影响FSW女套接受性的主要因素。干预中,女套使用技能训练和练习是改善接受性的重要环节。     

Sexually transmitted infections among female sex workers in Yunnan, China

A cross-sectional prevalence survey of sexually transmitted infections (STIs) was conducted among female sex workers (FSWs) in Kunming, Yunnan Province, China. A total of 505 FSWs participated in the survey. All eligible participants gave informed consent. Demographic, behavioral, and clinical information of the participants was gathered by direct structured interviews. Tampon swabs were collected to test for Chlamydia trachomatis, Nesseria gonorrhoeae, and Trichomonas vaginalis and serum specimens were collected to test for HIV antibody by enzyme-linked immunosorbent assay (ELISA) screening and Western blot confirmation, syphilis with rapid plasma reagin (RPR) and T. pallidum hemagglutination (TPHA) confirmation, and for HSV-2 antibodies with the HerpeSelect 2 ELISA. The most prevalent bacterial STI was Chlamydia trachomatis (58.6%), followed by Trichomonas vaginalis (43.2%) and Neisseria gonorrhoeae (37.8%). Three hundred twenty-seven (65.1%) sex workers had serologic evidence of exposure to HSV-2 infection. Ten percent were positive for HIV infection, all injecting drug users (IDUs); and 9.5% had infection with syphilis. Comprehensive prevention and effective STI services for sex workers and their clients will be the key strategies to the control of STIs, including HIV. Policies and prevention strategies for STI/HIV need to focus on high-risk subpopulations, such as sex workers (particularly sex workers who inject drugs) and their clients.     

Factors associated with HIV among female sex workers in a high HIV prevalent state of India

The study was carried out to assess the factors associated with HIV seropositivity among female sex workers (FSWs) in Dimapur, Nagaland, a high HIV prevalence state of India. A total of 426 FSWs were recruited into the study using respondent driven sampling (RDS). Data on demographic characteristics, sexual and injecting risk behaviours were collected from them and were tested for HIV, Syphilis, Neisseria gonorrhoeae and Chlamydia trachomatis. RDS-weighted univariate and multivariate logistic regression analysis was performed to assess the factors associated with HIV seropositivity. Consistent condom use with regular and occasional sexual clients was 9% and 16.4%, respectively. About 25% of the participants ever used and 5.7% ever injected illicit drugs. RDS adjusted HIV prevalence was 11.6%. In the univariate analysis, factors associated with HIV were initiating sexual intercourse before the age of 15 years, ≥2 years duration of sex work, serving clients at lodge/hotel, positive test result for one or more sexually transmitted infections (STIs), lifetime history of injecting drug use, lifetime history of consuming illicit drugs, ever having exchanged sex for drugs, having sexual partners who engaged in risky injecting practices and having been widowed or divorced. In multivariate analysis, factors found to be independently associated with HIV included lifetime injecting drug use, initiating sexual intercourse before the age of 15 years, positive test result for one or more STIs and having been widowed. Injecting drug use was found to be most potent independent risk factor for HIV (OR: 3.17, CI: 1.02-9.89). Because of lower consistent condom use among them, FSWs may act as bridge for HIV transmission to general population from injecting drug users (IDU) through their sexual clients. The informations from this study may be useful for enriching the HIV preventions effort for FSWs in this region.     

Partner violence and HIV risk among female sex workers in China

Global literature suggests that partner violence contributes to HIV-related vulnerability and risk among women. Female sex workers (FSWs) play a significant role in China’s skyrocketing increase of heterosexual transmission of HIV. The aim of this article is to examine the association between partner violence and HIV risk among FSWs in China. This study, based on a cross-sectional survey of 1,022 FSWs recruited from communities in China, attempted to address the relationship between partner violence and HIV risk among this vulnerable population. About 58% of the FSWs had experienced violence from their stable partners (including 55.5% reporting emotional violence, 20.1% physical violence, and 16.2% sexual violence) and 45% from their clients (including 39.7% reporting emotional violence, 17.1% physical violence, and 16.8% sexual violence). Partner violence perpetuated by either stable partners or clients was strongly associated with most of the HIV risk measures we assessed. This study confirmed the association of partner violence and HIV risk among FSWs. We call for culturally appropriate interventions for both partner violence and HIV risk reduction among FSWs in China.     

Psychological factors associated with protected sex among indirect female sex workers in Denpasar,Bali, Indonesia

ABSTRACT

A cross-sectional study was conducted among indirect FSWs (a type of FSWs who provide sex services under the cover of entertainment or recreational enterprises) in Denpasar, Bali from August to October 2017 to investigate factors associated with protected sex with clients using the Health Belief Model (HBM) framework. The protected sex as a dependent variable was identified through self-reported consistency in using condoms with clients in the last month. Independent variables consisted of six HBM constructs and three main groups of modifying factors (personal, sex work, and interventional factors). Binary logistic regression was employed to identify the determinants. The prevalence of protected sex with clients in last month was 50.17% (95%CI?=?41.50–80.83). Indirect FSWs were more likely to use condoms consistently if they completed senior high school or higher. Meanwhile, those working in a karaoke lounge, bar, or café were less likely to have protected sex than those in a massage parlour, spa, or beauty salon. Based on HBM, an increase of one-score of these following constructs increased likelihood of protected sex: perceived susceptibility, self-efficacy, and cues to action. Low protected sex among indirect FSWs indicates the need for public health interventions at individual, interpersonal, and institutional level.     

中国南方三个乡镇性服务妇女杀微生物剂可接受性研究

目的 分析中国南方3个乡镇性服务妇女对虚拟杀微生物剂的接受性,分析接受性不同的性服务妇女的人口学及性伴关系等特征.方法 采用横断面调查,在3个乡镇的性服务场所,采用配额抽样法招募300名性服务妇女.通过接受性量表测量她们对虚拟杀微生物剂的接受性,用聚类方法分析接受性量表.结果 按接受性量表的聚类分析,将性服务妇女分为3组,即对杀微生物剂不接受组、低接受性组和高接受性组.与其他两组相比,高接受性组妇女的平均年龄较大(27.9±8.2)岁,更多的是由出租屋招募来的、有过婚姻经历(分别占41.7%、57.4%).90.0%的该组妇女的性伴类型里有商业性伴,在过去30天里她们与主要性伴和客人的平均安全套使用率最低(分别为23.7%、71.3%);她们中更多的人使用过一些阴道产品,更可能经常做阴道灌洗.结论 性服务妇女的性伴类型、男用安全套使用率以及既往阴道产品使用经历,都与"杀微生物剂"这类阴道使用产品的接受性有关.     

HIV-related behavioral risk factors among older female sex workers in Guangxi,China

Previous literature suggests a high rate of HIV infections among older female sex workers (FSWs) in China. However, limited data are available regarding HIV- related behavioral risk factors among this population. In the current study, we aim to examine the demographic and behavioral factors that place older FSWs at a high risk of HIV infection. We conducted secondary analysis of the 2010 National Sentinel Surveillance (NSS) data from Guangxi, China. A self-administered, standard behavioral surveillance survey was completed by a total of 12,622 FSWs in Guangxi, China. The Guangxi 2010 NSS sample included 19.4% FSWs aged 35 years or older (“older FSWs”). The overall HIV prevalence was 1.0% for the entire sample with 2.0% among older FSWs and 0.8% among younger ones. Older age was an independent predictor of unprotected sex, injection drug use, and a self-reported history of syphilis infection. Future HIV prevention interventions targeting FSWs should consider older FSWs' vulnerable status. Efforts are needed to address their financial needs and invest in skills for socio-economic empowerment.