Differing HIV vulnerability among female sex workers in a high HIV burden Indian state

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Data generated through HIV Sentinel surveillance is a mumbai level government dataset and is not open for public access. Cross sectional data collected as a part of HSS among FSWs in year —11 from 21 sentinel sites in the state of Maharashtra were analyzed to understand the vulnerability and characteristics of different types of female sex workers based on their place of solicitation using multinomial logistic regression.

While aorkers Sex prevalence was 6. The duration since last paid sex was shorter [ARRR: 0. Sex identify them as a group to be focused on for prevention interventions and it is likely that they mumbxi be easily amenable to novel interventions due to their higher literacy rate as compared to other typologies. India ranks third in mumbai world in terms workers HIV disease burden[ 1 ]. The Indian HIV epidemic is geographically diverse and is predominantly heterosexual.

Female interventions are implemented by NACP funded non-governmental or community based organizations who follow specific guidelines for provision of prevention services. However HIV prevalence in India differs by states and even districts within states. However there has been a decline in HIV prevalence, which is associated with increasing coverage of targeted interventions for FSWs and rising prevention intervention utilization by this population under NACP [ 4 ].

Despite the steady decline, HIV prevalence among FSWs is still significantly higher as compared to the general population and other Indian states [ 4 ]. Changes in characteristics and proportions of different types of sex workers in Maharashtra over time, could be one of the other likely reasons [ 48 — 10 ], however more extensive examinations are still warranted. Traditionally, FSWs in Maharashtra used to be brothel based[ 1112 ]. Recent mapping data from Maharashtra; however, highlights that a majority of FSWs now largely solicit female the non-brothel based settings rather than brothels [ 13 ].

FSWs in Maharashtra can be broadly grouped into two groups according to their place of solicitation. The risk of acquiring HIV infection varies among different FSW typologies depending on their sexual behavior and use of condoms[ 1516 ]. Highway based sex workers are those, who recruit their clients from highways, usually from among long distance truck drivers[ 3 ].

It is also recognized, that there are certain occupations wherein workers significant female engage in female sex fairly regularly, although their primary occupational identity may not indicate sex work. They are special to the state of Maharashtra and are common in the capital city of Mumbai[ 3 ]. The Behavioral Surveillance conducted in in the state of Maharashtra, revealed that NBB FSWs reported higher proportion of sex without femxle vaginal or anal as compared to their BB counterparts.

However, they had fewer sexual partners in a week [ 17 ]. Their vulnerability to HIV infection was reported to be increased by acts of coercion and violence against them, resulting in less autonomy regarding mumbai use[ 17 ]. In addition, being less accessible to prevention programs increases their vulnerability[ 1517 ]. HIV Sentinel Surveillance HSS is a repeated cross sectional female conducted at the same site, among the same population subgroups every 2 years which includes HIV testing along with collection of minimal demographic and risk related data [ 19 ].

The most recent round of HSS for which data are available, was conducted workers —11 among all high risk populations including FSWs in Maharashtra. While HIV prevalence data from this survey have been published in various reports. However specific details about different types of FSWs and their vulnerabilities have not been fema,e.

Hence in this study, sex examined the data obtained from the HIV Sentinel Surveillance in Maharashtra conducted in —11 to understand the vulnerability and xex of different types of female sex workers based on their place of solicitation.

These categories are also used to guide programmatic interventions and funding. The sentinel sites for the HIV surveillance among high risk groups are predetermined sites, identified by NACO and the regional institutes [ 19 ]. The Targeted Workers [TI] project sites act as a sentinel surveillance sites for high risk population subgroups.

Data and samples from high risk individuals are collected over a 3 month period across each HSS site in the country during the surveillance round [ 319 ]. Woekers were 21 such surveillance sites in Maharashtra state for FSWs in Standard technical female were followed by all implementing sites nationwide described in detail elsewhere of which some are described below [ 19 female.

Selection of surveillance sites was based on epidemiologic need and availability of adequate numbers of the target population. In wor,ers workers we analyzed the data on FSWs collected from these sites. In HSS, a sample size of individuals per high risk group site has been predetermined to provide a state level estimate of HIV prevalence among high risk groups.

At each identified targeted intervention site, the sampling frame was the updated list of FSWs who were registered for prevention services and contactable in last 6 months, also called as line-list. These line-lists were checked at NARI mumbai inclusion criteria.

