Skip Navigation LinksHome > July 1, 2004 - Volume 36 - Issue 3 > HIV Prevention Among Sex Workers in India
JAIDS Journal of Acquired Immune Deficiency Syndromes:
Epidemiology and Social Science

HIV Prevention Among Sex Workers in India

Basu, Ishika MPhil*; Jana, Smarajit MD*; Rotheram-Borus, Mary Jane PhD†; Swendeman, Dallas MPH†; Lee, Sung-Jae PhD†; Newman, Peter PhD‡; Weiss, Robert PhD§

Free Access
Article Outline
Collapse Box

Author Information

From *STD/HIV Intervention Programme, Calcutta, India; †Department of Psychiatry, University of California, Los Angeles (UCLA); ‡Faculty of Social Work, University of Toronto, Ontario; and §Department of Biostatistics, UCLA.

Received for publication August 25, 2003; accepted November 13, 2003.

Reprints: Mary Jane Rotheram-Borus, UCLA Center for Community Health, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA 90024 (e-mail: Rotheram@ucla.edu).

Collapse Box

Abstract

Summary: To test the efficacy of a sustainable community-level HIV intervention among sex workers, the Sonagachi Project was replicated, including community organizing and advocacy, peer education, condom social marketing, and establishment of a health clinic. Sex workers were randomly selected in 2 small urban communities in northeastern India (n = 100 each) and assessed every 5–6 months over 15 months (85% retention). Overall condom use increased significantly in the intervention community (39%) compared with the control community (11%), and the proportion of consistent condom users increased 25% in the intervention community compared with a 16% decrease in the control community. This study supports the efficacy of the Sonagachi model intervention in increasing condom use and maintaining low HIV prevalence among sex workers.

In India, HIV seroprevalence rates among sex workers have ranged from 50–90% in Bombay, Delhi, and Chennai. 1–4 However, HIV rates of only 10% have been observed among sex workers in Calcutta, a city on the drug route into the heart of India and one of the most impoverished urban areas in the world. 5 Condom use has risen in Calcutta in recent years, from 3% in 1992 to 90% in 1999, compared with steady rates of low condom use among sex workers in other cities in India. 4

The surprisingly low rate of HIV infection and high rate of condom use among sex workers in Calcutta may reflect the impact of the Sonagachi Project, a sustainable community-level sexually transmitted disease (STD)/HIV intervention program. The components of the intervention model include defining HIV and STDs as occupational health hazards; articulating the human rights of sex workers; providing access to condoms and resources for treating STDs; and creating a sense of community and political awareness. The multipronged program has resulted in economic, political, and occupational power for sex workers in Calcutta. In October 2001, >60,000 sex workers from throughout India convened in Calcutta, with aims to reduce the stigma of sex work by advocating change in societal attitudes toward sexuality and sex work. Stigma related to HIV risk, including the compounded stigma connected with groups and behaviors associated with heightened risk for HIV infection, has earned increased recognition as a key factor hindering HIV identification, prevention, and treatment efforts. 6–11

Pathways into sex work in India are 3-fold. First, many women are born into sex work as the family profession. The stigma associated with sex work, often coupled with residual caste system discrimination, severely limits educational and alternative economic opportunities. Second, many young women from rural areas and neighboring countries (e.g., Nepal, Bangladesh) are deceived, sold, or otherwise trafficked into sex work against their will. Driven by the extreme poverty facing their families and the lure of relatively large incomes, some women choose to return to sex work, albeit in a less coercive context, once they are returned to their homes. Sex workers in Calcutta are conservatively estimated to earn an hourly wage almost twice that of women in urban India.12 Finally, some women, given limited options, choose sex work as a means to support their families after being widowed, divorced, or abandoned by their husbands. About 9% of a random sample of sex workers in the Sonagachi “red light” area stated that they entered the profession voluntarily.12 While some sex workers are street-based, the majority work, and often live, in brothels clustered in red light areas of big cities and small towns.

Effective HIV prevention programs among sex workers have been implemented in Brazil, 13 Thailand, 14 and Zaire. 15 Community participation among sex workers in HIV prevention, however, is not guaranteed, as in the demise of a community-based HIV prevention program among sex workers in southern India. 16

The World Health Organization has selected the Sonagachi Project as a “model” for STD/HIV intervention. 17 While the low HIV rates in Calcutta are impressive, there is little evidence under controlled conditions that Sonagachi is responsible for the results. Although several studies have examined the Sonagachi Project or the sex workers participating in the project, 12,18–24 none has been published that demonstrates the efficacy of the Sonagachi model. Accordingly, the staff from the Sonagachi Project designed and conducted a 2-community trial to document the efficacy of the program, and an external research team designed the assessment and conducted the analysis.

Back to Top | Article Outline

METHODS

Research Team Roles

There were 2 teams from the Sonagachi Project: an assessment team and an intervention team. The assessment team was comprised of staff that conducted the project's ongoing rapid assessment and evaluation activities, and the intervention team included sex worker peer educators and community organizers, as well as professional project staff involved in advocacy work. A team from the University of California, Los Angeles (UCLA), consulted on the design of assessment measures, data analysis, and assurance of fidelity in implementation of assessment and intervention.

