Background Clients of female sex workers (FSWs) are an important bridging population for HIV/STI transmission. Designing client-specific intervention programming faces several challenges, as clients do not comprise one single identifiable group. This study sought to describe HIV/STI prevalence by places of solicitation, among clients in south India.
Methods Data were from two rounds of cross-sectional biological and behavioural surveys of FSW clients from Karnataka State, India. Where available, the prevalence of HIV, active syphilis, herpes simplex virus type 2 (HSV-2), chlamydia (CT) and gonorrhoea (GC) was examined. Separately for each survey round and infection, multivariable logistic regression models were used to examine differences in infection prevalence by solicitation site, adjusted for clients’ district. Solicitation sites were categorised as public place, brothel, home and lodge. Sampling weights and survey methods were utilised in regression models.
Results Total sample size was 2,331 and 2,282 in Rounds 1 and 2, respectively. In Round 1, syphilis (6.1%), HIV (9.5%) and HSV-2 (31.3%) was highest among clients soliciting FSWs from brothels. CT/GC (6.6%) was highest among clients of FSWs based in lodges. In Round 2, syphilis (3.2%), HIV (6.9%) and HSV-2 (20.5%) were highest amongst clients soliciting in lodges, brothels and public places, respectively. Statistical significance was reached for HIV (p = 0.003) and CT/GC (p = 0.011) by site in Round 1 only. Differences by solicitation site in Round 1 remained significant when adjusted for district. Between rounds, prevalence decreased in all solicitation sites, with the exception of syphilis (2.0% to 3.2%) and HIV (0.6% to 1.1%) among clients frequenting lodges.
Conclusions Clients frequenting brothels had the highest HIV prevalence. Further study of the increasing prevalence of syphilis and HIV among clients frequenting lodges is warranted. Approaches focussing on where clients solicit FSWs, rather than identifying clients per se can help inform programming activities.
- FSW Clients
- HIV/STI prevalence
- Sex work