Background Recent studies from India show that self-reported anal sex increased from 3% to 22% among female sex workers. However, comparable data from male clients’ of FSWs are lacking. Using data from a bio-behavioural survey (2009–2010), we examined correlates of male clients’ self-reported inconsistent condom use during anal sex with FSWs in Andhra Pradesh, Maharashtra and Tamil Nadu.
Methods Using a two-stage time-location cluster sampling, we recruited 4,803 men aged between 18 and 60 years who purchased sex from FSWs in the past month. After obtaining informed consent, respondents were interviewed and tested for HIV and STIs (Syphilis, Gonorrhea and Chlamydia). Logistic regression analysis was used to identify factors associated with inconsistent condom use during anal sex (in the past six months) with FSWs controlling for socio demographics and other contextual characteristics.
Results Overall, 12.4% clients reported anal sex in the past 6 months and nearly half (48.4%) used condoms inconsistently. Majority of these inconsistent users solicited FSWs from public places (77%), consumed alcohol (50%), had unprotected vaginal sex (99%) and also reported anal sex with other men (19%). Factors associated with increased odds for inconsistent condom use were being aged above 25 years (AOR:3.38, p = 0.012), occupation as manual labourer (AOR:2.05, p = 0.029) and perceiving to be at risk of HIV (AOR:10.2, p = 0.000). Those literate (AOR:0.40, p = 0.033) and currently married (AOR:0.41, p = 0.056) were at decreased odds and being STI/HIV positive was not significantly associated with inconsistent condom use.
Conclusion Results suggest that a relatively high proportion of clients were not using condoms consistently during anal and vaginal sex with FSWs which implies a greater risk of acquiring HIV and its further transmission to their male and female sexual partners (including spouses). Given the multidirectional risk, safer sex messages addressing heterosexual anal sex needs to be incorporated into HIV prevention interventions.
- Anal sex
- female sex workers
- Male clients