Understanding low levels of condom use between female sex workers and their regular partners: Timing of sexual initiation in relationships as a differentiating factor in Karnataka, South India

ABSTRACT

Evidence shows that low condom use is the norm in relationships between female sex workers (FSWs) and their regular partners. We investigated the timing of sexual initiation in a relationship with a regular partner as a critical factor in determining condom use. Three rounds of Integrated Behavioral and Biological Assessment (IBBA) surveys were used to derive whether regular partner relationships began before or after sex work initiation. Of the 7,015 FSWs surveyed, 33% started an intimate partner relationship before sex work initiation, 27% after beginning sex work, and the remaining 40% did not have a regular partner. Condom use was significantly higher in a FSW’s relationship after sex work initiation (p < 0.01), compared to a relationship with a regular partner before sex work. Programmatically, more efforts and resources are necessary toward promoting condom use among FSWs who have regular partner relationships before their initiation of sex work.

KEYWORDS:

• condom use
• female sex workers
• India
• intimate partner
• Karnataka
• timing of relationship

Acknowledgments

The authors thank the nongovernmental and community-based organizations, and individuals who supported the field survey. We would also like to extend our heartfelt thanks to the FSW community for their participation in this investigation, and Prakash Javalkar and Bidhubhushan Mahapatra for their assistance in field work and data compilation.