AIDSWEEKLY Plus; Monday, November 21 +- , 2005
Staff Medical Writers

According to recent research from India, "Heterosexual contact is the most common mode of HIV transmission in India that is largely linked to sex work. We assessed the nonuse of condoms in sex work and with regular sex partners by female sex workers (FSWs), and identified its associations that could assist in planning HIV prevention programs.

"Detailed documentation of various aspects of sex work, and sexual behavior with regular sex partners, was done through confidential interviews for 6648 FSWs in 13 districts in the Indian state of Andhra Pradesh."

"Multivariate analysis was done to understand condom nonuse with clients. 5010 (75.4%), 1499 (22.5%), and 139 (2.1%) FSWs were street-, home-, and brothel-based, respectively.

"Of the total 6648 FSWs, 6165 (92.7%) had penetrative vaginal/anal sex with at least one client in the last 15 days, and of these 2907 (47.2%; 95% CI 41.2-53.2%) reported nonuse of condom with at least one of her last three clients," wrote R. Dandona and colleagues at the Administration Staff College of India in Andhra Pradesh.

"Lack of knowledge that HIV could be prevented (odds ratio 5.01; 95% CI 4.38-5.73), no access to free condoms (odds ratio 3.45; 95% CI 2.99-3.98), being street-based as compared with brothel-based (odds ratio 3.36; 95% CI 1.87-6.04), and no participation in FSW support groups (odds ratio 2.02; 95% CI 1.50-2.70) were the most significant predictors of condom nonuse with clients.

"Other associations included lower social support, lower income, age >24 years, illiteracy, and living in medium-size urban or rural areas. Of the 2582 who had penetrative sex with regular sex partner within the last 7 days," the authors continued, "2428 (94%; 95% CI 92.1-95.9%) had not used condom at last sex, and 1032 (41.8%) had neither used condom consistently with clients nor with regular sex partner."

"About half the FSWs do not use condom consistently with their clients in this Indian state putting them at high risk of HIV infection. Nonbrothel-based FSWs, who form the majority of sex workers in India, were at a significantly higher risk of HIV infection as compared with brothel-based FSWs," said researchers.

"With their high vulnerability," Dandona concluded, "the success of expansion of HIV prevention efforts will depend on achieving and sustaining an environment that enables HIV prevention with the nonbrothel based FSWs."

Dandona and colleagues published their study in BMC Public Health (High risk of HIV in nonbrothel based female sex workers in India. BMC Public Health. 2005 Aug 20;5:87.

For additional information, contact R. Dandona, Administration Staff College India, Center Human Development, Health Studies Area, Hyderabad, Andhra Pradesh, India.

Publisher contact information for the journal BMC Public Health is: Biomedical Central Ltd., Middlesex House, 34-42 Cleveland St., London W1T 4LB, England.

Keywords: Andhra Pradesh, India, HIV Transmission, Female Sex Workers, Condom Use, HIV Prevention.

This article was prepared by AIDS Weekly editors from staff and other reports.

Reference

Dandona R, Dandona L, Gutierrez JP, et al., "High risk of HIV in non-brothel based female sex workers in India", BMC Public Health. 2005 Aug 20;5:87.

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