Back to Top | Article Outline
Sites

Two communities in the Cooch Behar district of West Bengal in northeastern India (Cooch Behar and Dinhata) were matched on size, socioeconomic status, and number of sex workers. Communities were randomly assigned to an intervention and control condition. These communities represented 2 of the 7 urban centers in the district and were separated by a distance that limited cross-site contamination (i.e., most transportation by foot or bicycle). Each community had a red light area that consisted of a neighborhood, about 100 m2 in size, where brothel-based sex workers lived and worked.

Back to Top | Article Outline
Participant Recruitment

The Sonagachi Project sent an assessment team of peer outreach workers and trained research staff to conduct rapid assessments of the red light areas, identifying the population of sex workers in each community. Each community consisted of about 350 sex workers. One hundred sex workers were randomly selected in each area (n = 200), using a 2-stage randomization process. First, the brothel rooms in each red-light area were enumerated (e.g., building, room) and randomly selected using a random number table. Second, the sex workers living in those rooms were enumerated and randomly selected using a random number table. Ten sex workers in each area were oversampled at baseline to account for refusal and loss at the first follow-up. One hundred sex workers in each area were recruited with informed consent and participated in the longitudinal study.

The Institutional Review Boards of UCLA, the Durbar Mahila Samanwaya Committee (sex worker community organization), and the local community groups in Cooch Behar and Dinhata reviewed and approved the protocol. Participants provided voluntary informed consent that was written in simplified terms in the local dialect or delivered verbatim if the participant was illiterate.

Back to Top | Article Outline
Standardizing Resources in Each Community

Health clinics were established in the center of both communities' red light areas to improve existing care for sex workers in both communities. Health care services, focused on reproductive and sexual health, were free to sex workers and their families but were also available to other members of the community in need. If they gave consent, clinic attendees were tested for syphilis using the Venereal Disease Reference Laboratory (VDRL) test. The clinics were open 2 days a week in each community and operated by a medical doctor specializing in STD/HIV, a female nurse, a male clinic administrator, and 2 female peer health educators. The Sonagachi team trained all personnel, especially in terms of cultural sensitivity for HIV, STDs, and sexual health issues for sex workers.

Back to Top | Article Outline
Enhanced Intervention

In addition to the health clinic and basic STD information, the enhanced intervention group included trainings by a team of local peer educators. Goals were to build skills and confidence in providing education and to foster empowerment and advocacy for local sex workers. The team engaged in ongoing advocacy activities with local stakeholders (e.g., “madams” and brothel owners) and power brokers (e.g., police, mafia, local politicians) who exerted control over the sex workers' lives, with the goal of building toward increased dignity, autonomy, and self-determination among the sex workers.

Initially, outreach workers were selected among the local sex worker community by the Sonagachi Project intervention team. Charismatic sex workers living and working within the red light area were identified as leaders and trained to perform 2 primary roles involving diffusion processes of the Sonagachi model: empowerment and advocacy. Peer educators “apprenticed” under the Sonagachi trainers and eventually took over their empowerment training and advocacy activities. Empowerment activities included sustained engagement with local sex workers; showing an interest in sex workers' health and well-being and that of their children; nurturing group solidarity among sex workers; and raising consciousness about sex worker rights. The Sonagachi sex worker/trainers conducted sustained and ongoing training in Sonagachi empowerment methods and messages (e.g., “Sex work is valid work,” “Sex workers deserve to protect themselves”). Additionally, high-status advocates (i.e., the medical doctor, evaluation team, and Sonagachi representatives) conducted active and ongoing advocacy work with local police, elected officials, appointed policy makers, shop owners, civic and social clubs, and other gatekeepers in the sex worker community (e.g., madams, pimps, local gangs) to effect changes in the structural barriers to condom use by sex workers.

Back to Top | Article Outline
Assessment Procedures

The Sonagachi evaluation team administered the questionnaires in both communities. A baseline assessment was conducted with 3 follow-up assessments at 5- to 6-month intervals over 16 months. Follow-up rates were similar in the intervention and the control communities at each wave from the baseline interviews (n = 100 each condition): Wave 1, 90% intervention, 93% control; wave 2, 85% intervention, 88% control; wave 3, 92% intervention, 80% control. In the intervention community, 84% were interviewed at every follow-up time point; 75% were assessed at every follow-up assessment in the control community.

Back to Top | Article Outline
Assessment Measures

The following domains were assessed at each time point: age, income, time in the profession of sex work, marital status, working arrangements, substance use, condom availability, sex partner information, sexual behavior, STD information, STD knowledge, and HIV/AIDS knowledge. Primary outcome measures included condom utilization and changes in condom use.

Back to Top | Article Outline
Condom Utilization

Condom utilization was defined by the number of condoms used over the number of sexual intercourse acts reported by sex workers for the last day worked. If a condom was used during every act, such individuals were classified as having 100% condom use. Any condom use was defined as having used a condom at least once during a sexual act.

Back to Top | Article Outline
Changes in Condom Use

Change in condom use was examined by defining sex workers as adopters or relapsers. Adopters were those who converted from <100% condom use at baseline to 100% condom use at follow-up. Relapsers were those who switched from 100% condom use at baseline to <100% condom use at follow-up.

