Determinants of consistent condom use among sex workers in India: Testing competing hypotheses of perceived risk, empowerment, and financial security

Objective: To test three competing hypotheses for predicting consistent condom use among sex workers: 1) Sex workers use condoms if they feel at risk for contracting a sexually transmitted infection (risk perception hypothesis), 2) Sex workers use condoms if they have a high level of knowledge, influence, and autonomy (empowerment hypothesis), and 3) Sex workers use condoms if they are financially secure (economic hypothesis). 

Methods: A household survey was conducted with a random sample of sex workers (n=200) in two red light districts in Kolkata, India. Logistic regression was used to assess predictors of condom use with occasional clients, regular clients, intimate live-in partners, husbands, and all partners combined. 

Results: Financial security significantly increases the odds of using a condom with all partner types. Feeling susceptible to HIV (perceived risk), serving as a peer educator (empowerment), and participating in a door-to-door campaign to teach other sex workers about condoms (empowerment) significantly increases odds of using a condom with regular clients, intimate partners, and husbands but not with occasional clients. 

Conclusions: The findings demonstrate the importance of financial security for predicting consistent condom use between sex workers and all partner types. Risk perceptions and empowerment become more important predictors of condom use as the level of intimacy and regularity of interaction between sex worker and partner increases. Interventions to improve consistent condom use among sex workers should utilize strategies specific to each type of partner rather than employing a one-size-fits-all approach.