bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2-S2.08 Changing patterns and drivers of migration among female sex workers of Northern Karnataka to large cities of Maharashtra, India in the context of HIV/AIDS
Authors: Halli S , Blanchard J , Bhattacharjee P , Raghavendra T , Moses S 
Published: July 2011

Background and ObjectivesThe large number of FSWs from the rural areas of Northern Karnataka's three districts namely Bagalkot, Belgaum and Bijapur (3B districts) who migrate and work in Maharashtra cities particularly in Solapur, Poona, Bhiwandi and Mumbai in brothels and lodges. In this corridor” of migration and interconnected HIV epidemics, an attempt is made in this paper to specifically address the following objectives: 1. To assess the volume of sex worker migration from different sites and its annual turnover. 2. To describe the patterns of sex worker migration to and from the three districts of northern Karnataka and the large urban centres of Maharashtra.MethodsMapping was conducted following enumeration of the units; visited each unit (brothels and in some areas also lodges and/or dhabas) where we had prior information that sex work was conducted and interviewed the unit manager (ie, brothel madam, lodge/ dhaba manager). The manager provided information regarding: the number of FSWs working in the unit at the time—total number, FSWs from Karnataka, FSWs from the 3B districts; number of FSWs from the 3B districts that worked in the unit in the previous year and how many of them had moved to another unit in the same area. Moreover, managers provided the place of origin, age and duration of stay in the area of the FSWs from the 3B districts working in the unit at the time of data collection.ResultsIn case of Bhivandi, Mumbai's Kamathipur and Poona, 571, 390 and 604 FSWs were from 3B districts respectively. There were 338 women working in Solapur. Of the 338 women, 127 were from Karnataka and all most all of them (114) from the 3B districts.ConclusionsMigration of FSWs from 3B districts is decreasing considerably to Maharashtra brothels. There is high turnover of FSWs from 3B districts in Solapur (100% per month), especially in lodges. This suggests that the proximity of Solapur to Bijapur (the main place of origin for FSWs in this place of destination) may be an important driver of the movement of FSWs. In other words, the difference in turnover between Solapur and the other places of destination may be indicative of two changes in the migration pattern: a) FSWs from the 3B districts may prefer closer destinations, rather than the “classic brothel based” destinations (eg, Mumbai, Pune, Bhiwandi due to declining clients); and b) FSWs from the 3B district who migrate to nearby destinations may prefer working in lodges rather than brothels, the “classic” place of sex work in Maharashtra where high prevalence of HIV/AIDS is observed. This is supported by mean ages of the FSWs (31.5, 28.3, 34.5 and 27.6) and mean durations of stay (10.5, 6.8, 11.9 and 4.0) in Bhiwandi, Pune, Mumbai and Solapur respectively.
P2-S2.12 Condom use within intimate partnerships of female sex workers in Southern India
Authors: Deering K , Bhattacharjee P , Washington R , Bradley J , Boily M C , Shaw S , Shannon K , Ramesh B M , Rajaram S , Moses S , Alary M 
Published: July 2011