Back to Top | Article Outline
Data Analysis

Differences in baseline characteristics were examined using χ2 tests for categorical variables and t tests for continuous variables. Change in condom use from baseline to follow-up assessments was examined using the McNemar test, stratified on intervention condition. Changes in condom use were examined as changes in 100% condom use as well as changes in any condom use. Differences in percent condom use by intervention condition over time were examined by using a random effects regression model. 25 The intervention effect was evaluated by comparing slopes between the conditions over time.

Back to Top | Article Outline

RESULTS

Table 1 outlines the baseline characteristics of the sex workers by intervention condition. Baseline characteristics were comparable between the 2 sites except marital status, HIV/AIDS knowledge, and 100% condom use. A higher proportion of sex workers in the control community reported being married (43%), compared with 28% in the intervention community (χ2 = 4.91, P = 0.03). A higher proportion of sex workers in the intervention community knew at least 1 HIV/AIDS preventive method (67%), compared with 41% in the control community (χ2 = 13.61, P = 0.0002). Furthermore, a higher proportion of sex workers in the control group reported 100% condom use (47%), compared with 32% in the intervention group at the time of study initiation (χ2 = 4.71, P = 0.03).

Table 1
Table 1
Image Tools

Most sex workers perceived that they were at risk for STD/HIV. About one-third were married and more than half had a regular sexual partner; about 1 in 4 had been verbally abused in the past 3 months. Most had been working in the profession for at least 7 years and earned >500 rupees per month, the equivalent of $12 US. Only about one-third of the sex workers reported using alcohol and very few injected drugs. Almost all risk stemmed from penovaginal sex, with relatively low rates of oral sex and almost no anal sex. Over their lifetime, >40% of participants had sought treatment for an STD. Blood samples from a subset of study participants (baseline = 79%; wave 1 = 73%; wave 2 = 87%; wave 3 = 81%) were used to conduct VDRL tests for syphilis exposure; about 60% had been exposed in their lifetime. However, low rates of current STD infection were identified from external physical examinations (<1%) and internal examinations (<10%). The initial base rates of STD were too low to allow us to use STD as an outcome measure of the intervention.

As shown in Table 2, changes in 100% condom use were examined from baseline to follow-up assessments, stratified by intervention condition. For changes in 100% condom use in the intervention group, 35 sex workers (39%) were classified as adopters between the baseline and the first follow-up assessment. Only 4 relapsers (4%) were observed. This difference was statistically significant (McNemar test = 26.64, P < 0.0001). When we assessed changes in 100% condom use in the control group, we found no statistically significant difference between 17 adopters (18%) and 11 relapsers (12%).

Table 2
Table 2
Image Tools

Similar patterns were observed in changes in 100% condom use between the baseline and second follow-up assessment. We observed a significant difference between the 35 adopters (41%) and 6 relapsers (7%) (McNemar test = 20.51, P < 0.0001). In the control community, we found no significant difference between 16 adopters (18%) and 7 relapsers (8%). Changes in 100% condom use between the baseline and third follow-up assessment in the intervention group indicated that 37 sex workers (40%) were classified as adopters, whereas there were only 6 relapsers (7%) (McNemar test = 22.35, P < 0.0001). In the control group, we found no significant difference between 19 adopters (24%) and 10 relapsers (13%).

We were also interested in examining sex workers who remained as adopters throughout subsequent follow-up assessments. In the intervention community, we observed 27 adopters (32%) between the baseline to first follow-up who maintained 100% condom use in 2nd and 3rd follow-up assessments. Remarkably, we observed only 6 relapsers (7%) (McNemar test = 13.36, P = 0.0003). In the control community, only 7 sex workers (9%) maintained 100% condom use, whereas 19 sex workers (25%) failed to maintain 100% condom use. This difference was statistically significant (McNemar test = 5.54, P = 0.0186). Changes in condom use from baseline to follow-up assessments followed similar patterns (Table 2).

Figure 1 outlines the net difference in 100% condom use between adopters and relapsers by intervention condition. In the intervention community, we consistently observed significantly more adopters than relapsers at each assessment. In the control community, however, the net differences between the adopters and relapsers were not significant. In fact, the comparison of adopters and relapsers between baseline and all waves indicated that there were significantly more relapsers than adopters in the control community.

Figure 1
Figure 1
Image Tools

Figure 2 shows the percentage of condom use by intervention status. The percentage of condom use was examined using a random effects regression model, controlling for baseline differences in marital status and HIV/AIDS knowledge. We observed an increase in condom use in both the intervention and the control communities. However, condom use increased significantly more among sex workers in the intervention community than among those in the control community in a linear fashion over the 3 follow-up periods (B = 0.3447, P = 0.002).

Figure 2
Figure 2
Image Tools
Back to Top | Article Outline

DISCUSSION

The Sonagachi Project has achieved worldwide recognition for its innovative approach to public health, 26,27 including World Health Organization funding and coverage in The New York Times.28 The project organized an international meeting of sex workers in 2001 that mobilized thousands of sex workers in the Millennium Mila Mela Conference, demonstrating its impact as a social movement. However, there were few previous empirical data on which to evaluate the efficacy of this intervention.

