bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2-S2.06 Becoming a sex worker: the nexus between violence, gender disadvantage and poverty
Authors: Shahmanesh M , Wayal S , Cowan F 
Published: July 2011

BackgroundCommunity mobilisation of female sex workers is integral to India's HIV prevention strategy. Sex workers often become infected by HIV soon after initiation into sex work. The societal factors that propel women into sex work may also inhibit the self-efficacy/agency required to access healthcare and adopt safer sexual behaviour.MethodsIn-depth interviews were conducted with sixteen purposively selected (based on HIV status, ethnicity, age, area, and type of sex work) female sex workers in Goa, India (December 2004–December 2005). We interrogated the life narratives to explore the nexus between the social context/risk environment and self-efficacy/agency.ResultsThe narratives showed a dynamic interplay between underlying vulnerabilities, precipitating factors, and the route through which women gain entry into the sex trade: The ubiquitous mitigating theme that emerged was violence in childhood and youth. This ranged from dysfunctional and violent family life, sexual violence, and violence from intimate male partners. The other underlying vulnerabilities that emerged from the narratives were also manifestations of gender disadvantage, namely being unwanted; sexual naïveté and young marriage/sexual initiation; repression of sexuality, desire and entrapment in loveless marriages; and lack of life skills and low self-esteem. The loss of social support through bereavement, abandonment or financial need, were the commonest events that precipitated entry into sex work. Becoming a sex worker was frequently an expression of agency in a context with few other economically viable choices for women. The clearest division in the route into sex work was between traditional caste-based sex workers (devadasi) and those who were either introduced by peers, or sold through a broker; however the underlying and precipitating factors for both routes were remarkably similar. Mostly, initiation was described as a complex process that was mediated through peers.ConclusionThe interplay between caste, economy, gender, and violence drives the initiation into sex work, which is one of the few viable choices for the women. HIV prevention interventions therefore need to work upstream to impact upon the context within which women enter sex work and downstream to strengthen their agency. The peers who introduce women into sex work are potentially important vehicles to deliver “HIV prevention services and reduce the adverse health outcomes of sex work.”
P2-S2.07 Improving sexually transmitted infections (STI) prevention strategies: factors associated with STIs among female sex workers in India
Authors: Narayanan P , Das A , Gurung A , Parimi P , Rao G , Risbud A 
Published: July 2011

BackgroundStudies among high-risk groups (HRGs) have shown that the presence of STIs is associated with certain demographic and behavioural characteristics as well as exposure to HIV/STI prevention interventions. The objective of this study was to understand the correlates of STIs in female sex workers (FSWs) in India in order to improve STI programming for HRGs.MethodsDuring 2008–2009, 417 female sex workers were recruited from three STI clinics in two cities of India as part of an operations research to evaluate the effectiveness of STI prevention service package for sex workers under Avahan, the India AIDS Initiative of the Bill & Melinda Gates Foundation. Behavioural and clinical information along with biological samples were collected. Bivariate analysis of demographic and behavioural characteristics associated with the prevalence of common bacterial STIs-Neisseria gonorrhoeae,Chlamydia trachomatis,Treponema pallidumandTrichomonas vaginalisfrom the baseline data is presented in this paper.ResultsAt baseline 49.2% of the participants had a laboratory confirmed diagnosis for at least one of the four bacterial STIs. The significant factors associated with STI prevalence among FSWs were: inability to read or write (OR=2.2, p=0.002); not staying with a sexual partner (OR=1.5, p=0.036); typology of sex work: home-/hotel-based (OR=2.5, p=0.038) vs brothel-based and street-based (OR=3.1, p=0.004) vs brothel-based; regular or occasional consumption of alcohol (OR=1.9, p=0.002); poor knowledge of STI symptoms (OR=1.6, p=0.017); low self-risk perception for acquiring STIs (OR=1.6, p=0.031); less than 2 years in sex work (OR=1.8, p=0.008); no prior exposure to HIV/STI interventions (OR=2.0, p=0.001); and no STI check-ups in the past 6 months (OR=1.5, p=0.029) see Abstract P2-S2.07 Table 1.Abstract P2-S2.07 Table 1Factors associated with sexually transmitted infections among female sex workers in IndiaFactorsOR 95% CIp valueIlliterate (can not read or write)2.2 (1.3 to 3.7)0.002Not staying with a sexual partner1.5 (1.0 to 2.4)0.036Typology Brothel-basedReference Home/hotel-based2.5 (1.0 to 6.7)0.038 Street-based3.1 (1.3 to 7.7)0.004Consume alcohol (regularly or occasionally)1.9 (1.2 to 2.8)0.002Poor knowledge of STI symptoms1.6 (1.1 to 2.4)0.017Low self-risk perception for acquiring STIs1.6 (1.0 to 2.5)0.031New to sex work (less than 2 years)1.8 (1.1 to 2.8)0.008No prior exposure to STI/HIV interventions2.0(1.3 to 3.0)0.001No STI check-ups in past 6 months1.5 (1.0 to 2.3)0.029ConclusionsHIV/STI prevention programs for FSWs in India need to prioritise services for HRGs who have characteristics associated with STI prevalence. Additionally, awareness activities should promote the importance of regular STI check-ups, recognition and early treatment for STI symptoms.
P2-S2.09 Profile of clients of sex workers developed through imagery used with FSWs in six major Pakistani cities
Authors: Abbas S S 
Published: July 2011