BackgroundAlthough female sex workers (FSWs) report high levels of condom use with commercial sex clients, particularly after targeted HIV preventive interventions have been implemented, condom use is often low with intimate partners. There is limited understanding regarding the factors that influence condom use with FSWs' non-commercial intimate partners, and how programs can be designed to increase condom use. The main objectives of this study were therefore to describe FSWs' self-reported intimate partners, along with interpersonal factors characterising their intimate partnerships, and to examine factors associated with inconsistent condom use within intimate partnerships.MethodsThis study used data collected from cross-sectional questionnaires administered to 988 FSWs in four districts in Karnataka state in 2006. We used bivariate and multivariable logistic regression analysis to examine the relationship between inconsistent condom use (ie, “never”, “sometimes” or “frequently”, compared to “always”) with intimate partners of FSWs (including husbands/cohabiting partners and other non-paying partners) and interpersonal factors describing these partnerships. Weighting and survey methods were used to account for the cluster sampling design.ResultsOverall, 511 (51.8%) FSWs reported having husbands/cohabiting partners and 273 (26.0%) reported having other non-paying partners. Inconsistent condom use with these partners was high (77.4% and 60.4% respectively). In multivariable analysis, adjusting for social and environmental factors, the odds of inconsistent condom use with husbands/cohabiting partners and other non-paying partners were 12% (adjusted OR [AOR]: 1.12, 95% CIs 1.06 to 1.17) and 35% (AOR: 1.35, 95% CI 1.13 to 1.62) higher for a one-year increase in the duration of the relationship, respectively. The odds of inconsistent condom use with husbands/cohabiting partners was 50% lower if these partners knew that the respondent was a sex worker (AOR: 0.50, 95% CI 0.29 to 0.86). The odds of inconsistent condom use with other non-paying partners was 68% lower if the respondent reported ever having stayed or lived with these partners (AOR: 0.32, 95% CI 0.13 to 0.79).ConclusionsImproved designs for HIV preventive programs, including partner- or couples-focused programs, should be developed to address issues related to FSWs' intimate partnerships and increase condom use.
P1-S1.31 Chlamydia trachomatisin Norway, 1988–2009
Authors: Skjeldestad F E , Kløvstad H 
Published: July 2011

BackgroundChlamydia trachomatisis the most commonly reported STI in Europe. We present the epidemiology ofC trachomatisin Norway from 1988 to 2009.MethodsUntil 2004 the Norwegian Surveillance system of infectious diseases (MSIS) captured the total number of diagnosed cases and tests performed from all diagnosing laboratories. From 2005 date of diagnosis, birth year, sex and municipality of living has been included for each diagnosed case. We calculated testing rates, incidence rates (IR) and incidence rate ratios (IRR) with 95% CIs.ResultsThe IR of diagnosed cases was at its lowest in 1995 (287/100 000) and increased yearly until 2008 (467/100 000). The testing rate reached a peak in 1991 (8000/100 000), decreased towards year 2000 (5300/100 000) and has been stable until 2009 (5500/100 000). The proportion positive tests has increased yearly from 4.1 % in 1993 to 8.6 % in 2009. The highest mean annual IR was found in the age group 20–24 years for both men (2983/100 000) and women (4818/100 000). Women were 1.6 times more likely (IRR of 1.6, 95% CI 1.6 to 1.62) to be diagnosed withC trachomatiscompared to men, and inhabitants in the two most northern regions were more likely to be diagnosed than the rest of the country (IRR 1.6, 95% CI 1.5 to 1.7).ConclusionThe IR ofC trachomatisin Norway is increasing while the testing rate is stable. More detailed data of the case mix among the tested subjects is needed to interpret the observed trends.
P2-S2.14 Alcohol abuse and sexual victimisation among female sex workers in China
Authors: Hong Y , Zhang C , Li X 
Published: July 2011