After exclusion of ineligible cases and simple random sampling using SPSS software, beneficiaries were randomly selected. The additional 50 numbers were selected to allow for mumbai for refusals, inability to contact the individual or ineligibility. Trained peer educators working at the sentinel numbai were given the list of selected FSWs and they invited the selected FSWs to attend the drop in center to participate in the surveillance, using a standard message.

If the selected FSW refused to participate or could not be contacted a replacement was provided until sex sample of was achieved [ 19 ]. In —11, there workers 21 sentinel sites in Maharashtra with an anticipated sample of FSWs[ 19 ]. Complete recruitment [ i. A one workers structured, 11 item questionnaire was completed after consent. Five drops of blood were collected on a specialized protein saver card [Whatman protein saver card] through finger stick method.

The cards were dried, packed and transported to the designated testing laboratory following standard operating procedures [ 20 ]. A two-test HIV testing protocol was used for testing the dried sex spots using standardized methods. The data form of each respondent was assigned a woekers identification number along sex date of sample collection at the sentinel site to follow the principle of unlinked anonymous testing [UAT]. The respondents were offered prevention and care services at the site which included referral for HIV testing along with pre and post- test counseling.

The same dataset was used in this study. We hypothesized that the vulnerability to HIV varies among different types typology of sex workers. Additionally, FSWs who reported more than one place of solicitation were also excluded from all stages of analysis to avoid the confounding effect of multiple typologies. Overall HIV prevalence for the state of Maharashtra in —11 was 0. Characteristics of FSWs such as age, sex, duration of stay, duration of sex work, number of clients, Sex status, and TI-district categorization were analyzed in detail as per sex work typology [ Table 1 ].

These characteristics were compared using chi square test for discrete variables and Kruskal Wallis test for continuous variables. Multivariate multinomial regression was used to further understand the differences between female sex workers who were workers fekale based sex work and those who were not [ Table 2 ]. Typology typology: Brothel based, Home based, Bar based and Street based FSW was considered as a dependent variable while age, education, duration of stay at current place, duration since last female sex [LPS], number sex clients in preceding week, duration of sex work and TI-district categorization as covariates in this analysis.

Brothel based category was considered as reference. Of the FSWs included in analysis, [ Although the proportion of illiterates was high sex, the bar based, home based and street based Workrs were more likely to be literate workers BB FSWs [ Additionally these FSWs were 1. Bar-B FSWs were 3. They were 0.

This is probably reflective of their monetary needs. In this respect, they were very similar to BB sex workers in our study.

Other studies have discussed that SB FSWs were less likely to use condoms with their clients, thus increasing their vulnerability to HIV infection [ 21 ]. Additionally due to their mobility and anonymous nature of solicitation, they may have less access to prevention interventions [ 15 ]. Reducing future new workesr, would thus require intense focus on this population. We would therefore like to recommend specially designed interventions for this sub-typology.

It would be important to focus on reduction in number of risky sex acts, enabling periodic HIV workers for HIV uninfected FSW and immediate linkage to care and antiretroviral therapy[ 172223 ]. The higher literacy among SB sex workers could be leveraged in developing novel methods of delivery of interventions.

Therefore it is a challenge to ensure that this population maintains low HIV prevalence rates. However due to their home based nature of activity this population poses an important challenge for delivery of prevention interventions[ 24 ]. We mumbai that this could be because either they enter sex work at an older age or may be remaining in sex work for longer duration.

However our data reveals that, they were 3 times more likely to have been involved in sex work only for shorter period 1—3 years as compared to BB FSWs. This could support the hypothesis that they enter sex work at later age, probably due to emergent financial needs. We suggest structural interventions like microfinance loans and skill-based education at appropriate times for these women [ 25 — 27 ]. Femael intervention project conducted in Mumbai and Thane district revealed that regular wprkers with bar managers and owners to sensitize them on issues of Bar-B FSWs are extremely female 15 worlers.

Since bar managers and owners offer a gateway to approach this population, interventions among new recruits to the bar could be a focused strategy that can yield good prevention benefits. There are a few limitations inn the study. Being a cross sectional study, it was difficult to assign temporality between the HIV status and behavioral characteristics of the respondents [ 30 ].

In our study, the data was collected from intervened FSWs attending the TI sites, it may not be completely representative of female the FSW population, especially those who are hidden and hard to reach for the program.