Although it involved only 2 communities, the Sonagachi intervention resulted in significant increases in condom use in a relatively short period that were sustained for 16 months. Consistent condom use was demonstrated by an additional 40% of sex workers, a figure that was sustained over 3 assessments over 16 months. Fewer than 5% relapsed over that period in the intervention community. Comparable increases were not found in the control communities.

It is important to note that knowledge of STD- and AIDS-preventive methods were high prior to implementing the intervention. However, condom use was not similarly high. The rate of STDs was so low (<1%) that it was not feasible to demonstrate reductions in STD infection over the 16 months.

This is a relatively low-cost intervention that has benefits that extend beyond HIV prevention. The most significant cost is the establishment of a clinic that is available to provide treatment of STDs and training of sex workers to deliver prevention messages and promote condom use. Yet, there were significant increases in condom use once these resources were established in a community far removed from the initial intervention site in Calcutta. More than half of the sex workers had a regular sexual partner, a “babu.” Although we did not assess changes in communication between marital partners or babus, there were spontaneous reports that the intervention helped sex workers communicate and be assertive with their spouses, babus, and stakeholders. In addition to the treatment of STDs for sex workers, the health clinic also provided free health care to their families, clients, and other persons living in the red light areas. Having access to these resources may increase the perception of one's status, as well as the status of sex workers in the community.

As this intervention was mounted over a very long period in Calcutta, a set of social entrepreneurial programs became attached (e.g., a micro-savings and lending cooperative, literacy programs, cultural programs, schools). Over the 16-month period, sex workers in the local sites had only just begun to build these resources, prioritizing services and education for their children and literacy for sex workers. However, with a forum for community dialogue and the experience of sex worker peer organizers from Calcutta, benefits accrued over time and continue to be implemented.

Notwithstanding our findings, the study had several limitations. First, only 2 communities were included, which limits the generalizability of our results. Nevertheless, we found significant differences in consistent condom use, suggesting the effectiveness of the Sonagachi intervention among sex workers in the 2 communities and other locales in India. It would be helpful, however, to increase the number of communities within India, and to test the intervention in locales outside of India, so as to increase external validity.

While steps were taken to avoid contamination, the research team noted some movement back and forth between the 2 communities and an awareness of the existence of an enhanced intervention among some sex workers in the control community. However, we still found significant differences in condom use across the sites. Given the inclusion of only 2 communities, it is also possible that differences in these communities, other than the intervention, contributed to differential rates of condom use. However, efforts were made by the research team, working in concert with members of the Calcutta-based team, to ensure parity across the selected communities in terms of size, language, religion, and other sociode-mographic factors.

An additional limitation is that condom use was by self-report only. While we implemented VDRL testing at baseline and in subsequent waves as an independent marker of sexual risk, STD rates were too low to be of use in documenting sexual risk behavior. To reduce social desirability, separate teams of interviewers and intervention staff were maintained, interviewers were trained to remain nonjudgmental, and participants were identified by a code number only for the assessment and assured of confidentiality. Additionally, while not intended as an outcome measure for this study, the Calcutta-based team kept monthly records of the number of condoms sold (at a nominal, subsidized price) outside the clinic; the records indicate increases in condom sales over time and higher numbers of condoms distributed in the intervention community from the second wave onward as compared with the control community. While we cannot be assured that these condoms were used, condom supply measures tend to corroborate the self-reports of condom use among the sex workers, thus increasing our confidence in the results.

Lastly, the implementation of a control site that did not receive the enhanced intervention against STDs and HIV raises ethical dilemmas. However, efforts were made by the research team to address the ethical concerns. First, the provision of a free, accessible health clinic for sex workers in both of the sites was an improvement over the usual standard of care. Second, there was no guarantee that the intervention would be effective. And most importantly, in discussions between the U.S.-based research team and the Calcutta-based Sonagachi intervention team, it was agreed that at the end of the study period the control community would cross over; the Sonagachi team moved into the control community after the study period to provide the enhanced intervention.

Too often, effective interventions are conceptualized based on theories of social change and launched by university researchers. This intervention was designed by the community, 29,30 is sustained by the community, and is taken to new communities by sex workers. In this replication, the mounting and design of the intervention were controlled by the Calcutta team of sex workers from the Sonagachi Project. The research team only conducted the evaluation of a project conceived and refined over time by the community. Greater emphasis must be placed on interventions arising from communities if HIV prevention programs are to be sustained and broadly implemented.

Back to Top | Article Outline

REFERENCES

1. Gangakhedkar R, Bentley M, Divekar A, et al. Spread of HIV infection in married monogamous women in India. JAMA. 1997;278:2090–2092.

2. National AIDS Control Organisation. Country Scenario 1997–98. New Delhi, India: Ministry of Health and Family Welfare; 1998:15–31.

3. Centers for Disease Control and Prevention. Health: HIV/AIDS time bomb ticking in India. IPS Wire, December 1, 1997.

4. UNAIDS. Female Sex Worker HIV Prevention Projects: Lessons Learnt From Papua New Guinea, India, and Bangladesh. Geneva, Switzerland: UNAIDS; 2000.

5. National AIDS Control Organisation. Combatting HIV/AIDS in India 2000–2001. Ministry of Health and Family Welfare, Government of India; 2001. Available at: http://naco.nic.in. Accessed June 17, 2003.

