Trends in condom use among female sex workers in Andhra Pradesh, India: the impact of a community mobilisation intervention

Abstract

BackgroundCommunity mobilisation interventions for HIV prevention among female sex workers (FSWs) aim to organise FSWs for collective action and challenge the structures of power that underlie HIV risk. Assessing intervention impact is challenging because the importance of direct individual exposure to intervention components may decrease over time as change occurs at social-normative, policy and other structural levels. In this paper, the authors examine changes over time in consistent condom use among FSWs in Rajahmundry, Andhra Pradesh, the location of a long-standing community mobilisation intervention.MethodsThe authors analyse cross-sectional data collected among FSWs at three time points (n=2276) using respondent-driven sampling. Multiple logistic regression was used to assess the association of programme exposure with consistent condom use and whether this association varied over time.ResultsThe proportion of FSWs having no exposure or only receptive exposure to the intervention decreased over time, while active utilisation increased from 19.4% in 2006 to 48.5% in 2009–2010. Consistent condom use with clients also increased from 56.3% in 2006 to 75.3% in 2009–2010. Multivariate analysis showed that age, age at start of sex work, venue, living conditions and programme exposure were significantly associated with condom use. The positive association between programme exposure and consistent condom use did not vary significantly over time.ConclusionsFindings indicate improvements in HIV risk reduction behaviour among FSWs and suggest that the intervention has substantial reach in the FSW population. The intervention's strategies may be contributing to population-level HIV risk reduction among FSWs.

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

“…The available data for sex worker organisation is largely restricted to India, 25, 39, 40, 41, 42, 43 where substantial resource investments have been made in community empowerment efforts among sex workers as part of broader HIV prevention efforts. Aside from a few reports from China, 32 Kenya, 44 and Latin America, 45, 46 gaps in data for community empowerment up to now can be attributed in large part to scarcity of resources to assess grassroots sex worker efforts and macrostructural constraints of criminalisation and stigma that restrict the ability of FSWs to organise.…”

“…Physical features of the work environment (eg, venue characteristics or typology) are very context-specific and heterogeneous in structuring of HIV risk patterning in FSWs 23, 24, 34, 37, 41, 55, 57, 63, 67, 68, 69, 70, 71, 72, 73, 74, 75. Few investigators have examined the nuanced and intersecting influence of policy, social, and physical features of the work environment in the mitigation or conferment of HIV risk among FSWs.…”

“…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.…”

Social participation and drug use in a cohort of Brazilian sex workers

“…Beginning with the pioneering community-based Sonagachi project in India, a number of structural interventions that focus on community mobilisation and social inclusion have been implemented among sex workers 1 13. These interventions have reduced STI or HIV infections,2 4 14 increased condom use with clients2–4 15 16 and increased community development indicators 2 17. One component of community development that may be particularly important to reduce marginalisation is increasing capacity to interact beyond the immediate social group, defined in the social capital literature as extracommunity ties/linkages or bridging social capital and termed here social participation 18 19.…”

Community mobilisation for HIV prevention in India: What difference does it make?

“…This should contribute to increasing the programme coverage and enhancing its quality. Finally sex workers who were exposed to the intervention, reported an increase in consistent condom use and this will hopefully contribute to reduced HIV risk 12 13…”