Abstract

Background: Interventions targeting sex-workers are central to the National AIDS Control program of India's third five-year plan. Understanding the way in which societal and individual factors interact to shape sex-workers' vulnerability would better inform interventions.

Methods: 326 female sex workers, recruited throughout Goa using respondent-driven-sampling, completed interviewer-administered questionnaires. Biological samples were tested for Trichomonas vaginalis, Neisseria gonorrhoea, Chlamydia trachomatis, and antibodies to Herpes simplex type 2, and HIV. Multivariate analysis was used to define the determinants of HIV infection and any bacterial sexually transmitted infection.

Results: Infections were common with 25.7% prevalence of HIV and 22.5% prevalence of bacterial sexually transmitted infection (STIs); chlamydia 7.3%, gonorrhoea 8.9% and trichomonas 9.4%. Antibodies to Herpes simplex type 2 were detected in 57.2% of the women. STIs were independently associated with factors reflecting gender disadvantage and disempowerment namely, young age, lack of schooling, no financial autonomy, deliberate-self-harm, sexual-abuse and sex work related factors, having regular customers, and working on the streets. Other factors associated with STIs were Goan ethnicity, not having an intimate partner, and being asymptomatic. Having knowledge about HIV and access to free STI services was associated with a lower likelihood of STIs. HIV was independently associated with being Hindu, recent migration to Goa, lodge or brothel based sex work, genital-ulcer-disease, and dysuria.

Conclusion: Sex-workers working in medium prevalence states of India are highly vulnerable to HIV and STIs, and need to be rapidly incorporated into existing interventions. Structural and gender based determinants of HIV and STIs are integral to HIV prevention strategies.