Alcohol consumption patterns and sexual risk behavior among female sex workers in two South Indian communities

Abstract

Background HIV transmission in India is primarily heterosexual and there is a concentrated HIV epidemic among female sex workers (FSWs). Earlier reports demonstrate that many FSWs consume alcohol regularly before sexual encounters. This qualitative study is part of a larger quantitative study designed to assess alcohol consumption patterns among female sex workers and their association with sexual risk taking. Here we investigate the environmental influence, reasons for and consequences of consuming alcohol in the FSW population. Methods Trained staff from two Non-Governmental Organizations in Andhra Pradesh and Kerala conducted semi-structured interviews with 63 FSWs in Chirala, Andhra Pradesh (n=35) and Calicut, Kerala (n=28) following extensive formative research, including social mapping and key informant interviews, to assess drinking patterns and sexual risk behaviors. Results FSWs reported consuming alcohol in multiple contexts: sexual, social, mental health and self-medication. Alcohol consumption during sexual encounters with clients was usually forced, but some women drank voluntarily. Social drinking took place in public locations such as bars and in private locations including deserted buildings, roads and inside autorickshaws (motorcycle taxis). Consequences of alcohol consumption included failure to use condoms and to collect payments from clients, violence, legal problems, gastrointestinal side effects, economic loss and interference with family responsibilities. Conclusion FSWs consume alcohol in multilevel contexts. Alcohol consumption during transactional sex is often forced and can lead to failure to use condoms. Social drinkers consume alcohol with other trusted FSWs for entertainment and to help cope with psychosocial stressors. There are multiple reasons for and consequences of alcohol consumption in this population and future interventions should target each specific aspect of alcohol use.

Mobile phones and sex work in South India: the emerging role of mobile phones in condom use by female sex workers in two Indian states

“…The quantitative survey reported in this paper applied a cross-sectional design and was conducted among 1,139 female sex workers in Chirala, Andhra Pradesh (n=589) and Calicut, Kerala (n=550) in South India during 2009 and 2010. Detailed descriptions of the study sites and the original research study can be found elsewhere (Rodriguez et al 2010; Heravian et al 2012). …”

Understanding the Factors Associated with Alcohol Use among Female Sex Workers in a High HIV Prevalence Northeast State of India

“…Findings also indicates that alcohols using female sex workers are extremely less likely to use a condom most of the time; irrespective of the type of sexual partner. These findings suggest that alcohol using female sex workers need to be targeted by the prevention programs with better exigency to make the HIV and STI prevention programs more successful [24][25][26].…”

“…Alcohol consumption may contribute to sexual risk taking and ultimately the spread of HIV [6][7][8]. Studies from other countries document associations between alcohol use and high-risk heterosexual behaviours among those with and without HIV infection [9]. In India HIV transmission is primarily heterosexual and there is a concentrated HIV epidemic among female sex workers (FSWs) [10].…”

“…In several studies, it was made evident that many FSWs consume alcohol regularly before sexual encounters. In India, only a minority of the population drinks any alcohol (i.e., 2% of women and 32% of men), although it is becoming more common [9,10]. A national survey, however, suggests that FSWs and their male clients are more likely than other groups in India to drink.…”

Contextual influence on condom use in commercial sex venues: A multi-level analysis among female sex workers and gatekeepers in Guangxi, China

“…Many studies have reported alcohol use as a risk factor for inconsistent condom use (Heravian et al, 2012; Li, Li, & Stanton, 2010). This study also provides evidence to support similar findings.…”