However, leads identified in the study can still help the program to focus on the most vulnerable FSWs using mumbai strategies. The typologies in the study are considered as mutually exclusive in the TI program, but in real life these may be overlapping in few cases[ 314 ].

Findings from sez study reveal the heterogeneity in characteristics and sex of different typologies of FSWs in Maharashtra. The higher literacy rate mumbai this subpopulation could be an enabler for qualitative research to inform the design of novel interventions for sustaining the decreasing trends in Femmale epidemic and moving towards the end game. The data analysis plan and manuscript development was led by the first and corresponding and female authors from NARI.

The funder had no role in study design, data collection and analysis, decision to publish, or preparation of mumbai manuscript. National Center for Biotechnology InformationU. PLoS One. Published online Feb 8. Caroline Mitchell, Editor. Author information Article notes Copyright and License information Disclaimer. Competing Feamle The authors have declared that no competing interests exist. Received Nov 4; Accepted Jan swx This is an open access article distributed under the terms of the Creative Commons Attribution Licensewhich mumbai unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Material and methods Workers sectional data collected as a part of HSS among FSWs in year —11 from 21 sentinel sites in the state of Maharashtra were analyzed to understand the vulnerability and characteristics of different types of female sex workers based on their place of solicitation using multinomial logistic regression.

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Associated Data

In this analysis, we examined the correlates of frequency of using health care services under targeted interventions among FSWs.

We used negative binomial regression models to analyse frequency of utilisation of healthcare services among FSWs. Based on our analysis we suggest that various predisposing and enabling factors were found to be significantly associated with the visit to NGO clinics for treatment of any health problem, any STI symptom and the number of condoms received from the peer-worker or condom depot.

We suggest the need for further research with respect to various correlates of frequency of using health care among FSWs to develop effective intervention strategies in countries that have high HIV prevalence among FSWs and targeted interventions need more diligent implementation to reach the unreached. Mental health awareness: The Indian scenario. Jul Ind Psychiatry J.

Oct Sex Cult. This investigation was intended, first, to examine the early life and childhood experiences of adult women working in the red-light districts of Mumbai, India. A corollary to this goal was determination of processes that led to entry into the commercial sex industry CSI. Finally, we explored exiting options.

Guided by the life-course theory of development, in-depth interviews were conducted with 30 women working in two red-light districts of Mumbai, India. Most women described childhoods of extreme poverty, had been trafficked into the CSI, and reported minimal social support as adults. Exiting was challenged by multi-faceted cultural and structural constraints.

Implications for continued research are provided. Background: Food insufficiency is one of the important contributing factors among female sex workers FSWs to engage in risky sexual behaviors and cause of HIV infection in developing countries. Studies exploring linkages between food insufficiency and HIV risk behaviors among FSWs are limited despite having potential program and policy implications. This study attempts to assess the food insufficiency among FSWs and examine its relationship with HIV risk behaviors and violence in India.

This study underscores the need for community-led interventions focusing on food insufficiency and economic strengthening activities to reduce HIV vulnerability among FSWs. However, further evidence-based research and advocacies on food insufficiency is required to ensure that HIV prevention programs are appropriately addressed. How Should We Define Health? Jan Br Med J Jun J Soc Serv Res.

Kamathipura is considered to be Asia's largest red-light area and is located in Mumbai, India. It has approximately 5, sex workers. The majority of the sex workers are trafficked as minors from rural parts of India or from Bangladesh and Nepal. The purpose of this research study was to identify and explore the needs of female sex workers in Kamathipura.

In-depth interviewing was used to gather data from 48 sex workers from July to November Three critical needs emerged pertaining to work, health, and safety.

Sex workers described their challenges of living and working in Kamathipura and discussed several health- and safety-related issues faced on a day-to-day basis. Sex workers also discussed the need for various interventions and provisions. Finally, the study provides recommendations for social work practice, policy, and research in the area. Background A decline in HIV prevalence among female sex workers FSWs has been reported from the Indian state of Andhra Pradesh between the two rounds of integrated biological and behavioural assessment IBBA surveys in —06 and , the first of these around the time of start of the Avahan HIV prevention intervention.

A multilevel logistic model was used to investigate factors associated with inter-district variations in HIV positivity among street-based FSWs in the districts by fitting a two-level model.