BackgroundGlobal literature suggests women often have higher sexual risks under the influence of alcohol abuse. However, data are limited from vulnerable population such as the female sex workers (FSW) in developing countries. The current study aims to fill out the literature gap by examining the association between alcohol abuse and sexual victimisation among FSWs in China.MethodsA cross-sectional survey was conducted among 1022 FSWs who were recruited through community outreach from nine different types of entertainment establishments in Guangxi, China. The FSWs completed a self-administered survey on their demographic, information, alcohol use/abuse behaviours (AUDIT), and sexual victimisation experience. Multivariate regression was employed to assess the relationship between alcohol abuse and sexual victimisation.ResultsFSWs who were younger, less educated, never married, and working in an alcohol-serving establishment were more likely to have higher risks of alcohol abuse (p<0.05). FSWs who were at higher risks of alcohol abuse reported significantly higher sexual victimisation experience (p<0.001). Multivariate models indicated significant relationships between alcohol abuse and sexual victimisation experience while controlling for potential demographic confounders, such as having been made drunk by client (aOR=1.10, 95% CI 1.07 to 1.16), “having been stripped off (aOR=1.07, 95% CI 1.02, 1.13)”, “having been taking advantages (aOR=1.08,95% CI=1.05 to 1.12)”, “having been asked for extra demands (aOR=1.08, 95% CI 1.05 to 1.11)”, and “having been sexually assaulted (aOR=1.08, 95% CI 1.04 to 1.13)”.ConclusionAlcohol abuse was prevalent and associated with sexual victimisation experience among FSWs in China. Culturally appropriate interventions are urgently needed to reduce alcohol use related sexual risks among this vulnerable population.
P2-S2.16 Impact of duration of exposure to sex work on HIV prevalence in 23 districts of Southern India
Authors: Pickles M , Boily M C , Deering K , Vickerman P , Ramesh B M , Washington R , Isac S , Adhikary R , Paranjape R S , Alary M 
Published: July 2011

BackgroundHIV prevalence among female sex workers (FSW) in various districts of Andhra Pradesh (AP), Karnataka (KA), Maharashtra (MH), Tamil Nadu (TN) ranged between 8 and 26%, 10 and 34%, 6 and 38%, 2 and 13%, respectively, in 2005–2006. The duration of selling or buying sex has been suggested as a key determinant that may explain ecological difference in HIV prevalence. Thus, we estimated FSW duration across geographically distinct districts and assessed its impact on HIV transmission.MethodsCross-sectional FSW survey data from 23 districts of MH, TN, KA, AP (2005–2006) (IBBA), collected as part of the evaluation of Avahan, the India AIDS initiative, were used to estimate FSW duration (crude duration=difference between age at survey and age of entry into sex work). “Corrected” durations that adjust for the censored nature of the data (as FSW are still in sex work) were estimated for FSW using a birth-and-death dynamical model (with 9 duration compartments) fitted by maximum likelihood to each district-specific FSW IBBA duration distribution. A deterministic model of HIV transmission among FSW/clients was parameterized/fitted to Belgaum IBBA data with crude FSW duration of 9.6 years for FSW. FSW duration was thereafter varied between 1and 33 years to assess its influence on model HIV prevalence, for different assumed client duration (4–17 years). Each individual leaving was replaced by a new susceptible person.ResultsMean crude FSW durations ranged between 3.7 and 9.6 (median 3–7) years across districts compared to 4.3 (Bangalore, Thane street-based) and 12.5 (Belgaum) after correction. District average corrected durations tended to be shorter for TN (6 years) and longer for MH (9 years). Within-district differences (ratios) between corrected and crude durations ranged between 0.5 and 3 years (1.1–1.3-fold). Observed differences in FSW duration across districts had a modest impact on FSW/client HIV prevalence if duration exceeded 9 years (Abstract P2-S2.16 figure 1), independently of client duration. The impact of FSW duration below 3 years on FSW/client HIV was critical. FSW/client HIV prevalence was more sensitive to variation in client duration exceeding 9 years (Abstract P2-S2.16 figure 1).Abstract P2-S2.16 Figure 1ConclusionsCrude duration may underestimate FSW duration by up to 32%. This level of error is unlikely to influence FSW HIV prevalence projections. Large variation in HIV across districts is unlikely to be explained by FSW duration alone if exceeding 9 years but could be potentially be explained by variation in client duration.
P2-S2.17 Community-Led Structural Invention's promise for HIV prevention: a case study from the Ashodaya Samithi Sex Worker Collective of Mysore, India.
Authors: O'Brien N , Reza-Paul S , Akram P , Jai S , Venukumarc K T , Venugopalc M S , Fatima M P , Lorway R 
Published: July 2011

