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Consistent Condom Use by Female Sex Workers in Kolkata, India: Testing Theories of Economic Insecurity, Behavior Change, Life Course Vulnerability and Empowerment

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ABSTRACT

Consistent condom use (CCU) is the primary HIV/STI prevention option available to sex workers globally but may be undermined by economic insecurity, life-course vulnerabilities, behavioral factors, disempowerment, or lack of effective interventions. This study examines predictors of CCU in a random household survey of brothel-based female sex workers (n = 200) in two neighborhoods served by Durbar (the Sonagachi Project) in Kolkata, India. Multivariate logistic regression analyses indicated that CCU was significantly associated with perceived HIV risk, community mobilization participation, working more days in sex work, and higher proportion of occasional clients to regular clients. Exploratory analyses stratifying by economic insecurity indicators (i.e., debt, savings, income, housing security) indicate that perceived HIV risk and community mobilization were only associated with CCU for economically secure FSW. Interventions with FSW must prioritize economic security and access to social protections as economic insecurity may undermine the efficacy of more direct condom use intervention strategies.

No MeSH data available.


Integrated theoretical model of life course vulnerabilities, economic insecurity, risk perceptions, and empowerment attitudes influencing consistent condom use among female sex workers in India
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Fig1: Integrated theoretical model of life course vulnerabilities, economic insecurity, risk perceptions, and empowerment attitudes influencing consistent condom use among female sex workers in India

Mentions: An integrated theoretical model demonstrating how the constructs in each of the theories are related to one another is displayed in Fig. 1. Life course vulnerabilities are depicted in the figure by the demographic and environmental factors, which lead to different reasons for entry into sex work [43]. These background characteristics also influence all other variables in the model directly, indirectly through mediated processes, and as potential modifying factors altering the strength of the relationship between risk perceptions and consistent condom use behaviors. Economic insecurity is conceptualized as an antecedent, mediator, and moderator. Finally, exposure to the Durbar intervention influences empowerment attitudes, which in turn, influence consistent condom use directly and via the mediator of HIV/STI risk perceptions.Fig. 1


Consistent Condom Use by Female Sex Workers in Kolkata, India: Testing Theories of Economic Insecurity, Behavior Change, Life Course Vulnerability and Empowerment
Integrated theoretical model of life course vulnerabilities, economic insecurity, risk perceptions, and empowerment attitudes influencing consistent condom use among female sex workers in India
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016559&req=5

Fig1: Integrated theoretical model of life course vulnerabilities, economic insecurity, risk perceptions, and empowerment attitudes influencing consistent condom use among female sex workers in India
Mentions: An integrated theoretical model demonstrating how the constructs in each of the theories are related to one another is displayed in Fig. 1. Life course vulnerabilities are depicted in the figure by the demographic and environmental factors, which lead to different reasons for entry into sex work [43]. These background characteristics also influence all other variables in the model directly, indirectly through mediated processes, and as potential modifying factors altering the strength of the relationship between risk perceptions and consistent condom use behaviors. Economic insecurity is conceptualized as an antecedent, mediator, and moderator. Finally, exposure to the Durbar intervention influences empowerment attitudes, which in turn, influence consistent condom use directly and via the mediator of HIV/STI risk perceptions.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Consistent condom use (CCU) is the primary HIV/STI prevention option available to sex workers globally but may be undermined by economic insecurity, life-course vulnerabilities, behavioral factors, disempowerment, or lack of effective interventions. This study examines predictors of CCU in a random household survey of brothel-based female sex workers (n = 200) in two neighborhoods served by Durbar (the Sonagachi Project) in Kolkata, India. Multivariate logistic regression analyses indicated that CCU was significantly associated with perceived HIV risk, community mobilization participation, working more days in sex work, and higher proportion of occasional clients to regular clients. Exploratory analyses stratifying by economic insecurity indicators (i.e., debt, savings, income, housing security) indicate that perceived HIV risk and community mobilization were only associated with CCU for economically secure FSW. Interventions with FSW must prioritize economic security and access to social protections as economic insecurity may undermine the efficacy of more direct condom use intervention strategies.

No MeSH data available.