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Contraceptive practices, sexual and reproductive health needs of HIV-positive and negative female sex workers in Goa, India
  1. Sonali Wayal1,2,
  2. Frances Cowan2,
  3. Pamela Warner3,
  4. Andrew Copas2,
  5. David Mabey4,
  6. Maryam Shahmanesh1,2
  1. 1Positive People, Goa, India
  2. 2Center for Sexual Health and HIV Research, University College London, London, UK
  3. 3Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
  4. 4London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence toSonali Wayal, Center for Sexual Health and HIV Research, Mortimer Market Center, Off Capper Street, London WC1E 6JB, UK; sonaliwayal{at}


Objectives In India, female sex workers (FSWs), suffer from high HIV prevalence and abortions. Contraceptive use among general population women is well understood. However, FSWs contraceptives practices and reproductive health needs are under-researched. We investigated contraceptive practices among HIV-positive and negative FSWs in Goa, India and explored its association with socio-demographic and sex work related factors.

Methods Cross-sectional study using respondent driven sampling recruited 326 FSWs. They completed an interviewer-administered questionnaire and were screened for STI/HIV. Multivariable logistic regression was used to explore factors associated with sterilisation relative to no contraception.

Results HIV prevalence was high (26%). Of the 59 FSWs planning pregnancy, 33% were HIV-positive and 5–7% had Gonorrhoea, Chlamydia and Trichomonas. 25% and 65% of FSWs screened-positive for Syphilis and Herpes simplex virus type 2 antibodies respectively. Among the 260 FSWs analysed for contraceptive use, 39% did not use contraceptives, and 26% had experienced abortion. Half the FSWs had undergone sterilisation, and only 5% used condoms for contraception. Among HIV-positive FSWs, 45% did not use contraceptives. Sterilisation was independently associated with older age, illiteracy, having an intimate non-paying male partner, having children and financial autonomy. Exposure to National AIDS Control Organisation's HIV-prevention interventions was reported by 34% FSWs and was not significantly associated with contraceptive use (adjusted odds ratio 1.4, 95% CI 0.7 to 2.9).

Conclusion HIV-prevention interventions should promote contraception, especially among young and HIV-positive FSWs. Integrating HIV treatment and care services with HIV-prevention interventions is vital to avert HIV-positive births.

  • Contraception
  • HIV
  • STD
  • women

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  • Funding The authors are grateful to the Wellcome Trust for supporting this work through a fellowship grant given to MS.

  • Competing interests SW is supervised for her PhD by J Cassell, who is the editor of Sexually Transmitted Infections. AC is the statistical advisor for Sexually Transmitted Infections.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Independent Ethics Commission, Mumbai and University College London's Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.