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Are Female Sex Workers Able to Negotiate Condom Use with Male Clients? The Case of Mobile FSWs in Four High HIV Prevalence States of India

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  • Shalini Bharat
  • Bidhubhusan Mahapatra
  • Suchismita Roy
  • Niranjan Saggurti

Abstract

Introduction: Condom promotion among female sex workers (FSWs) is a key intervention in India’s National AIDS Control Program. However, there is limited understanding of how FSWs negotiate condom use with male clients, particularly in the context of their mobility for sex work. The objective of this study is to examine the factors associated with the mobile FSWs’ ability to refuse unsafe sex and successfully negotiate condom use with unwilling male clients. Methods: Data for 5498 mobile FSWs from a cross-sectional survey conducted in 22 districts of four states in southern India were analyzed. Questions assessed FSWs’ ability to refuse clients unprotected sex, convince unwilling clients for condom use and negotiate condom use in a new location. Logistic regression models were constructed to examine the association between socio-demographics, economic vulnerability, sex work practice, and program exposure and condom negotiation ability. Results: A majority of FSWs (60%) reported the ability to refuse clients for unprotected sex, but less than one-fifth reported the ability to successfully convince an unwilling client to use a condom or to negotiate condom use in a new site. Younger and older mobile FSWs compared to those who were in the middle age group, those with longer sex work experience, with an income source other than sex work, with program exposure and who purchased condoms for use, reported the ability to refuse unprotected sex, to successfully negotiate condom use with unwilling clients and to do so at new sites. Conclusion: FSWs need to be empowered to not only refuse unprotected sex but also to be able to motivate and convince unwilling clients for condom use, including those in new locations. In addition to focusing on condom promotion, interventions must address the factors that impact FSWs’ ability to negotiate condom use.

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  • Shalini Bharat & Bidhubhusan Mahapatra & Suchismita Roy & Niranjan Saggurti, 2013. "Are Female Sex Workers Able to Negotiate Condom Use with Male Clients? The Case of Mobile FSWs in Four High HIV Prevalence States of India," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-8, June.
    • Handle: RePEc:plo:pone00:0068043
    DOI: 10.1371/journal.pone.0068043
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    References listed on IDEAS

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    1. Ghose, Toorjo & Swendeman, Dallas & George, Sheba & Chowdhury, Debasish, 2008. "Mobilizing collective identity to reduce HIV risk among sex workers in Sonagachi, India: The boundaries, consciousness, negotiation framework," Social Science & Medicine, Elsevier, vol. 67(2), pages 311-320, July.
    2. Patterson, T.L. & Mausbach, B. & Lozada, R. & Staines-Orozco, H. & Semple, S.J. & Fraga-Vallejo, M. & Orozovich, P. & Abramovitz, D. & De La Torre, A. & Amaro, H. & Martinez, G. & Magis-Rodríguez, C. , 2008. "Efficacy of a brief behavioral intervention to promote condom use among female sex workers in Tijuana and Ciudad Juarez, Mexico," American Journal of Public Health, American Public Health Association, vol. 98(11), pages 2051-2057.
    3. Shannon, K. & Strathdee, S.A. & Shoveller, J. & Rusch, M. & Kerr, T. & Tyndall, M.W., 2009. "Structural and environmental barriers to condom use negotiation with clients among female sex workers: Implications for HIV-prevention strategies and policy," American Journal of Public Health, American Public Health Association, vol. 99(4), pages 659-665.
    4. Lianne A Urada & Donald E Morisky & Nymia Pimentel-Simbulan & Jay G Silverman & Steffanie A Strathdee, 2012. "Condom Negotiations among Female Sex Workers in the Philippines: Environmental Influences," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-9, March.
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    Cited by:

    1. Bidhubhusan Mahapatra & Ruchira Bhattacharya & Yamini Atmavilas & Niranjan Saggurti, 2018. "Measuring vulnerability among female sex workers in India using a multidimensional framework," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-13, September.
    2. Ruth C Chang & Katie Hail-Jares & Huang Zheng & Na He & Jennifer Z H Bouey, 2018. "Mitigating circumstances: A model-based analysis of associations between risk environment and infrequent condom use among Chinese street-based sex workers," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-15, May.
    3. Bidhubhusan Mahapatra & Monika Walia & Sangram Kishor Patel & Madhusudana Battala & Saradiya Mukherjee & Prachi Patel & Balakrishnan Subramanium & Yamini Atmavilas & Niranjan Saggurti, 2020. "Sustaining consistent condom use among female sex workers by addressing their vulnerabilities and strengthening community-led organizations in India," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-17, July.
    4. Caitlin McLachlan & Tinashe Dune, 2020. "A Systematic Review of Factors Influencing Condom Use among Female Sex Workers," International Journal of Social Science Studies, Redfame publishing, vol. 8(5), pages 97-126, September.

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