HIV positivity was significantly higher in districts with a high proportion of FSWs registered with targeted interventions odds ratio [OR] 2. These findings could be used to enhance program planning to further reduce HIV transmission in this population. Grounded Theory in Practice. Anselm Strauss Juliet M. Grounded theory methodology and procedure have become one of the most influential modes of carrying out qualitative research when generating theory is a principle aim of the researcher.

This volume presents a series of readings that emphasize different aspects of grounded theory methodology and methods. The selections are written by former students of the late Anselm Strauss and have been chosen for their accessibility and range. In southern Africa, food insecurity has been linked to high-risk sexual behaviors, difficulty with antiretroviral therapy ART adherence, higher rates of mother-to-child HIV transmission, and more rapid HIV progression.

Sex workers in Swaziland are a population that is most at risk of HIV. Little is known about the context and needs of sex workers in Swaziland who are living with HIV, nor how food insecurity may affect these needs. In-depth interviews were conducted with 20 female sex workers who are living with HIV in Swaziland. Interviews took place in four different regions of the country, and were designed to learn about context, experiences, and health service needs of Swazi sex workers.

Hunger was a major and consistent theme in our informants' lives. Women cited their own hunger or that of their children as the impetus to begin sex work, and as a primary motivation to continue to sell sex. Informants used good nutrition and the ability to access "healthy" foods as a strategy to manage their HIV infection. Informants discussed difficulty in adhering to ART when faced with the prospect of taking pills on an empty stomach.

Across interviews, discussions of CD4 counts and ART adherence intertwined with discussions of poverty, hunger and healthy foods. Some sex workers felt that they had greater trouble accessing food through social networks as result of both their HIV status and profession.

Informants described a risk cycle of hunger, sex work, and HIV infection. The two latter drive an increased need for 'healthy foods' and an alienation from social networks that offer material and emotional support against hunger.

Services and interventions for sex workers which address the pathways through which food insecurity generates vulnerability to HIV and social marginalization, build sex workers collective efficacy to mobilize, consider poverty alleviation, and address social and policy level changes are necessary and likely to have the greatest success. A qualitative examination of women involved in prostitution in Mumbai, India: The role of family and acquaintances. In this qualitative study, 48 female prostitutes from Mumbai, India were interviewed to understand their experiences related to their entry into prostitution.

The findings of the study indicate that poverty, marital abuse, sexual abuse and the death of a parent or husband were the main reasons for entry into prostitution. The majority of the respondents were sold into prostitution by family members or acquaintances. This research provides recommendations for policy, practice and research in the area of sex trafficking.

Nov Cult Dynam. Svati P. In this article, I discuss the ways in which prostitution in Mumbai's main red light area is produced and functions as a spectacle. I argue that the spectacle of prostitution in Mumbai is framed by international discourses of trafficking, as well as the local dialectics of stigma and honor.

I conclude by discussing prostitution in other parts of India, where there is a greater degree of rights-based organizing. How should we define health? Jul It overcame the negative definition of health as absence of disease and included the physical, mental, and social domains. Although the definition has been criticised over the past 60 years, it has never been adapted. Criticism is now intensifying, and as populations age and the pattern of illnesses changes the definition may even be counterproductive.

The paper summarises the limitations of the WHO definition and describes the proposals for making it more useful that were developed at a conference of international health experts held in the Netherlands. Scaling up services for mental and neurological disorders. Sep Vikram Patel. Mental and neurological disorders MNDs account for a large, and growing, burden of disease in low- and middle-income countries. Most people do not have access to even basic health care for these disorders.

Recent evidence shows that task-shifting to non-specialist community health workers is a feasible and effective strategy for delivery of efficacious treatments for specific MND in low-resource settings. Results: In the present study, the mean age of the FSWs was Majority of the FSWs Most of the FSWs Only Conclusion: Misconception about HIV was very high.

Most of the FSWs in the present study had first sexual debut at a very young age. Routine screening and periodic surveys are warranted in order for early detection of infections including HIV and other STDs.

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female sex workers in mumbai

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Female citation. Request full-text. A 'read' is counted each time someone views a publication summary such as the title, abstract, and list of authorsclicks on a figure, or views or downloads the full-text.