BackgroundNegligible data on clients of FSWs is available in Pakistan. Severe punishments like stoning to death for sex outside marriage etc, has made clients unusually cautious and researchers have shied away in carrying out researches on the clients of sex workers. An innovative psychological method has helped obtain significant information about clients.MethodsFSWs were asked to recall details about each of their 10 most recent clients through imagery conducted/guided by qualified Clinical Psychologists retrained to work with FSWs. FSWs were steered to remember client's: age, profession, time spent with them, place of risk taking, use of drugs, use of condom, who provided it, resistance if any against the use of condom. 120 FSWs out of 2055 FSWs recruited during recent surveillance round in six big cities of the country (20 FSWs from each city) were randomly selected. Each imagery session lasted 90–120 min. Profile of 1200 Clients was prepared.Results56.4% were less than 30 years (youngest: 13 years; oldest 75 years). 67.62% were married. Petty shop keepers, labourers and students constituted 62.18% of the clients and 81.4% of them lived in the same city. 51.84% were regular clients. In 59% of cases FSWs provided their own place for risk taking. Alcohol/Drugs were used in 53.31% cases. 45% of the clients left within 30 min. 52% of the clients bought oral or anal sex for extra money. Condom was used in 57% of the cases but in 58.46% of the cases it was provided by clients themselves. FSWs kept it with them to facilitate the clients. 78% of clients were worried about pregnancies and only 18% of clients worry about STIs. FSWs seldom tried to persuade Clients to use condoms and the most effective way was stated to be the fear of pregnancy.ConclusionsClients belong to the same city mostly regular, are inclined to use condom particularly to avoid pregnancy but could be educated to use it to avoid STIs. Client's population is definitely receptive for the use of condoms. Making the FSWs keep a condom on herself is likely to increase the use of condoms.
P2-S2.10 Sex worker collective organization in the absence of NGOs: a qualitative analysis of female sex worker hometown social networks in South China
Authors: Tucker J , Peng H , Wang K , Chang H , Yang L G , Zhang S , Yang B 
Published: July 2011

BackgroundReducing harm associated with selling and purchasing sex is an important public health priority in China, yet there are few examples of sustainable, successful programs to promote sexual health among female sex workers. Programs focusing on empowering sex workers using a rights-based framework have been effective in India and other regions, but have been challenging to replicate in China. The limited civil society and scope of nongovernmental organizations circumscribe the local capacity of female sex workers to collectively organise, advocate for their rights, and implement STI/HIV prevention programs. The purpose of this study was to examine social networks among low-income female sex workers in South China to determine their potential for sexual health promotion.MethodsSemi-structured interviews with 34 low-income female sex workers and 28 outreach members were used to examine how social relationships affected condom use and negotiation, STI/HIV testing and health-seeking behaviours, and dealing with violent clients.ResultsThese data showed that sex worker's hometown social connections were more powerful than relationships between women selling sex at the same venue in establishing the terms and risk of commercial sex. Female sex workers from the same hometown often migrated to the city with their hometown sisters and these social connections fulfilled many of the functions of non-governmental organizations, including collective mobilisation, condom promotion, violence mitigation, and promotion of health-seeking behaviours. Outreach members observed that sex workers accompanied by their hometown sisters were often more willing to accept STI/HIV testing and trust local sexual health services.ConclusionsOrganising STI/HIV prevention services around an explicitly defined hometown social network may provide a strong foundation for sex worker health programs. Further research on dyadic interpersonal relationships between low-income female sex workers, group dynamics and norm establishment, and the social network characteristics are needed. Hometown social networks may represent a powerful force for organising STI/HIV prevention among low-income sex workers in China and other regions with limited civil society.
P2-S2.11 Focused and early intervention in rural areas can impact on HIV transmission in Southern India
Authors: Washington R , Bhattacharjee P 
Published: July 2011