6. UNAIDS. HIV and AIDS-Related Stigmatization, Discrimination and Denial: Forms, Contexts, and Determinants. Geneva, Switzerland: UNAIDS; 2000.

7. UNAIDS. Report on the Global HIV/AIDS Epidemic. Geneva, Switzerland: UNAIDS; 2002.

8. Fortenberry JD, McFarlane M, Bleakley A, et al. Relationships of stigma and shame to gonorrhea and HIV screening. Am J Public Health. 2002;92:378–381.

9. Valdiserri RO. HIV/AIDS stigma: an impediment to public health. Am J Public Health. 2002;92:341–342.

10. Chesney MA, Smith AW. Critical delays in HIV testing and care. Am Behav Scientist. 1999;42:1162–1174.

11. Herek GM. AIDS and stigma. Am Behav Scientist. 1999;42:1106–1116.

12.Rao V, Gupta I, Lokshin M, et al. Sex workers and the cost of safe sex: the compensating differential for condom use among Calcutta prostitutes. J Dev Econ. 2003;71:585–603.

13. Pegacao. Brazil: sex and self-worth. AIDS Action. 1991;15:5.

14. Panos Institute. The Hidden Cost of AIDS: The Challenge of HIV to Development. London: The Panos Institute; 1992.

15. Schoeof BG. AIDS action-research with women in Kinshasa, Zaire. Soc Sci Med. 1993;37:1401–1413.

16. Asthana S, Oostvogels R. Community participation in HIV prevention: problems and prospects for community-based strategies among female sex workers in Madras. Soc Sci Med. 1996;43:133–148.

17. Nagelkerke NJD, Jha P, de Vlas SJ, et al. Modeling HIV/AIDS epidemics in Botswana and India: impact of interventions to prevent transmission. Bull World Health Organ. 2002;80:89–96.

18. Nath MB. Women's health and HIV: experience from a sex workers' project in Calcutta. Gend Dev. 2000;8:100–108.

19. Bandyopadhyay N, Banerjee B. Sex workers in Calcutta organize themselves to become agents for change. Sex Health Exch. 1999;2:6–8.

20. Chakraborty AK, Jana S, Das A, et al. Community based survey of STD/HIV infection among commercial sexworkers in Calcutta (India): part I: some social features of commercial sexworkers. J Commun Dis. 1994;26:161–167.

21. Jana S, Chakraborty AK, Das A, et al. Community based survey of STD/HIV infection among commercial sex-workers in Calcutta (India): part II: sexual behaviour, knowledge and attitude towards STD. J Commun Dis. 1994;26:168–171.

22. Kumar S. Model for sexual health found in India's West Bengal. Lancet. 1998;351:46.

23. Singh IP. STD-HIV intervention programme: the Sonagachi model. Health Millions. 1998;24:11–13.

24. Evans C, Lambert H. Health-seeking strategies and sexual health among female sex workers in urban India: implications for research and service provision. Soc Sci Med. 1997;44:1791–1803.

25. Littell RC, Milliken GA, Stroup WW, et al. SAS7 System for Mixed Models. Cary, NC: SAS Institute; 1996.

26. Jana S, Bandyopadhyay N, Mukherjee S, et al. STD/HIV intervention with sex workers in West Bengal, India. AIDS. 1998;12(suppl B):S101–108.

27. Jana S. Herpes, cytomegalovirus, and other STDs in high risk group. Indian J Sex Transm Dis. 1996;17:11–14.

28. Dugger CW. Calcutta's prostitutes lead the fight on AIDS. The New York Times. January 4, 1999:A1, A8.

29. Kelly JA. Community implementation of HIV research intervention. Paper presented at: Center for HIV Identification, Prevention and Treatment Services (CHIPTS) Colloquia at the AIDS Service Center; March 25, 1999; Pasadena, CA.

30. Kelly JA. Community-level interventions are needed to prevent new HIV infections. Am J Public Health. 1999;89:299–301.

Cited By:

This article has been cited 52 time(s).

American Behavioral Scientist
Racism and Health II: A Needed Research Agenda for Effective Interventions
Williams, DR; Mohammed, SA
American Behavioral Scientist, 57(8): 1200-1226.
10.1177/0002764213487341
CrossRef
International Journal of Std & AIDS
Correlates of consistent condom use among female entertainment workers in Shanghai, China: a repeated measures analysis
Yang, X; Xia, G
International Journal of Std & AIDS, 24(7): 555-559.
10.1177/0956462412473959
CrossRef
Social Science & Medicine
The necessary contradictions of 'community-led' health promotion: A case study of HIV prevention in an Indian red
Cornish, F; Ghosh, R
Social Science & Medicine, 64(2): 496-507.
10.1016/j.soescimed.2006.09.009
CrossRef
AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv
HIV infection dynamics in rural Andhra Pradesh south India: A sexual-network analysis exploratory study
Schneider, JA; Saluja, GS; Oruganti, G; Dass, S; Tolentino, J; Laumann, EO; Yeldandi, V; Pitrak, D
AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv, 19(9): 1171-1176.
10.1080/09540120701336392
CrossRef
AIDS Education and Prevention
Gender, work, and HIV risk: Determinants of risky sexual behavior among female entertainment workers in China
Yang, XS; Xia, GM
AIDS Education and Prevention, 18(4): 333-347.

