Challenges in advocating safe sex practices for Female Sex Workers (FSWs): A study of TI program phase 1

Background:  The HIV infection in India is concentrated in high risk groups (Female sex workers (FSWs); men who have sex with men (MSM)/Trans-gender (TGs) and Injection drug users (IDUs)); and is primarily spread through unprotected sexual intercourse. National AIDS Control Programme (NACP III) is distributing Targeted Interventions (TIs) ‘packages’ that encourage the processes of community led- and community owned TIs in supporting access to information and services based on identified local community needs.  

Methods: A needs assessment was conducted as the first step to identify challenges in tailoring this Targeted Interventions (TIs) as suggested by the NACP III to Female Sex Workers (FSWs) enrolled in the TI program by a local NGO in a small rural community in the state of Punjab in India. The sample (n=301) was recruited by snow ball method and a structured questionnaire was used to gather information to assess HIV risk.

Results/Outcome:  The mean age was 31.6 years (SD= 5.9); 64% were illiterate; about 79% were married and of that about 73% did not have any regular clients, i.e. they had multiple new sexual partners other than their husband. Majority of FSWs (94%) conducted their business from home and 41% reported a habitual use of substance (alcohol). 54% did not use protection in over 60% of sexual acts (last 3 months) and 22% reported having STIs (in last 3 months). Correlation showed that with increasing age and years in this profession, the frequency of number of sexual contacts per week decreased significantly.   Those with need to be intoxicated before sexual act were found to be significantly higher in their level of total risk status (# of acts, # of partners, condom use, STIs and substance use). Marital status did not have any statistically significant impact on these sexually risky behaviors in the sample.

Conclusions: Through empowering of local NGOs to tailor program to reach their risk population, the NGOs are leading the way to address stigma and marginalization by including FSWs as partners to inform the research and as peers to educate their own vulnerable community members. This will lead to improved health seeking behaviors and access to services.