Characterizing sexual histories of women before formal sex-work in south India from a cross-sectional survey: implications for HIV/STI prevention

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dc.contributor.authorMishra, Sharmistha
dc.contributor.authorRamanaik, Satyanarayana
dc.contributor.authorBlanchard, James F
dc.contributor.authorHalli, Shiva
dc.contributor.authorMoses, Stephen
dc.contributor.authorRaghavendra, T
dc.contributor.authorBhattacharjee, Parinita
dc.contributor.authorLorway, Rob
dc.contributor.authorBecker, Marissa
dc.date.accessioned2012-12-17T20:08:34Z
dc.date.available2012-12-17T20:08:34Z
dc.date.issued2012-09-28
dc.date.updated2012-12-17T20:08:34Z
dc.description.abstractAbstract Background Interventions designed to prevent HIV and STIs in female sex-workers (FSWs) reach women after they formally enter the sex-trade. We aimed to characterize the pattern of sexual behaviour among FSWs from first-sex to when they identify as sex-workers (transition period) in a region with traditional (historically characterized by dedication into sex-work at first-sex) and non-traditional forms of sex-work. Methods We conducted a cross-sectional survey of 246 traditional and 765 non-traditional FSWs across three districts in Karnataka, India. We performed univariate and multivariate logistic regression to profile FSWs most likely to engage in a commercial first-sex before identifying as a sex-worker. Sexual life-course patterns were distinguished using univariate and multivariate linear regression based on key events associated with length of transition period. Results Overall, 266 FSWs experienced a commercial first-sex, of whom 45.9% (95% CI: 38.2,53.7) continued a long-term relationship with the first partner. In adjusted analysis, traditional FSWs were more likely to experience a commercial first-sex (AOR 52.5, 95% CI: 27.4,100.7). The average transition time was 8.8 years (SD 3.9), but there was considerable variability between respondents. Among women who experienced a commercial first-sex, a slower transition was independently associated with non-traditional sex-work, the presence of long-term partnerships during the transition period, and ongoing partnerships at time of entry into sex-work. In the absence of a commercial first-sex, a faster transition was associated with traditional sex-work and the dissolution of long-term partnerships, while a slower transition was associated with the presence of long-term partnerships and widowhood. Only 18.5% (95% CI: 12.7,26.2) and 47.3% (95% CI: 32.7,62.3) of women reported ‘always’ condom use with their long-term and occasional partners during the transition period, respectively. Conclusions FSWs identify as sex-workers several years after becoming sexually active, even when the first-sex is commercial in nature. Long-term partnerships are common after a commercial first-sex, and are associated with a delay in formally entering the sex-trade. The findings call for a better understanding of HIV/STI risk before FSWs identify as sex-workers, and an adaptive programme to reach this period of vulnerability.
dc.description.versionPeer Reviewed
dc.identifier.citationBMC Public Health. 2012 Sep 28;12(1):829
dc.identifier.doihttp://dx.doi.org/10.1186/1471-2458-12-829
dc.identifier.urihttp://hdl.handle.net/1993/13695
dc.language.rfc3066en
dc.rightsopen accessen_US
dc.rights.holderSharmistha Mishra et al.; licensee BioMed Central Ltd.
dc.titleCharacterizing sexual histories of women before formal sex-work in south India from a cross-sectional survey: implications for HIV/STI prevention
dc.typeJournal Article
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