The Context of Economic Insecurity and its Relation to Violence and Risk Factors for HIV among Female Sex Workers in Andhra Pradesh, India

Abstract

SYNOPSISObjective. We examined the context of economic insecurity and debt among female sex workers (FSWs), how this context varies among FSWs, and its association with experiences of violence and sexual risk factors for human immunodeficiency virus (HIV).Methods. We recruited FSWs aged $18 years (n5673) through respondentdriven sampling for a survey on HIV risk in this region. Using logistic regression models (adjusted for partner status, education, financial support, and literacy), we assessed the relation between debt and sexual and physical victimization as well as sexual risk. We also conducted qualitative interviews with a subsample of the survey participants and examined these for related themes.Results. In adjusted logistic regression models, FSWs who reported debt were more likely to report the following: recent physical violence (adjusted odds ratio [AOR] 5 2.4, 95% confidence interval [CI] 1.5, 3.9), unprotected sex with occasional clients in the past week (AOR52.3, 95% CI 1.2, 4.3), anal sex with clients in the past 30 days (AOR52.0, 95% CI 1.1, 3.9), and at least one sexually transmitted infection symptom in the past six months (AOR51.6, 95% CI 1.1, 2.4). FSWs with debt were more likely to report current husbands or other male partners, and less likely to report condom use with these partners, further increasing their sexual risk. Qualitative data elaborated on these findings. Conclusion. Findings indicate the violence-and HIV-related vulnerability ofFSWs who report debt and further highlight how male partners may contribute to the debt and economic insecurity of FSWs.

Predictors of Injection Cessation and Relapse among Female Sex Workers who Inject Drugs in Two Mexican-US Border Cities

“…Research shows that socioeconomic conditions often underlie entry into sex work and that economic vulnerability can increase HIV-related risks by reducing women's negotiating power with clients and increasing unprotected sex in exchange for more money. 34,35 FSW-PWID who earn less income may be more vulnerable overall and deeply entrenched in drug use. Although having a pimp or manager can also exacerbate economic vulnerabilities, previous research with primarily streetbased female sex workers in Tijuana found that only 2.7 % reported having a Bpimp^3 and that these women report maintaining autonomy from men in their work, 36 so we do not think that this is a major factor driving this relationship.…”

Global epidemiology of HIV among female sex workers: influence of structural determinants

“…The authors of these studies examined how supportive venue-based policies 30, 32, 76, 77, 78, 79, 80, 81 or managerial practices (eg, client sign-in, safety mechanisms, or removal of violent clients) 48, 69, 76, 77, 80, 81, 82, 83, 84, 85 and physical features (eg, types or layout of venues) of sex work establishments are associated with increased condom use, often through synergistic effects with other social features of increased peer or sex worker support 32, 52, 53, 69, 72, 76, 79, 81, 83, 85, 86, 87, 88, 89, 90. Work environments for FSWs are shaped by economic features (eg, economic pressures, client financial incentives for non-condom use, refusal of payment, and bribes or fines by state agents [eg, police] to avoid arrest) resulting from macrostructural forces of poverty, laws, and access to resources and are associated with non-condom use27, 28, 29, 30, 40, 41, 48, 64, 70, 83, 84, 87, 91, 92, 93 and HIV infection among FSWs. 36, 65, 75, 94 Conversely, higher income and absence of economic dependence among FSWs mitigate HIV risks, including increased condom use 40, 48, 80, 86, 87 and lower HIV prevalence.…”

Community advocacy groups as a means to address the social environment of female sex workers: a case study in Andhra Pradesh, India

“…14 FSWs from the state experience substantially high rates of physical and sexual violence, which is positively correlated with economic insecurity. 10 Another study has concluded that unstable housing among FSWs is linked to experience of sexual and physical violence and their risky sexual behaviours. 12 Recognising the importance of such structural barriers, researchers have argued that HIV prevention programmes must go beyond the peer-led intervention approach to address the complex social, cultural, political and economic vulnerabilities faced by marginalised population groups most at risk of acquiring HIV infection.…”