Transactional sex risk and STI among HIV-infected female sex workers and HIV-infected male clients of FSWs in India

Abstract

To describe sex risk behaviors of HIV-infected female sex workers (FSWs) and HIV-infected male clients of FSWs, to evaluate associations between risky transactional sex and number of unprotected transactional sex episodes, and to assess the association between unprotected transactional sex and self-reported sexually transmitted infection (STI). Adult HIV-infected FSWs (n=211) and HIV-infected male clients (n=205) were surveyed in Mumbai about demographics, STI, and past 90-day and past year sex and substance use histories. Gender-stratified Poisson regression models were used to evaluate associations between four risky transactional sex behaviors (number of transactional sex partners; alcohol use before transactional sex; anal transactional sex; and transactional sex with a known HIV-infected partner) and number of unprotected transactional sex episodes; logistic regression was used to assess the association between unprotected transactional sex and self-reported STI. Twenty-nine percent of females and 7% of males reported any unprotected transactional sex episodes in the past 90 days. Thirty-nine percent of females and 12% of males reported past year STI. Among males, a greater number of transactional sex partners was associated with more unprotected transactional sex episodes (adjusted incidence rate ratio [IRR] = ;8.2, 95% confidence interval [CI] ;= ;1.8–38.4 highest vs. lowest tertile), and any unprotected transactional sex was associated with a higher odds of self-reported STI in the past year (adjusted odds ratio [AOR] ;= ;5.6, 95% CI ;= ;1.4–22.4). For women, risky transactional sex behaviors were not associated with condom non-use, and unprotected sex was negatively associated with STI (AOR ;= ;0.4, 95% CI ;= ;0.2–0.9). Reports of condom use during transactional sex were high for these samples. However, standard predictors of unprotected transactional sex (i.e., greater number of partners) and STI (i.e., unprotected sex) only held true for males. Further research is needed to guide an understanding of sex risk and STI among HIV-infected FSWs in India.

Keywords:

• female sex workers
• male clients of female sex workers
• HIV-infected
• sex risk
• India

Acknowledgements

Funded by the National Institute on Alcohol Abuse and Alcoholism (R01AA016059-S1 and K24AA015674) and the Indian Council of Medical Research. We thank Ms. Shabana Patel from the NMP+ for her oversight of study implementation in terms of helping ensure safe, confidential, and respectful treatment of our HIV-infected participants. We also thank the members of our partnering community based organizations in Mumbai for their assistance in implementing this study in the field. From the NPM+ in Mumbai, this includes Ms. Bharti Sonawane, Ms. Aruna Bhere, Ms. Sunita, Mr. Anil Dalvi, and Mr. Hement Pawar. From ASHA Mahila Sanshta, this includes Ms. Mailee Tamang, Ms. Rupa, and Mr. Santosh Patankar. Finally, we are immensely grateful to the participants of this study who gave their time and shared their personal information and experiences in relationships and sex encounters.