Substance Use & Misuse
Comparison of sexual and drug use behaviors between female sex workers in Tijuana and Ciudad Juarez, Mexico
Patterson, TL; Semple, SJ; Fraga, M; Bucardo, J; De La Torre, A; Salazar, J; Orozovich, P; Staines, H; Amaro, H; Magis-Rodriguez, C; Strathdee, SA
Substance Use & Misuse, 41(): 1535-1549.
10.1080/10826080600847852
CrossRef
Health Education Research
Community development and HIV/STI-related vulnerability among female sex workers in Rio de Janeiro, Brazil
Kerrigan, D; Telles, P; Torres, H; Overs, C; Castle, C
Health Education Research, 23(1): 137-145.
10.1093/her/cym011
CrossRef
Tropical Medicine & International Health
Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review
Shahmanesh, M; Patel, V; Mabey, D; Cowan, F
Tropical Medicine & International Health, 13(5): 659-679.
10.1111/j.1365-3156.2008.02040.x
CrossRef
Lancet
HIV prevention 4 - Structural approaches to HIV prevention
Gupta, GR; Parkhurst, JO; Ogden, JA; Aggleton, P; Mahal, A
Lancet, 372(): 764-775.
10.1016/S0140-6736(08)60887-9
CrossRef
Journal of Urban Health-Bulletin of the New York Academy of Medicine
Structural interventions: Concepts, challenges and opportunities for research
Blankenship, KM; Friedman, SR; Dworkin, S; Mantell, JE
Journal of Urban Health-Bulletin of the New York Academy of Medicine, 83(1): 59-72.
10.1007/s11524-005-9007-4
CrossRef
Lancet Infectious Diseases
Containing HIV/AIDS in India: the unfinished agenda
Chandrasekaran, P; Dallabetta, G; Loo, V; Rao, S; Gayle, H; Alexander, A
Lancet Infectious Diseases, 6(8): 508-521.

American Journal of Public Health
A Systematic Review of the Effectiveness of Peer-Based Interventions on Health-Related Behaviors in Adults
Webel, AR; Okonsky, J; Trompeta, J; Holzemer, WL
American Journal of Public Health, 100(2): 247-253.
10.2105/AJPH.2008.149419
CrossRef
AIDS Education and Prevention
Effectiveness of Peer Education Interventions for Hiv Prevention in Developing Countries: A Systematic Review and Meta-Analysis
Medley, A; Kennedy, C; O'Reilly, K; Sweat, M
AIDS Education and Prevention, 21(3): 181-206.

Journal of Biosocial Science
Female autonomy as a contributing factor to women's HIV-related knowledge and behaviour in three culturally contrasting states in India
Bloom, SS; Griffiths, PL
Journal of Biosocial Science, 39(4): 557-573.
10.1017/S0021932006001623
CrossRef
Sexually Transmitted Infections
A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia
Foss, AM; Hossain, M; Vickerman, PT; Watts, CH
Sexually Transmitted Infections, 83(7): 510-516.
10.1136/sti.2007.027144
CrossRef
Lancet
Coordinating HIV control efforts: what to do with the national AIDS commissions
England, R
Lancet, 367(): 1786-1789.

American Journal of Public Health
Structural and Environmental Barriers to Condom Use Negotiation With Clients Among Female Sex Workers: Implications for HIV-Prevention Strategies and Policy
Shannon, K; Strathdee, SA; Shoveller, J; Rusch, M; Kerr, T; Tyndall, MW
American Journal of Public Health, 99(4): 659-665.
10.2105/AJPH.2007.129858
CrossRef
Sexually Transmitted Infections
Factors associated with awareness and utilisation of a community mobilisation intervention for female sex workers in Andhra Pradesh, India
Blankenship, KM; Burroway, R; Reed, E
Sexually Transmitted Infections, 86(): I69-I75.
10.1136/sti.2009.038653
CrossRef
Social Science & Medicine
Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases
Swendeman, D; Basu, I; Das, S; Jana, S; Rotheram-Borus, MJ
Social Science & Medicine, 69(8): 1157-1166.
10.1016/j.socscimed.2009.07.035
CrossRef
International Journal of Infectious Diseases
HIV infection in women utilizing a major hospital in Andhra Pradesh, India, 1993-2004
Sudha, T; Teja, VD; Lakshmi, V
International Journal of Infectious Diseases, 11(1): 63-68.
10.1016/j.ijid.2005.09.006
CrossRef
Bmc Public Health
Fostering disability-inclusive HIV/AIDS programs in northeast India: a participatory study
Morrow, M; Arunkumar, M; Pearce, E; Dawson, HE
Bmc Public Health, 7(): -.
ARTN 125
CrossRef
AIDS
Declines in risk behaviour and sexually transmitted infection prevalence following a community-led HIV preventive intervention among female sex workers in Mysore, India
Reza-Paul, S; Beattie, T; Syed, HUR; Venukumar, KT; Venugopal, MS; Fathima, MP; Raghavendra, HR; Akram, P; Manjula, R; Lakshmi, M; Isac, S; Ramesh, BM; Washington, R; Mahagaonkar, SB; Glynn, JR; Blanchard, JF; Moses, S
AIDS, 22(): S91-S100.

