The structure of sex work : variability in the numbers and types of sex partners of female sex workers in southern India

• Main Author: Deering, Kathleen Nicole
• Language: English
• Published: University of British Columbia 2011
• Online Access: http://hdl.handle.net/2429/33978

Background and objectives: There is limited knowledge of sexual structure (i.e., the numbers, types and distributions of sex partners and patterns of sexual contact) and its relationship with HIV infection and prevention among female sex workers (FSWs). The objectives of this study were therefore: to examine the social and environmental factors associated with the numbers of clients of FSWs; to characterize heterogeneity in sexual structure and assess how sexual structure influences HIV prevalence; and to examine the impact of an HIV intervention on condom use by different partners (clients, intimate partners), as reported by FSWs. Methods: This study used data collected from FSWs and clients in Karnataka state, southern India as part of the Avahan AIDS Initiative, an ongoing large-scale HIV intervention. Bivariate and multivariable statistical techniques were used to examine the relationships between two outcomes (numbers of clients and condom use) and key social and environmental factors, including exposure to the Avahan intervention. A deterministic compartmental mathematical model was developed to understand how sexual structure influenced HIV prevalence on a population level. Results: Sexual structure displayed substantial geographic variation across districts in Karnataka. The most common predictors of higher rates of clients were a reliance on sex work as sole income, younger age, and being single or cohabiting as compared to married. The effect of the solicitation environment (e.g., brothels, public places, homes) varied by district. Intervention exposure was associated with increased condom use by FSWs’ clients, but not their intimate partners. Mathematical modelling identified sexual structure parameters with the largest influence on increasing (numbers of clients of FSWs; numbers of visits to FSWs by clients; frequency of sex acts with repeat clients) and decreasing (duration of the repeat FSW-client partnership; fraction of repeat clients) HIV prevalence within and across districts. Conclusions: Differences in the sexual structure of FSWs and their commercial clients have important implications for HIV transmission dynamics. In light of findings related to both differences in sexual structure across districts and the impact of an intervention on condom use by different partners of FSWs, HIV prevention planners need to tailor interventions to respond to local contexts.