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A Cross-Sectional Study of Sexually Transmitted Pathogen Prevalence and Condom Use With Commercial and Noncommercial Sex Partners Among Clients of Female Sex Workers in Southern India

Shaw, Souradet Y. MSc*; Bhattacharjee, Parinita MSc; Isac, Shajy PhD; Deering, Kathleen N. PhD; Ramesh, Banadakoppa M. PhD; Washington, Reynold MD; Moses, Stephen MD, MPH; Blanchard, James F. PhD, MD*

Sexually Transmitted Diseases: June 2013 - Volume 40 - Issue 6 - p 482–489
doi: 10.1097/OLQ.0b013e3182904a9a
Original Study

Background Clients of female sex workers (FSWs) are an important bridging population for HIV and other sexually transmitted infections. However, the extent of risk to female noncommercial partners (NCPs) of clients has not been explored.

Methods Data originated from a cross-sectional behavioral and biological survey of FSW clients from 5 districts in Karnataka state, southern India. Clients were classified into 3 groups: married, single with at least 1 NCP, and single without an NCP. Bivariate and multivariable logistic regression models were constructed to examine the association between group membership and condom use patterns with FSWs and, where applicable, NCPs. HIV, herpes simplex virus type 2 (HSV-2), and other sexually transmitted infections were examined. Normalized weights were used to account for a complex sampling design.

Results Most respondents in our sample (n = 2328) were married (61%). Compared with single respondents without an NCP, married clients were more likely to never use condoms with both occasional (adjusted odds ratio [AOR], 1.8; 95% confidence interval [CI], 1.3–2.5; P < 0.0001) and regular (AOR, 1.7; 95% CI, 1.1–2.6; P = 0.015) FSWs. Among clients with an NCP, married clients were at higher odds of never using a condom with their NCP (AOR, 5.5; 95% CI, 3.7–8.1; P < 0.0001). Overall prevalence for HIV, HSV-2, syphilis, and chlamydia or gonorrhea infection was 5.7%, 28.3%, 3.6%, and 2.1%, respectively. The prevalence of HSV-2 was 37%, 16%, and 19% among those who were married, those single without an NCP, and those single with an NCP, respectively.

Conclusions Married respondents were least likely to use condoms with both commercial and noncommercial sexual partners, while also having the highest prevalence of HSV-2. These results illustrate the risk posed to both commercial partners and NCPs of married clients.

A cross-sectional study of female sex worker clients in southern India found that married clients were most likely to report never using condoms with their sex partners and had the highest prevalence of herpes simplex virus type 2. Supplemental Digital Content is available in the article.

From the *Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada; †Karnataka Health Promotion Trust, Bangalore, India; ‡University of British Columbia, Vancouver, Canada; and §Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.

This research was funded by the Bill & 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 & Melinda Gates Foundation. Souradet Shaw is supported, in part, by doctoral scholarships from the Manitoba Health Research Council, the International Infectious Disease and Global Health Training Program, the David G. Fish Memorial Scholarship, and the Canadian Institutes of Health Research. James Blanchard is supported, in part, by the Canada Research Chair in Epidemiology and Global Public Health.

Competing interests: The authors declare that they have no conflicts of interest.

Author contributions: S.Y.S. was responsible for conducting the analysis, interpretation of results, and writing of the manuscript; K.N.D. made substantial contributions to data analysis and interpretation, revised the manuscript critically, and made important intellectual contributions to the manuscript; S.I., P.B., B.M.R., and R.M. contributed to the project’s conception, design, implementation, and progress and provided extensive feedback and edits; S.M. and J.F.B. were extensively involved in the conception, methodology, and organization of the project and provided extensive intellectual guidance and substantial feedback for the manuscript.

Correspondence: Souradet Y. Shaw, MSc, Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, R070 Med Rehab Building, 771 McDermot Ave, Winnipeg, Manitoba, Canada R3E 0T6. E-mail:

Received for publication July 27, 2012, and accepted February 11, 2013.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

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