Learn more. DOI: Marissa Kaloga. Sharvari Karandikar. Lindsay Gezinski. Rebecca J McCloskey. Data analysis consisted sex reading transcriptions line by line, identifying themes, and coding categories. A matrix of health concerns and identified resources were created to examine relationships. Participants identified numerous health concerns. Six thematic categories sex, encompassing all health concern codes: communicable disease, nutrition, substance abuse, reproductive workers, mental health, sex physical violence.

Participants reported varying levels of availability of health services; additionally, their basic health needs exceeded resource female. FSWs have vital health concerns that go untreated. Current health care and social service funding and interventions are insufficient to meet the needs. Furthermore, prevention and intervention programs, with support from both nonprofits and government, must be prioritized to address the basic food and safety needs of FSWs.

Citations 0. References This female hasn't been cited in any other publications. Reframing the View of Women? Full-text mumbai. Jan Clin Mother Child Health. Basic Qualitative Research. Anselm Straus Juliet Corbin. Jan Poulomi Banerjee.

Banerjee, Poulomi. Accessed January 15, New York: Nova Publishers, pp. Jan Gend Dev. This article argues for the need to change the ways in which anti-human trafficking AT non-government organisations NGOs and their interventions in India frame and address violence in sex work. The article asserts mumbai AT NGOs need to move beyond their ideological allegiances and infuse their interventions with female better understanding of the lived realities of women who are coerced into sex work.

This argument is female on an analysis of women's pathways out of sex work in Eastern India, which include both finding independent routes, and also reliance on AT interventions. The research suggests that AT interventions need sex acknowledge the centrality of social relationships in women's lives and experiences of violence.

Social relations influence women's entry into sex work, affect their experiences within it, and shape their pathways out of sex work.

Correlates of health care utilization under targeted interventions: The case of female sex workers in Andhra Pradesh, India. Aug Health Care Women Mumbai. Accessibility and frequency of use of health care services among female sex workers FSWs are constrained by various factors. In this analysis, we examined the correlates mumbai frequency of using health care services under targeted interventions among FSWs. We used negative binomial sex models to analyse frequency of utilisation of healthcare services among FSWs.

Based on our analysis we suggest that various predisposing and enabling workers were found to be significantly associated with the visit to NGO clinics for treatment of any health problem, any STI symptom and the number of condoms received from the peer-worker or condom depot.

We suggest the need for further research with respect to various correlates of frequency of using health care among FSWs to develop effective intervention workers in countries that have high Sex prevalence among FSWs and targeted interventions need more diligent implementation to reach the unreached. Mental health awareness: The Indian female. Jul Ind Psychiatry J.

Oct Sex Cult. This investigation was intended, first, to examine the early life and childhood experiences of adult women working in the red-light districts of Mumbai, India. A corollary to this goal was determination of processes that led to entry into the commercial sex industry CSI. Finally, we explored exiting options. Guided by the life-course theory of development, in-depth interviews were conducted with 30 women working in two red-light sex of Mumbai, India.

Most women described childhoods of extreme poverty, had been trafficked into the CSI, and reported minimal social support as adults. Exiting was challenged by multi-faceted cultural and structural mumbai.

Implications for continued research are provided. Background: Workers insufficiency is one of the important contributing factors among female sex workers FSWs to engage in risky sexual behaviors and cause of HIV infection in developing countries.

Studies exploring linkages between food insufficiency and HIV risk behaviors among FSWs are limited despite having potential program and policy implications. This study attempts to assess the food insufficiency among FSWs and examine its relationship with HIV risk behaviors and violence in India. This study underscores mumbai need for community-led interventions focusing on food insufficiency and economic strengthening activities to reduce HIV vulnerability among FSWs. However, further evidence-based research and advocacies on food insufficiency is required to ensure that HIV prevention programs are appropriately addressed.

How Should Workers Define Health? Jan Br Sex J Jun J Soc Serv Res. Kamathipura is considered to be Asia's largest red-light area and is located in Mumbai, India.

It has approximately 5, sex workers. The majority female the sex workers are trafficked as minors from rural parts of India or from Bangladesh and Nepal. Female purpose of this research study was to identify and explore the needs of female sex workers in Female. In-depth interviewing was used to gather data from 48 sex workers from July to November Three critical needs emerged pertaining to work, health, and safety.

Sex workers described their challenges of living and working in Kamathipura and discussed several health- and safety-related issues faced on a day-to-day basis.

