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HIV, sexually transmitted infections and sexual behaviour of male clients of female sex workers in Andhra Pradesh, Tamil Nadu and Maharashtra, India: results of a cross-sectional survey

Subramanian, Thilakavathia; Gupte, Mohan Da; Paranjape, Ramesh Sb; Brahmam, Ginnela NVc; Ramakrishnan, Lakshmid; Adhikary, Rajatashuvrad; Kangusamy, Boopathia; Thomas, Beena Ee; Kallam, Srinivasand; Girish, CPKafor the IBBA Study Team

doi: 10.1097/01.aids.0000343765.00573.ce

Objective: To characterize and describe patterns of HIV, sexually transmitted infections (STI) and sexual behaviour of male clients of female sex workers (FSW).

Methods: A cross-sectional study was conducted among 4821 clients of FSW from 12 districts in three states in India: Andhra Pradesh, Maharashtra and Tamil Nadu. A structured questionnaire was administered to elicit demographic characteristics and sexual behavioural patterns. Blood and urine samples were tested for HIV, syphilis and herpes simplex type 2 serology, gonococal and chlamydial infection.

Results: The median age of clients surveyed was 30 years; 57% were married and 64% had a steady sexual partner; 61% had sex with more than one FSW and 39% had four or more sexual encounters in the past month. The prevalence of HIV ranged from 2.0% to 10.9%, syphilis ranged from 3.1% to 10.1%; gonorrhoea and chlamydia ranged between 0% and 4.5%. Clients older than 30 years [odds ratio (OR) 1.65; 95% confidence interval (CI) 1.33–2.05] and having a different mix of commercial and non-commercial partners (OR 1.56; 95% CI 1.25–1.96) had a higher volume of sex acts with FSW. Inconsistent condom use with FSW was significantly associated with older clients (OR 4.2; 95% CI 3.33–5.29), illiteracy (OR 1.39; 95% CI 1.14–1.69), age <18 years at first paid sex (OR 1.83; 95% CI 1.24–2.70) and having different FSW partners in the past month (OR 1.64; 95% CI 1.23–2.18).

Conclusion: Clients of FSW studied here constitute a significant bridge group for HIV and other STI, because of their high volume of different sexual partners and very low consistent condom use. HIV prevention programmes need to address male clients.

aNational Institute of Epidemiology, ICMR, Chennai, India

bNational AIDS Research Institute, ICMR, Pune, India

cNational Institute of Nutrition, ICMR, Hyderabad, India

dFamily Health International, New Delhi, India

eTuberculosis Research Centre, ICMR, Chennai, India.

* Members of the IBBA study team are listed at the end of the paper.

Correspondence and requests for reprints to Thilakavathi Subramanian, National Institute of Epidemiology, ICMR, 2nd Main Road, TNHB, Ayapakkam, Chennai 600 077, India. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.