Correlates and Trend of HIV Prevalence Among Female Sex Workers Attending Sexually Transmitted Disease Clinics in Pune, India (1993-2002)

Abstract

In India, substantial efforts have been made to increase awareness about HIV/AIDS among female sex workers (FSWs). We assessed the impact of awareness regarding safe sex in a cohort of FSWs by studying trends in HIV prevalence, sexually transmitted diseases (STDs), and risk behaviors measured from 1993 to 2002 in Pune, India. A total of 1359 FSWs attending 3 STD clinics were screened for HIV infection, and data on demographics, sexual behaviors, and past and current STDs were obtained. The overall HIV prevalence among FSWs was 54%. Not being married (adjusted odds ratio [AOR] = 1.74, 95% confidence interval [CI]: 1.17 to 2.59), being widowed (AOR = 2.10, 95% CI: 1.16 to 3.80), inconsistent condom use (AOR = 1.60, 95% CI: 1.02 to 2.50), clinical presence of genital ulcer disease (GUD; AOR = 1.66, 95% CI: 1.07 to 2.56), and genital warts (AOR = 4.70, 95% CI: 1.57 to 14.08) were independently associated with HIV infection among FSWs. The prevalence of HIV remained stable over 10 years (46% in 1993 and 50% in 2002; P = 0.80). The prevalence of GUD decreased over time (P < 0.001), whereas that of observed genital discharge remained stable. Reported consistent condom use as well as the proportion of FSWs who refused sexual contact without condoms increased over time (P < 0.001). These data collectively suggest that safe sex interventions have had a positive impact on FSWs in Pune, India.

Trends in risk behaviors among female sex workers in south India: Priorities for sustaining the reversal of HIV epidemic

“…These surveys also found that FSWs who used condom at last sex with one-time clients had significantly less risk for reported STI symptoms. However, few Indian studies have failed to detect such associations (Brahme et al, 2006;Desai et al, 2003). Nevertheless, the present study observed a lower level of condom use among regular partners which also indicated a negative trend over the years.…”

“…Low condom use among these marginalized and illiterate FSWs might lead to increased HIV infections among them. Few other studies also reported a higher HIV prevalence among widowed, separated, and divorced (Brahme et al, 2006;Ramesh et al, 2008). Similarly, a strong association was found between low level of literacy and HIV infection (Mehendale et al, 1996).…”

The impact of out-migrants and out-migration on the HIV/AIDS epidemic: a case study from south-west India

“…The HIV epidemic in India displays significant heterogeneity with respect to geographical location and risk behaviour, with female sex workers (FSW), their male clients, men who have sex with men and injection drug users being at highest risk [1][2][3][4][5][6][7]. The south-west Indian state of Karnataka is considered one of the most severely affected [1,2,8], with heterosexual transmission thought to be the main infection route [3].…”

Health risks among female sex workers of Agra, India: Implications for HIV/AIDS/STDs prevention

“…Several authors have reported that in India, maximum number of FSWs is based in the metropolitan cities like Delhi, Mumbai, Chennai, Kolkata, Bangalore and Hyderabad. There is a great variation of sexual practices and HIV risks among FSWs across different work settings in the different regions of the country [5][6][7][8][9]. Our study revealed that the reasons for being in the profession appeared to be widespread poverty, economic distress, helplessness, low level of education, lack of alternative income generation possibilities, ignorance, social customs and acceptance of prostitution alongwith gender discrimination which created pressures, which in turn, drove these women into prostitution.…”