HIV prevalence remains high in many settings in south India (13.3% across three districts in Karnataka State 2009–2010). While sex workers have been shown to be at heightened vulnerability to contracting HIV through commercial sex partnerships, the role of intimate or other non-paying partnerships (NPPs) in shaping vulnerability of sex workers in south India to HIV and other sexually transmitted infections (STIs) is unclear.

This study, conducted by STRIVE partner Karnataka Health Promotion Trust (KHPT), aims to:

• examine the relationship between interpersonal as well as social-demographic, cultural and structural factors, and condom non-use by sex workers’ main intimate or other NPPs, as reported by a sample of sex workers.
• understand HIV/ STIs risk (e.g., numbers of sexual partners; condom use with different partners) among couples comprised of a sub-set of sex workers and their NPPs.

This study is part of the Samvedana Plus intervention that is designed to reduce violence and increase condom use in the intimate partnerships of female sex workers.

Methods

Bivariate and multivariable logistic regression was used to identify factors associated with condom non-use at last sex by the main NPP, as reported by sex workers. Data were drawn from cross-sectional surveys in Bagalkot District, Karnataka. Overall, this study included 257 sex workers and 76 NPPs.

Findings

Sex workers

• 48% reported that their first sex partner was within the context of a first-night ceremony, and there was substantial overlap between reported places of solicitation, with the most common being home (74.2%)
• 49.8% described their main NPP as a lover
• 50.6% currently had a child with the main NPP
• 62.4% reported not using condoms at last sex with their main NPP

Non-paying partners (NPPs)

• 76% reported that they were married to someone other than their sex worker partner
• 56.2% reported that their first sex partner was a lover, with 20.5% reporting a commercial sex partner, 16.4% reporting a wife and 6.8% reporting a casual intimate or other non-paying partner
• 56.8% reported that they had ever paid for sex with a sex worker
• 54.7% reported being a prior client of the sex work partner

In line with global calls, this study suggests that approaches to HIV/STIs prevention for sex workers should include programming designed to address barriers to condom use within intimate or other NPPs.