BackgroundA number of districts in Karnataka, south India have an equal prevalence of HIV in rural and urban areas. A link worker scheme focused on prevention interventions with rural female sex workers, was implemented under the USAID supported Samastha project (2006–2011).MethodsA rapid rural mapping covering 7700 villages across eight districts helped map 16 043 rural female sex workers clustered in about 1700 villages. Rural female sex workers (RFSW) were defined as women who lived and practiced sex work within the village. Peer educators supervised by outreach link workers identified, educated, directly provided condoms and mobilised RFSW to reach HIV services. STI and counselling and testing services were integrated into Primary Health Centres. An individualised web based management information system tracked outreach and services. Polling booth surveys were used to measure key behavioural outcomes.ResultsBy the fourth year of implementation, 14 697 (91.6%) of the estimated RFSW were reached. Monthly contact rates were sustained at 85%, with each RFSW directly receiving a mean of 28.3 condoms per month. Condom use rates rapidly increased to 63% at last sex with any partner and 78% with clients. 81% received STI services and more than 67% had been directly referred and received their HIV status. The proportion reporting with STI symptoms remained stable at around 60%; however, 64% of these were vaginal discharge. Genital ulcer rates decreased from 5.5 to 0.8% and other STI conditions from 6.1 to 1.7%. HIV prevalence among RFSW across districts ranged from 2 to 4%. Overall, HIV prevalence among antenatal women declined from 1.9 to 0.5% (2006–2009) in these districts.ConclusionsFocused and early interventions can reduce HIV transmission in rural areas and could be impacting even at the population level. It would be important to sustain focused prevention interventions in rural India.
P2-S2.13 A pilot study of the effectiveness of a vaginal washing cessation intervention among Kenyan female sex workers
Authors: Masese L , McClelland R S , Gitau R , Wanje G , Shafi J , Kashonga F , Ndinya-Achola J , Richardson B , Lester R , Kurth A 
Published: July 2011

BackgroundIntravaginal practices have been associated with HIV-1 acquisition. This may be mediated by mucosal disruption, changes in vaginal flora, or inflammatory responses in the genital tract. Reducing vaginal washing could lower women's risk of HIV-1 acquisition. We conducted a prospective study to test the hypothesis that a theory-based intervention would reduce vaginal washing in a cohort of high-risk Kenyan women. We collected pilot data on changes in biological markers that might help to explain the relationship between vaginal washing and HIV-1.MethodsHIV-1 seronegative women who reported current vaginal washing were recruited from a prospective cohort study of high-risk women in Mombasa, Kenya. A theoretical framework including Information Motivation and Behaviour and Harm Reduction was implemented to encourage participants to reduce or eliminate vaginal washing. At baseline and after 1 month, we evaluated vaginal epithelial lesions by colposcopy, vaginal flora by Nugent's criteria, and vaginal cytokine milieu using ELISA on cervicovaginal lavage specimens.ResultsTwenty-three women were enrolled. The most commonly reported vaginal washing substance was soap and water (N=14, 60.9%). The median frequency of vaginal washing per week was 7 (IQR 0–14). After one week, 21 (91.3%) participants reported cessation of vaginal washing. After 1 month, all participants reported cessation of vaginal washing (p≤0.001 for comparison of baseline to follow-up prevalence). The average number of cervicovaginal epithelial lesions by colposcopy decreased after 1 month compared to baseline (Mean [SD] 0.4 [0.6] vs 0.2 [0.5]; coefficient −0.14; 95% CI −0.29 to 0.01; p=0.08). Although there was no change in the prevalence of BV (OR 1.00, 95% CI 0.42 to 2.38; p=1.00]), these pilot data suggest that the likelihood of detecting Lactobacillus by culture might increase after cessation of vaginal washing (2 [8.8%] vs 6 [26.1%]; OR 3.71, 95% CI 0.73 to 18.76, p=0.11). Most cytokine levels were reduced after cessation of vaginal washing, but in this small, time-limited sample none of these changes were statistically significant.ConclusionsA theory-based intervention was highly successful in reducing vaginal washing over 1 month. This pilot study suggests the need for future studies with a larger sample size and longer follow-up to determine the effects of vaginal washing cessation on the cervicovaginal epithelium, vaginal flora, and inflammatory markers.
P2-S2.15 Typology of female sex workers and association with HIV risks: evidence from China
Authors: Hong Y , Li X 
Published: July 2011