Canadian Medical Association Journal
India's HIV-1 epidemic
Arora, P; Cyriac, A; Jha, P
Canadian Medical Association Journal, 171(): 1337-1338.

Journal of Community & Applied Social Psychology
Challenging the stigma of sex work in India: Material context and symbolic change
Cornish, F
Journal of Community & Applied Social Psychology, 16(6): 462-471.
10.1002/casp.894
CrossRef
International Journal of Epidemiology
Commentary: Categorizing risks for HIV among female sex workers: the importance of context
Lambert, H
International Journal of Epidemiology, 39(2): 448-449.
10.1093/ije/dyq042
CrossRef
AIDS and Behavior
Acceptability of a Microenterprise Intervention Among Female Sex Workers in Chennai, India
Sherman, SG; Srikrishnan, AK; Rivett, KA; Liu, SH; Solomon, S; Celentano, DD
AIDS and Behavior, 14(3): 649-657.
10.1007/s10461-010-9686-z
CrossRef
Culture Health & Sexuality
'As prostitutes, we control our bodies': perceptions of health and body in the lives of establishment-based female sex workers in Tijuana, Mexico
Choudhury, SM
Culture Health & Sexuality, 12(6): 677-689.
10.1080/13691051003797263
CrossRef
Social Science & Medicine
Mobilizing collective identity to reduce HIV risk among sex workers in Sonagachi, India: The boundaries, consciousness, negotiation framework
Ghose, T; Swendeman, D; George, S; Chowdhury, D
Social Science & Medicine, 67(2): 311-320.
10.1016/j.socscimed.2008.03.045
CrossRef
AIDS
Power, community mobilization, and condom use practices among female sex workers in Andhra Pradesh, India
Blankenship, KA; West, BS; Kershaw, TS; Biradavolu, MR
AIDS, 22(): S109-S116.

Health Psychology
Impact of a social influence intervention on condom use and sexually transmitted infections among establishment-based female sex workers in the Philippines: A multilevel analysis
Morisky, DE; Stein, JA; Chiao, C; Ksobiech, K; Malow, R
Health Psychology, 25(5): 595-603.
10.1037/0287-6133.25.5.595
CrossRef
Sexually Transmitted Infections
The importance of sex-worker interventions: the case of Avahan in India
Laga, M; Galavotti, C; Sundaramon, S; Moodie, R
Sexually Transmitted Infections, 86(): I6-I7.
10.1136/sti.2009.039255
CrossRef
Indian Journal of Medical Research
Participation in HIV vaccine trials: Listening to participant & community concerns
Mills, EJ; Jha, P
Indian Journal of Medical Research, 124(6): 608-610.

Health Education & Behavior
Measuring Exposure to Health Messages in Community-Based Intervention Studies: A Systematic Review of Current Practices
Morris, DS; Rooney, MP; Wray, RJ; Kreuter, MW
Health Education & Behavior, 36(6): 979-998.
10.1177/1090198108330001
CrossRef
Culture Health & Sexuality
'She's a professional like anyone else': social identity among Brazilian sex workers
Murray, LR; Lippman, SA; Donini, AA; Kerrigan, D
Culture Health & Sexuality, 12(3): 293-306.
10.1080/13691050903450122
CrossRef
Journal of Community & Applied Social Psychology
Empowerment to participate: A case study of participation by Indian sex workers in HIV prevention
Cornish, F
Journal of Community & Applied Social Psychology, 16(4): 301-315.
10.1002/casp.866
CrossRef
Sexually Transmitted Infections
Concepts and strategies for scaling up focused prevention for sex workers in India
Blanchard, JF; Bhattacharjee, P; Kumaran, S; Ramesh, BM; Kumar, NS; Washington, RG; Moses, S
Sexually Transmitted Infections, 84(): II19-II23.
10.1136/sti.2008.033134
CrossRef
Operations Research
Controlling Co-Epidemics: Analysis of HIV and Tuberculosis Infection Dynamics
Long, EF; Vaidya, NK; Brandeau, ML
Operations Research, 56(6): 1366-1381.
10.1287/opre.1080.0571
CrossRef
Sexually Transmitted Infections
Community engagement in HIV prevention in Asia: going from 'for the community' to 'by the community'-must we wait for more evidence?
Sarkar, S
Sexually Transmitted Infections, 86(): I2-I3.
10.1136/sti.2009.039289
CrossRef
Human Resources for Health
Empowering the people: Development of an HIV peer education model for low literacy rural communities in India
Van Rompay, KKA; Madhivanan, P; Rafiq, M; Krupp, K; Chakrapani, V; Selvam, D
Human Resources for Health, 6(): -.
ARTN 6
CrossRef
Journal of Urban Health-Bulletin of the New York Academy of Medicine
Exploring "Wine shops" as a venue for HIV prevention interventions in Urban India
Sivaram, S; Johnson, S; Bentley, ME; Srikrishnan, AK; Latkin, CA; Go, VF; Solomon, S; Celentano, DD
Journal of Urban Health-Bulletin of the New York Academy of Medicine, 84(4): 563-576.
10.1007/s11524-007-9196-0
CrossRef
AIDS Education and Prevention
Social Influence and Individual Risk Factors of Hiv Unsafe Sex Among Female Entertainment Workers in China
Yang, XS; Xia, GM; Li, XM; Latkin, C; Celentano, D
AIDS Education and Prevention, 22(1): 69-86.

