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Understanding Out-Migration Among Female Sex Workers in South India

Banandur, Pradeep MD*†; Ramanaik, Satyanarayana MSW*; Manhart, Lisa E. PhD; Buzdugan, Raluca PhD§; Mahapatra, Bidhubhushan MPhil; Isac, Shajy PhD*; Halli, Shiva S. PhD; Washington, Reynold G. MD, DNB**; Moses, Stephen MD, MPH; Blanchard, James F. PhD

doi: 10.1097/OLQ.0b013e3182641d90
Original Study

Background Migrant sex workers are known to be vulnerable to HIV. There is substantial female sex worker (FSW) mobility between the borders of Maharashtra and Karnataka, but little programming emphasis on migrant FSWs in India. We sought to understand the individual/cultural, structural, and contextual determinants of migration among FSWs from Karnataka.

Methods A cross-sectional face-to-face interview of 1567 FSWs from 142 villages in 3 districts of northern Karnataka, India was conducted from January to June 2008. Villages having 10+ FSWs, a large number of whom were migrant, were selected following mapping of FSWs. Multinomial logistic regression was conducted to identify characteristics associated with migrant (travelled for ≥2 weeks outside the district past year) and mobile (travelled for <2 weeks outside the district past year) FSWs; adjusting for age and district.

Results Compared with nonmigrants, migrant FSWs were more likely to be brothel than street based (Adjusted Odds Ratio (AOR): 5.7; 95% confidence interval: 1.6–20.0), have higher income from sex work (Adjusted Odds Ratio (AOR): 42.2; 12.6–142.1), speak >2 languages (AOR: 5.6; 2.6–12.0), have more clients (AORper client: 2.9; 1.2–7.2), and have more sex acts per day (AORper sex act: 3.5; 1.3–9.3). Mobile FSWs had higher income from sex work (AOR: 13.2; 3.9–44.6) relative to nonmigrants, but not as strongly as for migrant FSWs.

Conclusion Out-migration of FSWs in Karnataka was strongly tied to sex work characteristics; thus, the structure inherent in sex work should be capitalized on when developing HIV preventive interventions. The important role of FSWs in HIV epidemics, coupled with the potential for rapid spread of HIV with migration, requires the most effective interventions possible for mobile and migrant FSWs.

This study analyzes the factors affecting out-migration 1 among female sex workers Bagalkot, Belgaum and Bijapur districts in Karnataka south India.

From the *Karnataka Health Promotion Trust, Bangalore, India; †Department of Community Medicine, Rajarajeswari Medical College and Hospital, Bangalore, India; ‡University of Washington, Seattle, WA; §Department of Infection and Population Health, University College London, London, United Kingdom; ¶Population Council, New Delhi, India; ∥University of Manitoba, Winnipeg, MB, Canada; and **St. John’s Research Institute, Bangalore, India

The authors would like to thank all the field and data entry staff for collecting and compiling the data, as well as the study participants in Belgaum, Bagalkot and Bijapur districts, the program staff of Karnataka Health promotion trust and the sex work collectives of the 3 districts.

Conflict of interest and sources of funding: Supported by grants from the World Bank, United States Agency for International Development (USAID), Canadian International Development Agency and Canadian Institutes of Health Research (to J.F.B.); by the Indian Council of Medical Research (to R.W.). Support for this study was provided by the Bill & Melinda Gates Foundation. The data analysis component of this study was supported by NIH research grant D43 TW000007, funded by the Fogarty International Center. All other authors declare no conflict of Interest.

The views expressed in this paper are solely those of the authors and do not necessarily reflect the official views of the Bill & Melinda Gates Foundation or the Fogarty International Center.

Correspondence: Pradeep Banandur, MD, Department of Community Medicine, Rajarajeswari Medical College and Hospital, Bangalore 560074, India. E-mail:

Received for publication December 23, 2011, and accepted June 5, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association