142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

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Determinants of consistent condom use among sex workers in India: Testing competing hypotheses of perceived risk, empowerment, and financial security

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 9:10 AM - 9:30 AM

Anne Fehrenbacher, MPH , Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA
Dallas Swendeman, PhD, MPH , Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, UCLA Center for HIV Identification, Prevention & Treatment Services (CHITPS), Los Angeles, CA
Toorjo Ghose, PhD , School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
Objective: To test three competing hypotheses for predicting consistent condom use among sex workers: 1) Sex workers use condoms if they feel at risk for contracting a sexually transmitted infection (risk perception hypothesis), 2) Sex workers use condoms if they have a high level of knowledge, influence, and autonomy (empowerment hypothesis), and 3) Sex workers use condoms if they are financially secure (economic hypothesis). 

Methods: A household survey was conducted with a random sample of sex workers (n=200) in two red light districts in Kolkata, India. Logistic regression was used to assess predictors of condom use with occasional clients, regular clients, intimate live-in partners, husbands, and all partners combined. 

Results: Financial security significantly increases the odds of using a condom with all partner types. Feeling susceptible to HIV (perceived risk), serving as a peer educator (empowerment), and participating in a door-to-door campaign to teach other sex workers about condoms (empowerment) significantly increases odds of using a condom with regular clients, intimate partners, and husbands but not with occasional clients. 

Conclusions: The findings demonstrate the importance of financial security for predicting consistent condom use between sex workers and all partner types. Risk perceptions and empowerment become more important predictors of condom use as the level of intimacy and regularity of interaction between sex worker and partner increases. Interventions to improve consistent condom use among sex workers should utilize strategies specific to each type of partner rather than employing a one-size-fits-all approach.

Learning Areas:

Occupational health and safety
Public health or related education
Public health or related public policy
Public health or related research
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Evaluate competing hypotheses for predicting condom use among sex workers. Define the "intimacy gradient" guiding condom use behaviors among sex workers across partner types. Describe a community-based structural intervention that acts on multiple levels to improve the health and social status of sex workers in India.

Keyword(s): Sex Workers, Women and HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Ph.D. student with over ten years of research experience in sexual health. I conducted fieldwork with the sex work community who provided qualitative and quantitative data for this study. I have also worked as a women's rights activist in post-colonial and critical race feminist movements.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.