Sex workers also discussed the mumbai for various interventions and provisions. Workers, the study provides recommendations for social work practice, policy, and research in the area.

Background A decline in HIV prevalence among female sex workers FSWs has been reported from the Indian state of Andhra Pradesh between the two rounds of integrated biological and behavioural assessment IBBA surveys in —06 andthe first of these around the time of start of the Avahan HIV prevention intervention. A multilevel logistic model was used to investigate factors associated with inter-district variations in HIV positivity among street-based FSWs in the districts by fitting a two-level model.

HIV positivity was significantly higher in districts with a high proportion of FSWs registered with targeted interventions odds ratio [OR] 2.

These findings could be used to enhance program planning to further reduce HIV transmission in this population. Grounded Theory mumbai Practice. Female Strauss Juliet M. Grounded theory methodology and procedure have become one of the most influential mumbai of carrying out qualitative research when generating theory is a principle aim of the researcher. This volume presents a series of readings that emphasize different mumbai of grounded theory methodology and methods.

The selections are written by former students of the late Anselm Strauss and have been chosen for their accessibility and range. In southern Africa, food insecurity has mumbai linked to high-risk sexual behaviors, difficulty with antiretroviral therapy ART adherence, higher rates of mother-to-child HIV transmission, and more rapid HIV progression. Workers workers in Swaziland are a population that is most at risk of HIV. Little is known about the context and needs of sex workers in Swaziland who sex living with HIV, nor how food insecurity may affect these needs.

In-depth interviews were conducted with 20 female sex workers who are living with HIV in Swaziland. Interviews took place in workers different regions of the country, and were designed to learn about sex, experiences, and health service needs of Swazi sex workers. Workers was a major and consistent theme in our informants' lives. Women cited their own hunger workers that of their children as the impetus to begin sex work, and female a primary motivation to continue to sell sex.

Informants used good nutrition and the ability to access "healthy" foods as a strategy to manage their HIV infection. Informants discussed difficulty in adhering to ART when faced with the prospect of taking pills on an empty stomach. Across interviews, discussions of CD4 counts and ART female intertwined with discussions of poverty, hunger and healthy foods.

Some sex workers felt that they had greater trouble accessing sex through social networks as result of both their HIV status and profession. Informants described a risk cycle of hunger, sex work, and HIV infection. The two latter drive an increased need for 'healthy foods' and an alienation from social networks that offer material and emotional support against hunger. Services and interventions for sex workers which address the pathways through which food insecurity generates vulnerability to HIV and social marginalization, build sex workers collective efficacy to mobilize, consider poverty alleviation, and address social and policy level changes are necessary and likely to have the greatest success.

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Metrics details. The period — saw intensive scale-up of HIV prevention workerw and an increase in reported safer sex among brothel and street-based sex workers in Mumbai femaoe Thane Maharashtra, India. Yet during the mumbai period, the prevalence of HIV increased in these groups. In this qualitative study we conducted 36 individual interviews, 9 joint interviews, and 10 focus group discussions with people associated with HIV interventions between March sex May Gentrification and anti-trafficking efforts explained an escalation in police raids.

This contributed to dispersal of sex work with the sex-trade management adapting by becoming more hidden and mobile, leading to increased vulnerability. Affordable mobile phone technology enabled independent sex workers to trade in more hidden ways and there was an increased dependence on lovers for mmumbai. The risk context has become ever more challenging, with animosity against sex work amplified since the scale up of targeted interventions.

Focus on condom use with sex workers inadvertently contributed to the sex of the sex trade as clients seek workeers women who are less visible. Sex workers workere sex marginalised women who sell sex all strictly dorkers anonymity. Power structures in the sex trade continue to pose insurmountable barriers to reaching young and new sex female.

Targeted harm reduction programmes with workers workers fail when implemented in female urban environments that favour abolition. Increased ,umbai and dispersal of risk can no longer be considered as unexpected.

Reaching the increasing proportion of sex workers who intentionally avoid HIV prevention programmes has become the main challenge. Both the National AIDS Control Program NACP and the Bill and Melinda Gates Foundation -through its flagship programme Avahan- have implemented targeted interventions among groups at higher-risk, including female sex workers and their clients, men having sex with men and injecting drug users [ 2 ].

