Fertility intentions, power relations and condom use within intimate and other non-paying partnerships of women in sex work in Bagalkot District, South India

Abstract

This study aimed to: (1) examine the relationship between interpersonal as well as social-demographic, cultural and structural factors, and condom non-use by sex workers' main intimate or other non-paying male sex partners (NPPs), as reported by a sample of sex workers (SWs); and (2) understand HIV/sexually transmitted infections (STIs) risk (e.g., numbers of sexual partners; condom use with different partners) among couples comprised of a sub-set of SWs and their NPPs. Bivariate and multivariable logistic regression was used to identify factors associated with condom non-use at last sex by the main NPP, as reported by SWs. Adjusted odds ratios and 95% confidence intervals are reported (AOR[95%CIs]). Data were drawn from cross-sectional surveys in Bagalkot District, Karnataka State, South India. Responses by SWs whose main NPPs agreed to enrol in the study and the main NPP enroled were linked; these responses by couples (pairs of SWs and NPPs) were examined to assess sexual risk for HIV/STIs. Overall, this study included 257 SWs and 76 NPPs. The data from 67 couples (88.2%) could be linked. In over a quarter of partnerships, at least one (SW or NPP) partner reported having another type of partner besides each other (and clients of SWs). In multivariable analysis, significantly increased odds of condom non-use at last sex with the main NPP were found for the following key factors: planning to have a child with their main NPP (AOR = 3.71[1.44–9.58]); and having decisions about condom use made by their main NPP (AOR = 9.87[4.03–24.16]) or both equally (AOR = 3.18[1.39–7.80]) (versus by the SWs herself). Our study highlights the potential risk for HIV/STI acquisition and transmission between NPPs and SWs, and between NPPs and their non-SWs wives and other sex partners. Study results underscore the need for HIV/STI prevention approaches that incorporate informed decision-making about childbearing and parenting, and empowerment strategies for SWs in the context of their relationships with NPPs.

Keywords:

• Sex workers
• intimate or other non-paying partners
• regular partners
• intimate partners
• non-paying partners
• HIV risk
• condoms

Acknowledgements

KD made key contributions to the conceptual and analytic design of the study and drafted the manuscript. LT, SR, TR, MD, PB and SM made key conceptual contributions and reviewed the manuscript. SS performed statistical analysis and reviewed the manuscript. RL made key contributions to the conceptual and analytic design of the study and takes responsibility for the accuracy of the data. We would like to especially thank the women who participated in our study, as well as the study staff and local partners. We acknowledge the active participation and support of Chaitanya AIDS Tadegatwa Mahila Sangha in designing and conducting this study. We are very encouraged by the fact that the study findings have supported the CBO to design an intervention with non-paying partners in the region. We would also like to acknowledge the research and technical support of Dr James Blanchard. Kathleen Deering is supported by Post-Doctoral Research Fellowships from the Canadian Institutes of Health Research (Bisby Award) and the Michael Smith Foundation for Health Research. This study was supported in part by the by Bill & Melinda Gates Foundation. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Bill & Melinda Gates Foundation.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Funding support for this study came from STRIVE Structural HIV drivers Research Programme Consortium, funded by the Department For International Development, Government of UK, as well as the University of Manitoba.