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Consistent Condom Use by Married and Cohabiting Female Sex Workers in India: Investigating Relational Norms with Commercial Versus Intimate Partners

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Abstract

This study examines determinants of consistent condom use (CCU) among married and cohabiting female sex workers (FSW) in India. Although CCU with clients is normative in the study area, most FSW do not consistently use condoms with intimate partners. Multiple logistic regression models indicated that condom use with intimate partners was associated with relationship status, cohabitation, HIV knowledge, STI symptoms, and being offered more money for sex without a condom by clients. Additionally, more days of sex work in the last week, serving as a peer educator, and participating in community mobilization activities were associated with higher odds of CCU across all partner types. Although improving economic security may increase CCU with clients, mobilization to reduce stigma and promote disclosure of sex work to non-cohabiting partners may be necessary to increase CCU overall.

Resumen

Este estudio examina los determinantes del uso constante del condón (CCU) entre las trabajadoras sexuales (FSW) casadas y en cohabitación en la India. Aunque la CCU con los clientes es normativa en el área de estudio, la mayoría de las FSW no usan condones con sus parejas íntimas. Múltiples modelos de regresión logística indicaron que el uso del condón con parejas íntimas se asoció con el estado de la relación, la cohabitación, el conocimiento del VIH, los síntomas de infecciones transmitidas sexualmente (ITS), y que los clientes les ofrecieron más dinero para tener relaciones sexuales sin un condón. Además, más días de trabajo sexual en la última semana, sirviendo como educador inter pares, y participando en actividades de movilización comunitaria se asociaron con mayores probabilidades de CCU en todos los tipos de socios. Aunque la mejoria de la seguridad económica puede aumentar la CCU con los clientes, puede ser necesaria la movilización para reducir el estigma y promover la divulgación del trabajo sexual a parejas que no viven en concubinato para aumentar la CCU en general.

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Acknowledgements

This research was supported by a pilot grant from the UCLA Center for HIV Identification, Prevention, and Treatment Services (CHIPTS, NIMH Grant MH058107) to the anchoring author. A fellowship from the American Institute of Indian Studies also supported the anchoring author. The first author was supported by an institutional training grant at the California Center for Population Research through Award Number T32HD007545 from the National Institute of Child Health and Human Development and a training grant at the Semel Institute for Neuroscience and Human Behavior through Award Number T32MH109205 from the National Institute of Mental Health. Additional support was provided by NIH Grants 5P30AI028697, UL1TR000124, and R21AI094666. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other funders. We are grateful to the sex workers who participated in this study and the Durbar evaluation team who implemented the study. We also acknowledge the University of California Global Health Institute’s Center of Expertise in Women’s Health, Gender, and Empowerment for supporting the intellectual environment related to this work.

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Authors and Affiliations

  1. Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA

    Anne E. Fehrenbacher & Dallas Swendeman

  2. Public Health Foundation of India (PHFI), Sector-44, Plot No-47, Gurgaon, 122003, India

    Debasish Chowdhury

  3. Sonagachi Research & Training Institute, Durbar Mahila Samanwaya Committee, 12/5 Nilmoni Mitra Street, Kolkata, West Bengal, India

    Smarajit Jana & Protim Ray

  4. Durbar Mahila Samanwaya Committee, 12/5 Nilmoni Mitra Street, Kolkata, West Bengal, India

    Bharati Dey

  5. School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Caster D17, Philadelphia, PA, 19104, USA

    Toorjo Ghose

  6. University of California Global Health Institute’s Center of Expertise in Women’s Health, Gender, and Empowerment, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA

    Dallas Swendeman

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  1. Anne E. Fehrenbacher
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Corresponding author

Correspondence to Dallas Swendeman.

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All authors declare no conflict of interest.

Ethical Approval

All procedures performed involving human participants were in accordance with the ethical standards of the Institutional Review Boards of the University of California, Los Angeles and the Durbar Ethical Review Board in West Bengal, India.

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Informed consent was obtained from all individual participants included in the study.

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Fehrenbacher, A.E., Chowdhury, D., Jana, S. et al. Consistent Condom Use by Married and Cohabiting Female Sex Workers in India: Investigating Relational Norms with Commercial Versus Intimate Partners. AIDS Behav 22, 4034–4047 (2018). https://doi.org/10.1007/s10461-018-2219-x

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