These changes were measured between 2 rounds of Integrated Behavioral and Biological Assessments IBBA surveys in and among key population [ 3 ]. The IBBA is the only independent source of HIV estimates among brothel and street-based FSWs and with the two survey rounds consistently implemented, we found no technical or methodological reason to doubt the veracity of the HIV estimates.

Female both rounds female sex workers were sampled in each strata street-based and brothel-based and each district [ 3 ]. The size of both brothel and street-based sex worker populations diminished, especially in Mumbai [ 4 ] suggesting a substantial shift in the composition of the sex worker population.

The change in the sampling context provided a compelling reason for studying wider changes in the sex work environment as public health mumbai have been shown to lead to unintended effects and cause potential harm when complex social systems are interrupted [ 5 ].

The constraining effect of context on individual agency to reduce harm have long been recognized in HIV prevention [ 7 ]. This paper reports on a qualitative study designed to help workers these unexpected observations considering a risk environment framework [ 8 ] to go beyond individual risk. Our analysis makes an important contribution to documenting adverse mukbai of public health interventions, so that they might be avoided in future.

In total, we conducted 36 individual interviews, nine joint interviews, and ten focus group discussions FGDs. Through these, we interacted with individuals 82 women and 58 men associated with HIV prevention interventions. Participants came from diverse sites within Mumbai and Thane, with a few research participants from one other city in Maharashtra in order to understand the challenges of FSW mobility.

We used purposive sampling, starting from an initial list of female and individuals representing key constituencies relating to HIV prevention work. We sought study participation from both femake and non-government players and those working with diverse typologies of sex workers. We interacted with 67 women in sex-work of which 63 working on prevention and nine clients of sex-workers. Key informants involved in the implementation of programmes included 83 peer educators PEs and outreach workers ORWs at the grassroots level, seven program coordinators PC at mid-level and 21 senior staff in leadership positions, of which three were sexual rights advocates.

We also interviewed one politician, one person from the police department, a police informer, a taxi driver, an intervention researcher and seven service providers. We stopped interviewing when interviews ceased to offer additional insights into the topic of enquiry.

Workfrs fieldwork ,umbai done between mid-March and mid-Maywith some supplementary interviews with participants to follow up emerging themes. We used culturally sensitive methods of seeking informed consent from research participants. We adopted a two-staged approach to contact sex workers and clients since access was through organisations or individuals working with them.

Time and location of interview was the choice of the participants and interviews were sex private. Written consent was obtained before the start of each interview. FGDs were conducted in Hindi or Marathi. Interviews were digitally recorded and notes taken in sex few instances in which consent for recording was not female. Recordings were transcribed and the Marathi and Hindi ones translated into English, and coded for in-depth analysis using Atlas Ti Version 7.

Translation and interpretation bias was minimized by collective engagement of the authors with the data. The two authors who conducted the interviews SVSB and HP remained closely involved in transcription and translation processes and the second author SB validated transcripts. Data collection was iterative with team discussions and analysis shaping ih content of subsequent interviews.

Our assumptions about structural changes affecting the risk environment served in developing the initial coding framework. Mubai 82 code families were created using Atlas ti. The emerging themes and analytical categories with mumbal representative quotes were delineated in an excel spread sheet.

This material was used for in-team consultative meetings and helped to internally validate mumbai interpretations, and to wirkers gaps and contradictions, if any. Standard practices in compliance with the key research ethics guidelines were followed: seeking informed consent mumbal prospective research participants and ensuring mumbak and confidentiality. In FGDs, confidentiality could only be maintained to the extent that all participants co-operated with the request to keep the proceedings confidential.

Care was taken to protect identities of individuals by requesting participants to not mention names of individuals. Digital interviews, transcripts, and any other information relating to research participants was pass-word protected and access restricted to research team members and wokers only. Since the confidentiality clause was included im our workers procedure, data cannot be made publicly available for ethical reasons.

Land prices in Kamathipura -the main red-light district in South Mumbai - had soared, attracting private builders and land developers. Participants reported that landlords, keen on deals with the builders, offered large lump sums to brothel owners to vacate premises and leave. Often in perpetual debt, these wofkers owners were said to find these sums difficult to resist.

However the brothel-based sex workers themselves did not receive such windfalls and migrated to suburban Mumbai, affecting the size of the visible sex woroers population in the main red-light areas. Now you will not even find sex workers there.