BackgroundAs evidence has revealed the role of broader political, economic and local environmental factors in shaping HIV epidemic transmission patterns, new approaches have emerged that move beyond addressing individual risk behaviour to addressing the structural forces that condition risk. Within this context, Community-Led Structural Interventions (CLSI) aimed at reducing sex workers' vulnerability have demonstrated successes in reducing STI and HIV transmission in India.MethodsA comprehensive CLSI, know as Ashodaya Samithi, was initiated in the South Indian district of Mysore. Established in 2004 by the India AIDS Initiative (Avahan), Ashodaya is funded through the Bill and Melinda Gates Foundation and implemented by Karnataka Health Promotion Trust. Four-years into its inception, the project lays claim to significant successes. The collective has reported a reduction in STIs, an increase in condom use, and the mobilisation of 1500 sex workers. Our research describes and analyzes sex workers' participation as it unfurled across various phases of collectivisation. Qualitative, community-based research methodologies were utilised including; 40 open-ended interviews, participant observations and focus groups. Drawing upon these findings we explored how a community of sex workers came to develop the ability to recognise, challenge and significantly alter an array of unequal power relations that shape HIV vulnerability in their everyday lives.ResultsOur research demonstrates the promise CLSI projects hold for preventing the spread of HIV. Ashodaya's success depends on its ability to set new community norms, create a safer working environment, improve stakeholder relationships, and provide a supportive network. The interrelated processes of mobilisation, collectivisation, sex-worker identity, and political action, which transformed day-to-day vulnerability to HIV for Mysore sex workers demonstrates how complex HIV prevention remains.ConclusionsFindings from the Ashodaya collective offer valuable lessons for public health practice. The Ashodaya collective demonstrates how CLSI strategies can be employed to help transform the very vulnerabilities that endanger health and sustain STI and HIV transmission. The collective provides an example of the positive impact of CLSIs and provides evidence for strategies that steer away from individual or education based public health programs, to those that engage with structural inequities.
P2-S2.18 Are we doing enough to cover risk of STI/HIV transmission from the lovers “of female sex workers (FSWs)?”
Authors: Doddamane M , Bhattacharjee P , Rao D 
Published: July 2011

BackgroundCondoms use among Female sex workers with paid clients found to have increased rapidly in three years from 58% to 76% (IBBA data) due to scale up of interventions among them. However condom use with lovers still remains low at 33% (IBBA 2008). PBS 2009 shows 50% of the sex workers have lovers. Programmatically it has been challenging to design and implement programme to reach out to Lovers and to provide them services consistently. To understand the Lovers and the risk factor associated with them we conducted Focused Group Discussion (FGDs).Method14 Separate FGDs were conducted with both the FSWs and their Lovers in seven districts of Karnataka. A structured tool guided the Facilitators of the FGD. Each FGD was documented by a Recorder.ResultsThree fourths of the FSWs had more than one lover at any given point of time. One fourth of the lovers had physical relationship with other FSWS or women other than wife. Half of the FSWs especially the urban based changed lovers in less than a year. Majority of the lovers knew that their partner is a sex worker. Key barriers for Lovers to use condoms with the sex workers were: 1. Faith and trust with FSWs (almost half of the respondents) 2. Condoms don't give pleasure (one third of the respondents). The barriers stated by the FSWs were: 1. Faith and trust in the lover because they are like husbands (one third of the respondents) 2. Did not want to make the lover suspicious (one fourth of the respondents) One fourth of the sex workers responded experiencing harassment from the lovers especially for money. Only one third of the lovers had correct information about HIV (modes of transmission) and negligible number of lovers accessed STI services.ConclusionEvidence shows that there is clear need to intervene with Lovers of female sex workers to improve condom use among them. The interventions have to address not only gaps in information, condom use, access to service, but also the perception of faith and trust.
P2-S2.22 Innovations to attract young female sex workers to access STI services in drop in centres (DIC): a case study from Bangalore, South India
Authors: Michael E , Murugan S K , Viswanatha L , Pushpalatha R 
Published: July 2011

