Global literature on female sex workers suggests that being in an intimate relationship is associated with barriers to practising safe sex behaviours. Condom use within intimate relationships is often seen as a sign of infidelity and fosters mistrust which could affect longevity, trust and intimacy within partnerships. Using qualitative data from Devadasi sex workers and their intimate male partners in Bagalkot District, Karnataka, India, we examined both partners' perspectives to understand the quality and dynamics of these relationships and the factors that influence condom use in intimate relationships. Our thematic analysis of individual interviews conducted in May 2011 with 20 couples suggests that many Devadasi sex workers and their intimate partners define their relationships as 'like marriage' which reduced their motivation to use condoms. Evidence from this study suggests that active participation in sex workers' collectives (sanghas) can increase condom use, education and family planning services, among other things, and could be helpful for both Devadasis and their intimate partners to better understand and accept safer sexual practices. Our work has direct implications for designing couple-based health interventions for traditional Devadasi sex workers and their intimate partners in India.

The patrons and the workers in the hospitality sector continue to be exposed to secondhand smoke despite the enactment of COTPA, which bans smoking in public places. This situation demands stringent measures for effective implementation of the Smoke Free Act and negative response to smoking among civil society.

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This paper presents a methodology for estimating the burden of diseases in monetary terms instead of a demographic indicator. The purpose was to ascertain the financial burden arising out of various categories of morbidity in the community. The disease-wise burden would act as a pointer for the policy maker to assign priority while allocating resources to different programmes within the health sector budget. The empirical study was carried out by CMDR, Dharwad under the sponsorship of IDRC, Canada, in four selected districts, viz. Belgaum, Bijapur, Dharwad and Dakshina Kannada of Karnataka with a sample size of 2039 households and 1156 patients. High share of unavoidable components of direct costs, viz. expenditure on medicines and doctors’ fees, makes morbidity all the more burdensome particularly for the poor people. Such results highlight the need for a specific policy about drug prices, charges for doctors’ services, discriminating pricing, etc. The study highlights that the nature of interventions about different permutations and combinations of preventive, promotive and curative care, or about the institutions of health care delivery (liberal, private, public, mix, on payment or free, etc), have to be consistent with the resource costs, incidence pattern of morbidity, socio-economic background of the morbid population and such other factors. Exercises of ranking of diseases according to total resource costs would aid adoption of an “eclectic cost-effectiveness approach”. Though the precision of the estimates from any empirical study may not be beyond dispute, the issues raised and new directions in thinking suggested, from the empirical study, deserve a serious consideration. The modest attempts made in this study to estimate resource costs should also be considered in that spirit, as issues of policy relevance in the health sector are raised from the present exercise.

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