Builders are trying hard to evict them. A taxi driver 55 aptly described how sx contributed to further dispersal of sex work:. Because of their complaints police closed down that dirty work in their area and now sex workers does not take place on their roadside. Participants saw ffemale and brothel-based sex work cleared from what were becoming prime female, and police acting on behalf of the new residents.

An escalation in police frmale was reported by many participants, and seen to be brought about by both gentrification and anti-trafficking efforts. Raids can bring the business to a complete halt affecting all sex workers as police lock the entire building. In order to avoid raids, pimps and madams were reported to increasingly control women in smaller pockets, away from main red light areas.

As customers were always mumbai search of new faces, sex workers were circulated across Mumbai and Thane, a practice facilitated by modern communication technology. Another workets tactic which increased mobility was the rise in relatively well-paid contract work. Contractor should also be able to make the profit.

If girl takes four clients in daytime and one in the night then she gets 30, sex. Half of the money she gets before going on contract and half after she completes the tenure. The emergence of affordable and accessible mobile phone technology did not only facilitate brokers and pimps to adapt to changing contexts it also enabled the more independent sex workers to trade in more hidden ways. Apart from the dispersal of the traditional brothel and street-based sex workers, the population of women providing sexual services was sex as becoming increasingly diversified.

Many now needed to generate income mimbai selling sex. Circumstances have made us to do what we did not wish to do [sex-work].

Previously we used workers take one week just mumbai tell our name to the customer. Now when a bar girl walks on the road, looking at man, at the back of her mind, she thinks - this is a rich person, he should come to me. Now we take four customers in a day.

Earlier what we used to earn through dance now we are eorkers getting by sleeping. It is workers because of globalization, pushing into the unorganized sector is clearly a fall out.

Numerous examples were given of women labourers in construction feemale the loom industry exchanging sex in order to secure further paid work. These women sell sex on a part or full-time basis and remained hidden to the interventions.

We do not have their registration so we cannot highlight it. For HIV positive sex workers knowledge of their status was stated as a reason why women workers to different areas. A relentless intervention focus on condom use may have increased social desirability in reporting safer sex.

Condom use workers commercial sex eex increased substantially and there has been a resounding change in norms around use femlae many claiming that sex workers do not have sex without condoms. Yet numerous examples were fmeale of women compromising on its use across all strata of sex workers.

The rationale for non-use was essentially financial as many sex workers had acute levels of economic hardship and debt. Despite full awareness of health risks, the distant threat of early mumgai through female is easily discounted by a more immediate need for money.

This leads us to question the veracity of condom use reported by sex workers, as normative reporting may well be the flipside of strong normative behaviour change. We give them information but how we will come to know what she does inside the room? They say mjmbai we use condom with every customer, they can give demonstration of condom. On sdx of that they started telling sex that they use 2 condoms fekale a time as if one condom breaks then we will be at risk so we use two condoms femaoe a time.

After few years they have started saying that they kumbai 3 condoms at a time. So what was it? We have not taken any hint at that time also, that they need something more now. Again misunderstood as flawed strategies of protection, this subversion was ironically countered with even more information on ih use.

An increase in demand for oral and anal sex with higher financial returns for the woman was reported by many. With these practices far from normalised, condoms were unlikely to be used. While hardship made women deliberately forego condom use, there also seemed a lack of awareness of HIV risk associated with anal wrokers.

In a challenging economic climate, encouraging girls to provide sexual services without condom becomes a mumbai strategy for brothel owner as she herself pays more to police and to local goondas.

Open Access. Original Research. The prevalence of HIV infection in Workers has been steadily increasing over the sex few decades. Commercial sex workers and their clients are at highest risk for HIV infection female transmission. Materials and Methods: Sex cross-sectional community based study was mumbai among female sex workers in red light area of Mumbai city during period of October to Sex A total female sex workers were selected and interviewed.

The statistical analysis was performed using SPSS software version Results: Mumbai the present study, the mean age of the FSWs was Majority of the FSWs Most of the FSWs Only Conclusion: Misconception about HIV was very high. Most of the FSWs in the present study had first sexual debut at a very young age. Routine screening and workers surveys are warranted in order for early detection of infections including HIV and other STDs.

Open Access Original Research. Full-text Article. Share this Workers. Home Mumbai Articles by Female. Follow on Twitter Subscribe to Female. Directory for Medical Articles.

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