BackgroundYoung female sex workers pose a challenge in accessing continuous services in prevention program. Being young, relatively active and new to sex work increases their vulnerability drastically but also attract more clients. As young sex workers they often do not access services provided in the drop in centre due to several factors including self stigma, lack of Peer interaction, and less awareness about services in the DIC.MethodCommunity consultations were done initially to know the barriers to accessing services in the DIC. As physical appearance goes a long way in determining how an individual is perceived by oneself and others around, introducing sessions on beauty and healthcare by a trained beautician, was felt suitable in attracting sex workers to the Drop in Centre. A beautician was hired and oriented towards the program. The primary focus of the sessions was to showcase and teach the sex workers basic skills in dressing well and looking good using quick and cost-effective ways. Apart from this the beautician also provided few beauty services which was accessed by the sex workers. These services were charged nominally so that the amount was used to replenish the cosmetics and makeup materials. Other crucial aspects of health, such as cleanliness, hygiene and prevention of STI, female condom demonstration and distribution were covered during counselling session and one to one interactions. This innovative approach aimed towards increasing uptake and access of services proved cost effective and was received well by the most vulnerable, young sex workers, attracting them to the DIC.ResultsAs a result of introducing these sessions in the DIC 25 young sex workers were accessing services from the drop in centre every week. There was a steady increase in testing for STI in the introductory months itself. A peer network among the young sex workers was initiated and this helped the project to ensure that access to STI services were regular by this community. This innovative approach acted as a catalyst to improve the self-esteem of sex workers and ensured access to services there by reducing their vulnerability.ConclusionIt is imperative for prevention programs to evolve and find newer and innovative methods to address the changing needs of vulnerable communities like the female sex workers. This strategy has proved to attract young sex workers there by effectively providing them STI and other services within the program.
P2-S3.01 STI risk among persons attending burning man in 2010
Authors: Marcus J L , Bernstein K T , Philip S S 
Published: July 2011

BackgroundBurning Man is a week-long event held annually over Labour Day in the Nevada desert, with over 50 000 attendees in 2010. We aimed to assess the potential for STI transmission among San Francisco attendees and the availability and acceptability of safer-sex services at Burning Man.MethodsWe conducted a survey among a convenience sample of persons who attended Burning Man in 2010. An online questionnaire on demographics, sexual practices, and safer-sex services at Burning Man was created on SurveyMonkey and advertised on two email lists, one for all attendees and one for those living in San Francisco. Attendees were invited to participate anonymously from 1 week through 6 weeks after the event. We conducted a descriptive analysis of the responses.ResultsOf the 1477 persons who completed the survey during 10 September–22 October 2010, most were heterosexual men (45.1%), heterosexual women (30.0%), or men who have sex with men (12.4%); of white race/ethnicity (86.5%); and from 25 to 44 years of age (62.5%). The majority (70.6%) had attended the event in prior years, and 17.8% resided in San Francisco. Over one quarter (28.5%) had been previously diagnosed with an STI. Of the 69.8% who reported having oral, vaginal, or anal sex at Burning Man, almost half (43.5%) reported sex with new partners. Although most attendees (86.3%) noticed that condoms were available at the event, nearly one quarter (23.0%) of respondents with new partners had intercourse without a condom, of whom two thirds (64.9%) did not plan to test for STIs during the month after the event. Of those planning to test, 49.3% planned to test with a private doctor, 23.9% at a community clinic, and 19.7% at an STI clinic. Only 2.6% of attendees reported that STI testing was available at the event; 41.3% said they would use the service if it were available.ConclusionsAlthough some safer-sex services were available at Burning Man in 2010, attendees reported unprotected intercourse with new partners during the event, a behaviour that confers high risk for STI acquisition. Large gatherings such as Burning Man might present opportunities for rapid STI transmission among geographically diverse sexual networks. Local health jurisdictions, both in the host location and those in which event attendees reside, should consider further assessment of STI transmission and prevention at Burning Man and similar events.