Barcelona 2013
Barcelona 2013
Abstract book - Abstract - 283
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Conference Details
International Committee
Plenary Speakers
Presenting Speakers
Scientific Committee
Abstract #283  -  Sex Workers
  15.4: Sex Workers (Parallel) on Monday @ 14.30-16.00 in Auditorium Chaired by Tonya Thurman,
Angels Jaen

  Presenting Author:   Dr Maria Ekstrand - University of California, United States
  Additional Authors:  Dr Kouassi Auguste Eric Komena,  
Female Sex Workers (FSW) are a marginalized population, vulnerable to HIV, STIs, and Intimate Partner Violence (IPV) from their partners. Their lack of power makes it difficult for them to protect themselves and obtain help from the legal system. We need to better understand the relationship between violence and risk in different FSW subgroups to design sensitive, targeted and effective interventions.
Method / Issue:
We interviewed 589 FSW living in and around Chirala, Andhra Pradesh, a state classified as high HIV prevalence, by the Indian National AIDS Control Organization. The interviewer-administered survey assessed demographic characteristics, place of sex work, HIV-related knowledge, IPV by clients and non-paying partners, alcohol use patterns, perceived gender norms, and sexual risk behaviors. We subsequently conducted 4 FSW focus groups to help elucidate the quantitative results.
Results / Comments:
Among the Chirala FSW, 38% reported unprotected sex with clients in the past month, 41% reported doing sex work in their homes, 38% scored in hazardous range on the AUDIT, 31% stated that they were drunk the last time they consumed alcohol, and 64% reported being abused by clients in the past year. Bivariate analyses showed that consistent condom use rates were significantly lower (all p<0.001) among married than unmarried women (56% vs 68%), among Christians than Hindus (53% vs. 69%), among women performing sex work at home vs elsewhere (44% vs 75%), who were drunk last time vs not (20% vs 81%), among those physically abused by clients vs not (47% vs 90), and those having low gender-equity scores (47% vs 78%). These results held up in multivariate regression analyses, showing that unprotected sex with clients was significantly associated with being married (OR=2.7, 95% CI:1.6-4.6), being Christian (OR=2.1, 95% CI:1.2-3.4), performing sex work from home (OR=2.2, 95% CI:1.3-3.8), having been physically abused by clients in the past year (OR=4.7, 95% CI:2.5-8.6), being drunk last time(OR=8.0, 95% CI:4.7-13.9), having high gender-inequity scores (OR=1.3 95% CI:1.2-1.4) and low gender-equity scores (OR=1.7, 95% CI:1.4-2.3) Subsequent focus group participants reported that they were more isolated and had less peer support when they were alone with clients at home and that violence and threats of violence made it more difficult to insist on condom use. Although some women admitted to drinking to numb negative feelings and shame, most reported that they were forced to drink by their clients and that alcohol use added to the challenge of identifying and escaping from potentially dangerous situations in a timely manner.
These findings demonstrate a need for culturally relevant targeted interventions, designed to meet the needs of this vulnerable group. Women working from home need peer support and community resources to deal with violence. Prevention programs should include strategies to avoid drinking, identify and escape from potentially dangerous situations as well as sensitization programs for the local police. FSW community leaders should be involved in all phases from design to implementation and dissemination to ensure that strategies are relevant and useful.
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