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Inconsistent condom use by male clients during anal intercourse with occasional and regular female sex workers (FSWs): survey findings from southern states of India

OBJECTIVES: Self-reported anal intercourse by female sex workers (FSWs) documented in recent studies from India range between 11.9% and 22%. However, comparable data on anal intercourse and condom use from male clients of FSWs is lacking. Using data from a bio-behavioural survey (2009–2010), we exam...

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Autores principales: Ramanathan, Shreena, Nagarajan, Karikalan, Ramakrishnan, Lakshmi, Mainkar, Mandar K, Goswami, Prabuddhagopal, Yadav, Diwakar, Sen, Shrabanti, George, Bitra, Rachakulla, Harikumar, Subramanian, Thilakavathi, Paranjape, Ramesh S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244455/
https://www.ncbi.nlm.nih.gov/pubmed/25410604
http://dx.doi.org/10.1136/bmjopen-2014-005166
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author Ramanathan, Shreena
Nagarajan, Karikalan
Ramakrishnan, Lakshmi
Mainkar, Mandar K
Goswami, Prabuddhagopal
Yadav, Diwakar
Sen, Shrabanti
George, Bitra
Rachakulla, Harikumar
Subramanian, Thilakavathi
Paranjape, Ramesh S
author_facet Ramanathan, Shreena
Nagarajan, Karikalan
Ramakrishnan, Lakshmi
Mainkar, Mandar K
Goswami, Prabuddhagopal
Yadav, Diwakar
Sen, Shrabanti
George, Bitra
Rachakulla, Harikumar
Subramanian, Thilakavathi
Paranjape, Ramesh S
author_sort Ramanathan, Shreena
collection PubMed
description OBJECTIVES: Self-reported anal intercourse by female sex workers (FSWs) documented in recent studies from India range between 11.9% and 22%. However, comparable data on anal intercourse and condom use from male clients of FSWs is lacking. Using data from a bio-behavioural survey (2009–2010), we examined prevalence of anal intercourse, male clients’ self-reported inconsistent condom use during anal intercourse with FSWs, and correlates of this behaviour in India's high HIV prevalence southern states (Andhra Pradesh, Maharashtra and Tamil Nadu combined). METHODS: Using two-stage time location cluster sampling, we recruited 4803 clients of FSWs, ages 18–60 years, who had purchased sex from an FSW in the past month. After obtaining informed consent, respondents were interviewed and tested for HIV and sexually transmitted infections (syphilis, gonorrhoea and chlamydia). Logistic regression analysis was used to identify the factors associated with inconsistent condom use during anal intercourse (in the past 6 months) with FSWs. RESULTS: Overall, 12.3% clients reported anal intercourse in the past 6 months, of whom 48.4% used condoms inconsistently. Clients of FSWs who were ages 26 years or older (AOR 2.68, p=0.032); employed as manual labourers (AOR 2.43, p=0.013); consumed alcohol (AOR 2.63, p=0.001); reported five or more sex acts with FSWs in the past month (AOR 2.53, p=0.031); and perceived themselves to be at higher risk for HIV (AOR 4.82, p=0.001) were more likely to inconsistently use condoms during anal intercourse. CONCLUSIONS: The results suggest that sex workers and their clients commonly practice anal intercourse, but a relatively high proportion of clients do not consistently use condoms, leading to a greater risk of acquiring HIV and its further transmission to other male and female sexual partners. Given the multidirectional risk, safer sex communication on heterosexual anal intercourse must be incorporated into HIV prevention programmes.
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spelling pubmed-42444552014-11-28 Inconsistent condom use by male clients during anal intercourse with occasional and regular female sex workers (FSWs): survey findings from southern states of India Ramanathan, Shreena Nagarajan, Karikalan Ramakrishnan, Lakshmi Mainkar, Mandar K Goswami, Prabuddhagopal Yadav, Diwakar Sen, Shrabanti George, Bitra Rachakulla, Harikumar Subramanian, Thilakavathi Paranjape, Ramesh S BMJ Open HIV/AIDS OBJECTIVES: Self-reported anal intercourse by female sex workers (FSWs) documented in recent studies from India range between 11.9% and 22%. However, comparable data on anal intercourse and condom use from male clients of FSWs is lacking. Using data from a bio-behavioural survey (2009–2010), we examined prevalence of anal intercourse, male clients’ self-reported inconsistent condom use during anal intercourse with FSWs, and correlates of this behaviour in India's high HIV prevalence southern states (Andhra Pradesh, Maharashtra and Tamil Nadu combined). METHODS: Using two-stage time location cluster sampling, we recruited 4803 clients of FSWs, ages 18–60 years, who had purchased sex from an FSW in the past month. After obtaining informed consent, respondents were interviewed and tested for HIV and sexually transmitted infections (syphilis, gonorrhoea and chlamydia). Logistic regression analysis was used to identify the factors associated with inconsistent condom use during anal intercourse (in the past 6 months) with FSWs. RESULTS: Overall, 12.3% clients reported anal intercourse in the past 6 months, of whom 48.4% used condoms inconsistently. Clients of FSWs who were ages 26 years or older (AOR 2.68, p=0.032); employed as manual labourers (AOR 2.43, p=0.013); consumed alcohol (AOR 2.63, p=0.001); reported five or more sex acts with FSWs in the past month (AOR 2.53, p=0.031); and perceived themselves to be at higher risk for HIV (AOR 4.82, p=0.001) were more likely to inconsistently use condoms during anal intercourse. CONCLUSIONS: The results suggest that sex workers and their clients commonly practice anal intercourse, but a relatively high proportion of clients do not consistently use condoms, leading to a greater risk of acquiring HIV and its further transmission to other male and female sexual partners. Given the multidirectional risk, safer sex communication on heterosexual anal intercourse must be incorporated into HIV prevention programmes. BMJ Publishing Group 2014-11-19 /pmc/articles/PMC4244455/ /pubmed/25410604 http://dx.doi.org/10.1136/bmjopen-2014-005166 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle HIV/AIDS
Ramanathan, Shreena
Nagarajan, Karikalan
Ramakrishnan, Lakshmi
Mainkar, Mandar K
Goswami, Prabuddhagopal
Yadav, Diwakar
Sen, Shrabanti
George, Bitra
Rachakulla, Harikumar
Subramanian, Thilakavathi
Paranjape, Ramesh S
Inconsistent condom use by male clients during anal intercourse with occasional and regular female sex workers (FSWs): survey findings from southern states of India
title Inconsistent condom use by male clients during anal intercourse with occasional and regular female sex workers (FSWs): survey findings from southern states of India
title_full Inconsistent condom use by male clients during anal intercourse with occasional and regular female sex workers (FSWs): survey findings from southern states of India
title_fullStr Inconsistent condom use by male clients during anal intercourse with occasional and regular female sex workers (FSWs): survey findings from southern states of India
title_full_unstemmed Inconsistent condom use by male clients during anal intercourse with occasional and regular female sex workers (FSWs): survey findings from southern states of India
title_short Inconsistent condom use by male clients during anal intercourse with occasional and regular female sex workers (FSWs): survey findings from southern states of India
title_sort inconsistent condom use by male clients during anal intercourse with occasional and regular female sex workers (fsws): survey findings from southern states of india
topic HIV/AIDS
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244455/
https://www.ncbi.nlm.nih.gov/pubmed/25410604
http://dx.doi.org/10.1136/bmjopen-2014-005166
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