Relationship between mobility, violence and HIV/STI among female sex workers in Andhra Pradesh, India

Abstract

BackgroundViolence and mobility have been identified as critical factors contributing to the spread of HIV worldwide. This study aimed to assess the independent and combined associations of mobility and violence with sexual risk behaviors and HIV, STI prevalence among female sex workers (FSWs) in India.MethodsData were drawn from a cross-sectional, bio-behavioral survey conducted among 2042 FSWs across five districts of southern India in 2005–06. Regression models were used to estimate odds ratios and 95% confidence intervals (CIs) for sexual risk behaviors and HIV infection based on experience of violence and mobility after adjusting for socio-demographic and sex work related characteristics.ResultsOne-fifth of FSWs (19%) reported experiencing violence; 68% reported travelling outside their current place of residence at least once in the past year and practicing sex work during their visit. Mobile FSWs were more likely to report violence compared to their counterparts (23% vs. 10%, p < 0.001). Approximately 1 in 5 tested positive for HIV. In adjusted models, FSWs reporting both mobility and violence as compared to their counterparts were more likely to be infected with HIV (Adjusted odds ratio (adjusted OR): 2.07, 95% CI: 1.42–3.03) and to report unprotected sex with occasional (adjusted OR: 2.86, 95% CI: 1.76–4.65) and regular clients (adjusted OR: 2.07, 95% CI: 1.40–3.06).ConclusionsThe findings indicate that mobility and violence were independently associated with HIV infection. Notably, the combined effect of mobility and violence posed greater HIV risk than their independent effect. These results point to the need for the provision of an enabling environment and safe spaces for FSWs who are mobile, to augment existing efforts to reduce the spread of HIV/AIDS.

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“…However, gatekeepers activities may sometimes be protective. A qualitative study from two cities in the United Kingdom which compared the violence experienced between women who work on the street and those who work from indoor sex work venues, found that the indoor workers and their management were able to develop and maintain safety and order in the establishment through organization of protection measures 10,11 .…”

“…In Kazakhstan, policemen routinely arrested, beat and forced sex workers to bribe arresting officers with money or sexual services 33 . Police officers were also reported to have gang-raped FSWs during brothels raids, and refused to pay FSWs after patronage 11,13,14 . In Pakistan, a study of male and female sex workers revealed that both groups experienced human rights abuses from relations, clients and the police who all perpetrated verbal, physical and sexual violence to FSWs 13 .…”

“…communities where they work [10][11][12] . They are ostracized, marginalized and they experience discrimination from the society.…”

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