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LETTER TO EDITOR
Year : 2014  |  Volume : 35  |  Issue : 2  |  Page : 165-166
 

Control of HIV: Role of female sex workers in risk of HIV transmission


Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Web Publication9-Oct-2014

Correspondence Address:
S Ganesh Kumar
Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7184.142421

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How to cite this article:
Kumar S G. Control of HIV: Role of female sex workers in risk of HIV transmission. Indian J Sex Transm Dis 2014;35:165-6

How to cite this URL:
Kumar S G. Control of HIV: Role of female sex workers in risk of HIV transmission. Indian J Sex Transm Dis [serial online] 2014 [cited 2017 Dec 14];35:165-6. Available from: http://www.ijstd.org/text.asp?2014/35/2/165/142421


Sir,

Understanding the exposure status of risk factors for acquiring the risk of HIV infection in female sex workers (FSWs) and its transmission to the general population are the important parameters to be considered in HIV control strategies since there is a difference in distribution of these factors at regional or country level. A recent study from Nagaland among FSWs reported that lifetime injecting drug use, initiating sexual intercourse before the age of 15 years, positive test result for one or more sexually transmitted infections (STIs) and having been widowed were independently associated with HIV infection with the risk being found more for injecting drug use. [1] In contrast to this, study done in Moscow found that injecting drug user among FSWs was not significantly associated with HIV infection. [2] Andhra Pradesh study in India showed that residential instability is associated with HIV risk among female health workers in addition to its association with individual risky sexual behaviors that included unprotected sex, reported STIs, and recent physical and sexual victimization. [3]

Heterogeneity in the organization and structure of sex work is an important determinant of variations in HIV prevalence among FSWs across districts in India. The risk of being HIV positive was comparatively greater for brothel-based FSW, public place-based FSW, unmarried FSW and those who were widowed or divorced or separated, or from the devadasi tradition. Similarly, those with high mobility were more likely to report recent HIV risk factors such as sexual violence, physical violence, unprotected sex for more money, at least one STI symptom and anal sex with clients.

It has shown that social cognitive behavioral intervention was not found to be effective in reducing the incidence of HIV infection among FSWs, but intervention of promotion of female and male condom use was found to be effective in lower and middle income countries. [4] However, in India, Andhra Pradesh study showed that consistent condom use with regular and occasional sexual clients was 9% and 16.4%, respectively. [2] This may result in transmission of HIV to the general population through sexual clients. A recent meta-analysis reported that HIV prevalence in India among FSWs is 13.7%. Furthermore, it highlighted the fact that 23.5% of prevalent HIV infection among women was attributable to FSWs in India. Except some African and other countries that include China, Nepal and Malaysia which reported the attributable risk more than this level, most of the countries reported it far below this figure where the attributable risk factors were different from India. [5]

This differential exposure status of risk factors to HIV infection among FSWs and difference in attributable risk for HIV infection among women due to FSWs at country level is an important matter of concern for control strategies. Intervention strategies should be strengthened toward FSWs along with other strategies to achieve the Millennium Development Goals that states the target to halt HIV spread by the year 2015 and begun to reverse the spread of HIV/AIDS to reduce the burden of HIV.

 
   References Top

1.
Medhi GK, Mahanta J, Paranjape RS, Adhikary R, Laskar N, Ngully P. Factors associated with HIV among female sex workers in a high HIV prevalent state of India. AIDS Care 2012;24:369-76.  Back to cited text no. 1
    
2.
Decker MR, Wirtz AL, Baral SD, Peryshkina A, Mogilnyi V, Weber RA, et al. Injection drug use, sexual risk, violence and STI/HIV among Moscow female sex workers. Sex Transm Infect 2012;88:278-83.  Back to cited text no. 2
    
3.
Reed E, Gupta J, Biradavolu M, Devireddy V, Blankenship KM. The role of housing in determining HIV risk among female sex workers in Andhra Pradesh, India: Considering women′s life contexts. Soc Sci Med 2011;72:710-6.  Back to cited text no. 3
    
4.
Wariki WM, Ota E, Mori R, Koyanagi A, Hori N, Shibuya K. Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries. Cochrane Database Syst Rev 2012;2:CD005272.  Back to cited text no. 4
    
5.
Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: A systematic review and meta-analysis. Lancet Infect Dis 2012;12:538-49.  Back to cited text no. 5
    




 

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