Sexually Transmitted Infections
Changes in risk behaviours and prevalence of sexually transmitted infections following HIV preventive interventions among female sex workers in five districts in Karnataka state, south India
Ramesh, BM; Beattie, TSH; Shajy, I; Washington, R; Jagannathan, L; Reza-Paul, S; Blanchard, JF; Moses, S
Sexually Transmitted Infections, 86(): I17-I24.
10.1136/sti.2009.038513
CrossRef
Janac-Journal of the Association of Nurses in AIDS Care
HIV infection returning to Mexico with migrant workers: An exploratory study
Sowell, RL; Holtz, CS; Velasquez, G
Janac-Journal of the Association of Nurses in AIDS Care, 19(4): 267-282.
10.1016/j.jana.2008.01.004
CrossRef
American Journal of Community Psychology
The Social Conditions for Successful Peer Education: A Comparison of Two HIV Prevention Programs Run by Sex Workers in India and South Africa
Cornish, F; Campbell, C
American Journal of Community Psychology, 44(): 123-135.
10.1007/s10464-009-9254-8
CrossRef
Bmc Public Health
Community mobilization, empowerment and HIV prevention among female sex workers in south India
Blanchard, AK; Mohan, HL; Shahmanesh, M; Prakash, R; Isac, S; Ramesh, BM; Bhattacharjee, P; Gurnani, V; Moses, S; Blanchard, JF
Bmc Public Health, 13(): -.
ARTN 234
CrossRef
Journal of Epidemiology and Community Health
Social participation and drug use in a cohort of Brazilian sex workers
Leslie, HH; Ahern, J; Chinaglia, M; Kerrigan, D; Lippman, SA
Journal of Epidemiology and Community Health, 67(6): 491-497.
10.1136/jech-2012-202035
CrossRef
AIDS and Behavior
Community Empowerment Among Female Sex Workers is an Effective HIV Prevention Intervention: A Systematic Review of the Peer-Reviewed Evidence from Low- and Middle-Income Countries
Kerrigan, DL; Fonner, VA; Stromdahl, S; Kennedy, CE
AIDS and Behavior, 17(6): 1926-1940.
10.1007/s10461-013-0458-4
CrossRef
International Journal of Drug Policy
Alcohol consumption patterns and sexual risk behavior among female sex workers in two South Indian communities
Heravian, A; Solomon, R; Krishnan, G; Vasudevan, CK; Krishnan, AK; Osmand, T; Ekstrand, ML
International Journal of Drug Policy, 23(6): 498-504.
10.1016/j.drugpo.2012.03.005
CrossRef
Journal of Urban Health-Bulletin of the New York Academy of Medicine
Syringe Confiscation as an HIV Risk Factor: The Public Health Implications of Arbitrary Policing in Tijuana and Ciudad Juarez, Mexico
Beletsky, L; Lozada, R; Gaines, T; Abramovitz, D; Staines, H; Vera, A; Rangel, G; Arredondo, J; Strathdee, SA
Journal of Urban Health-Bulletin of the New York Academy of Medicine, 90(2): 284-298.
10.1007/s11524-012-9741-3
CrossRef
AIDS
Effectiveness of HIV prevention strategies in resource-poor countries: tailoring the intervention to the context
Wegbreit, J; Bertozzi, S; DeMaria, LM; Padian, NS
AIDS, 20(9): 1217-1235.
10.1097/01.aids.0000232229.96134.56
PDF (218) | CrossRef
JAIDS Journal of Acquired Immune Deficiency Syndromes
Risk Reduction Counseling Is Associated With Decreased HIV Transmission-Associated Behaviors in High-Risk Indian Heterosexuals
Solomon, SS; Solomon, S; Masse, BR; Srikrishnan, A; Beauchamp, G; Thamburaj, E; Gulvady, M; Anand, S; Mayer, KH
JAIDS Journal of Acquired Immune Deficiency Syndromes, 42(4): 478-483.
10.1097/01.qai.0000221684.83057.2f
PDF (95) | CrossRef
JAIDS Journal of Acquired Immune Deficiency Syndromes
Sustained Changes in Sexual Behavior by Female Sex Workers After Completion of a Randomized HIV Prevention Trial
MacDonald, KS; Bwayo, JJ; Cohen, CR; Moses, S; Kaul, R; The Kibera HIV Study Group, ; Ngugi, EN; Chakkalackal, M; Sharma, A; Bukusi, E; Njoroge, B; Kimani, J
JAIDS Journal of Acquired Immune Deficiency Syndromes, 45(5): 588-594.
10.1097/QAI.0b013e3180f616db
PDF (134) | CrossRef
Back to Top | Article Outline
Keywords:

condom use; condoms; HIV; HIV in India; sex workers; Sonagachi Project

© 2004 Lippincott Williams & Wilkins, Inc.

Login

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.