BackgroundThe fast growing heterosexual transmission of HIV in China has drawn global attention. Millions of female sex workers (FSW) play a critical role in the escalating epidemic. Existing studies on FSW in China have typically used venue, income or venue to categorise FSW and none developed a data-driven typology based FSW's HIV risks.MethodsA cross-sectional survey was administered among 1022 FSW recruited from 60 different types of entertainment establishments or personal service sectors in southwest China. FSW's HIV risk was measured by a composite score of 12 items on condom use, HIV testing, STD infection, drug abuse. We used multiple regression and graphics to illustrate the relationship between the HIV risk and key FSW characteristics including age, working venue, and income.ResultsUnlike previous studies that assumed a linear relationship between HIV risk and age or income, our data revealed that the relationships between HIV risk or income varied by venue. For example, older FSW in clubs or massage parlour reported lower level of HIV risks compared to their counterparts whereas older FSW in saner or KTV reported higher level of HIV risks; but age was not significantly associated with HIV risk for FSW working in hair salons or streets. Income was positively associated with HIV risks; however, the association reversed after the income reached 1500 ¥ ($225). None of the key variables such as age, income, or venue can predict HIV risks singularly; in addition, all three variables need to be integrated to devise the appropriate typology.ConclusionOur study suggests that it was too simplistic to categorise FSW HIV risks by a single indicator; the interactions between individual and environmental factors underscored the importance of multiple indicators for typology. Interventions to reduce HIV risks in FSW in China could be more focused and targeted those at highest risks.
P2-S2.21 Traditional devadasi system under transition: boon or bane for HIV prevention programme?
Authors: Gurav K , Cooper E , Junno J , Stein D , Chintada D R , Doddamane M , Moses S 
Published: July 2011

BackgroundOne of the key factors attributed to high prevalence of HIV in Northern Karnataka (in India) is socially accepted and widely practiced sex work. Girls from “Devadasi” community enter into sex work through socially accepted way of being dedicated to deity “Yellamma”. Currently, the “Devadasi” system is under transition where, new dedications are not accepted by community leaders. As a result, the social organization of traditional sex work is changing.MethodsAn exploratory research was undertaken in the district of Bagalkot, Karnataka. Ethnographic methods, including participant observation and Focus Group Discussions (FGDs) were used. FGDs were conducted with leaders, sex workers, peer educators, adolescent girls from “Devadasi” community and HIV service providers.Results“Daiva” is a committee consisting of key leaders from “Devadasi” community. “Daiva” functions at the local (village) level and make decisions for the welfare of their community. The death of many young “Devadasi” sex workers due to AIDS was reported as a key factor for “Daiva” in stopping girls from entering sex work. Towards this end, “Daiva” has declared that the families who dedicate their daughters will be fined (RS 5000 to 20 000) and be outcasted. Although there seem to be a consensus to the decision of “Daiva”, there are families who still want their daughters to start sex work. The fear of social and financial reprimand is placing new sex workers and their families in a marginalised and potentially illegal position within their village. Meanwhile, it is making new “Devadasi”? sex workers, conceal their identity and also avoid the HIV prevention services offered by peer educators of their own community at the door step.ConclusionChanging social organization and conditions of “Devadasi” sex workers increases their intrinsic risk and vulnerability to HIV. Therefore it is important to address the structural changes occurring within the “Devadasi” community and also create an environment for new sex workers to freely access HIV prevention and care services. An innovative intervention model that could negotiate between objectives of “Daiva” and needs of sex workers is required.“
P2-S3.02 Latent class analysis of sexual risk patterns among heterosexually-identified, socially marginalised men in urban, coastal Peru
Authors: Konda K , Celentano D , Kegeles S , Coates T , Caceres C ,   NIMHCollaborative HIV/STD Prevention Trial Group
Published: July 2011

IntroductionWe explored patterns of sexual risk behaviour in a population of heterosexually-identified Peruvian men using latent class analysis, a technique that creates classes based on response patterns to questions related to a latent variable. In this study, the latent variable of interest is sexual risk behaviour.MethodsWe used data from the Peru site of the National Institute of Mental Health (NIMH) Collaborative HIV/STD Prevention Trial to investigate patterns of high-risk behaviour among heterosexually-identified men (n=2109). Seven sexual risk behaviours were analysed in latent class analysis to group men into risk classes. These self-reported behaviours included using drugs in the past month, using alcohol or drugs prior to sex, having 3 or more sex partners in the past 6 months, having concurrent sex partnerships, exchanging sex for money, and having a male sex partner in the past 6 months.ResultsFour latent classes of risk were identified, of which two classes had lower probabilities of these risk behaviours and two classes had higher risk classes probabilities of these risk behaviours. Increasing probability of risk behaviours by classes was significantly correlated with increasing reports of unprotected sex (p value for trend test <0.001). HIV/STI prevalence was elevated in all classes and prevalence increased with increasing probability of reporting the risk behaviours, although the differences were not significant. The risk behaviours in two of the latent classes identified were primarily related to alcohol and drug use.ConclusionsRisk behaviours in this population of heterosexually-identified men vary by latent class; however, given HIV/STI prevalence in each class all require prevention interventions. Interventions should also focus on alcohol and drug use, as these are important risk factors for this population. Future behavioural interventions for the prevention of HIV/STI infection may benefit from this information by tailoring messages to fit the observed patterns risk.