The Association between Noncommercial Partnerships and Risk of HIV among Female Sex Workers: Evidences from a Cross-Sectional Behavioral and Biological Survey in Southern India
This paper examines the association between female sex workers' (FSWs) noncommercial partnerships with risk of HIV in Andhra Pradesh, India. Data were drawn from a cross-sectional behavioral and biological survey conducted in 2009 among 3225 FSWs from Andhra Pradesh. Participants were asked about their sexual partnerships, condom use, and vulnerability factors and tested for HIV and sexually transmitted infections. The key independent variables considered were presence of a noncommercial sexual partner (no, yes) and the nature of such partnerships (regular, nonregular). FSWs who reported husband as noncommercial partner were considered to have a regular partner, while the rest were defined as having nonregular partners. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated to measure the associations between variables of interest. Almost three-fourths (74.8%) of FSWs reported having noncommercial partners (regular: 55.6%; nonregular: 19.3%). FSWs in nonregular partnerships were more likely to be HIV positive (13.1% versus 10.9%, adjusted OR: 1.4, 95% CI: 1.1–1.8), have syphilis (10.3% versus 4.2%, adjusted OR: 2.3, 95% CI: 1.6–3.3), use condoms inconsistently with occasional clients (21.0% versus 16.5%, adjusted OR: 1.5, 95% CI: 1.2–1.9), and report forced sex (25.1% versus 14.1%, adjusted OR: 1.9, 95% CI: 1.5–2.4) as compared to those in regular partnerships. HIV prevention programs need to emphasize safe sex behaviors, particularly among FSWs who have nonregular partners. 1. Introduction Currently, there are about 2.4 million people living with HIV in India [1]. The HIV epidemic in the country is predominantly heterosexual and is assumed to be fuelled mainly through unprotected sex with female sex workers (FSWs) [2]. Although the country has witnessed a declining trend in the adult HIV prevalence rate, the HIV prevalence is substantially high among most at risk groups such as FSWs [1]. Indeed, HIV prevalence among FSWs in the country is about 15 times higher than in the low-risk general population [3, 4]. Hence, HIV prevention programs in India continue to focus on the prevention of new HIV infections among FSWs and their sexual partners by promoting consistent condom use and treatment of sexually transmitted infections (STIs) in these groups [5]. While programmatic efforts across the country are believed to have resulted in higher levels of consistent condom use among FSWs with commercial sex partners [6–8], the consistent condom use practice remains at a much lower level with noncommercial partners such as husbands, boyfriends,
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