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Violence and HIV Risk Among Female Sex Workers in Southern India

Deering, Kathleen N. PhD*; Bhattacharjee, Parinita MA; Mohan, H.L.; Bradley, Janet MA; Shannon, Kate PhD*; Boily, Marie-Claude PhD§; Ramesh, B.M. PhD; Isac, Shajy PhD; Moses, Stephen MD; Blanchard, James PhD

doi: 10.1097/OLQ.0b013e31827df174
Original Study

Background: This study characterized the type and frequency of violence against female sex workers (FSWs) perpetrated by their clients and their main intimate or other nonpaying partner (NPP) and examined the relationship between violence and inconsistent condom use (ICU, <100%). The factors associated with client violence were also assessed.

Methods: Data were analyzed from cross-sectional surveys of FSWs in Karnataka state (2007–2008), India. Multivariable logistic regression was used to assess the following: (1) relationship between client or NPP violence (physical and/or sexual) and ICU by occasional/repeat clients or the NPP and (2) relationship between social and environmental factors and client violence.

Results: Of 1219 FSWs, 9.6% (111) and 3.7% (42) reported experiencing violence by clients and the NPP, respectively. In multivariable analysis, after adjusting for social and environmental factors, the odds of ICU by occasional clients were significantly higher for women who had experienced client violence (adjusted odds ratio [AOR], 2.7; 95% confidence interval (CI), 1.6–4.4). Similar results were found with repeat clients (AOR, 2.2; 95% CI, 1.4–3.4). Nonpaying partner violence was not significantly associated with ICU by the NPP. In multivariable analysis, only being recently arrested remained significantly associated with experiencing client violence (AOR, 1.8; 95% CIs, 1.0–3.3).

Conclusions: The findings from this study provide evidence of a relationship between experiencing client violence and ICU by occasional and repeat clients, and a relationship between being arrested and client violence. Comprehensive structural/policy programming for FSWs, including within HIV-focused prevention programs, is urgently needed to help reduce FSWs’ vulnerability to violence.

This study provides evidence of a strong relationship between client violence and inconsistent condom use by occasional and repeat clients, and a relationship between being arrested and experiencing client violence.

From the *Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada; †Karnataka Health Promotion Trust, Bangalore, India; ‡Laval University, Quebec City, Canada; §Department of Infectious Diseases Epidemiology, Imperial College, London, UK; Departments of ¶Medical Microbiology and ∥Community Health Sciences, University of Manitoba, Manitoba, Canada

The authors acknowledge and thank the women who participated in this study and the study and support team at the Karnataka Health Promotion Trust in Bangalore India. The authors thank Souradet Shaw for technical and analytic advice and expertise. K.N.D. is supported by Postdoctoral Research Fellowships from the Canadian Institutes of Health Research (Bisby Award) and the Michael Smith Foundation for Health Research. Support for this study was provided by the Bill and Melinda Gates Foundation. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Bill and Melinda Gates Foundation.

The authors declare no conflict of interest.

Correspondence: Kathleen N. Deering, PhD, Division of AIDS, Faculty of Medicine, University of British Columbia, and BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6. E-mail:

Received for publication July 30, 2012, and accepted October 10, 2012.

© Copyright 2013 American Sexually Transmitted Diseases Association