Keshab Deuba1, Sarah Anderson2, Anna Mia Ekström3, Satish Raj Pandey4, Rachana Shrestha5, Deepak Kumar Karki6, Gaetano Marrone3. 1. Public Health and Environment Research Center, GPO Box 8973, NPC 473, New Baneshwor, Kathmandu, Nepal; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Electronic address: deuba4k@gmail.com. 2. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 3. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. 4. FHI360, Kathmandu, Nepal. 5. Centre for International Health, University of Bergen, Bergen, Norway. 6. Department of Public Health, Nobel College, Pokhara University, Kathmandu, Nepal.
Abstract
OBJECTIVES: Sex workers face stigma, discrimination, and violence across the globe and are almost 14 times more likely to be HIV-infected than other women in low- and middle-income countries. In Asia, condom campaigns at brothels have been effective in some settings, but for preventive interventions to be sustainable, it is important to understand micro-level social and structural factors that influence sexual behaviours of sex workers. This study assessed the syndemic effects of micro-level social and structural factors of unprotected sex and the prevalence of HIV among female sex workers (FSWs) in Nepal. METHODS: This quantitative study included 610 FSWs who were recruited using two-stage cluster sampling from September to November 2012 in 22 Terai Highway districts of Nepal. Rapid HIV tests and face-to-face interviews were conducted to collect biological and behavioural information. A count of physical (sexual violence and other undesirable events), social (poor social support and condom negotiation skills), and economic (unprotected sex to make more money) factors that operate at the micro-level was calculated to test the additive relationship to unprotected sex. RESULTS: The HIV prevalence was 1%; this is presumably representative, with a large sample of FSWs in Nepal. The prevalence of unprotected sex with clients was high (24%). For each additional adverse physical, social, and economic condition, the probability of non-use of condoms with clients increased substantially: one problem = 12% (p<0.005), two problems = 19% (p<0.001), and three to five problems = 38% (p<0.001). CONCLUSIONS: Interactions between two or more adverse conditions linked to physical, social, and economic environments increased the risk of unprotected sex among Nepalese FSWs.
OBJECTIVES: Sex workers face stigma, discrimination, and violence across the globe and are almost 14 times more likely to be HIV-infected than other women in low- and middle-income countries. In Asia, condom campaigns at brothels have been effective in some settings, but for preventive interventions to be sustainable, it is important to understand micro-level social and structural factors that influence sexual behaviours of sex workers. This study assessed the syndemic effects of micro-level social and structural factors of unprotected sex and the prevalence of HIV among female sex workers (FSWs) in Nepal. METHODS: This quantitative study included 610 FSWs who were recruited using two-stage cluster sampling from September to November 2012 in 22 Terai Highway districts of Nepal. Rapid HIV tests and face-to-face interviews were conducted to collect biological and behavioural information. A count of physical (sexual violence and other undesirable events), social (poor social support and condom negotiation skills), and economic (unprotected sex to make more money) factors that operate at the micro-level was calculated to test the additive relationship to unprotected sex. RESULTS: The HIV prevalence was 1%; this is presumably representative, with a large sample of FSWs in Nepal. The prevalence of unprotected sex with clients was high (24%). For each additional adverse physical, social, and economic condition, the probability of non-use of condoms with clients increased substantially: one problem = 12% (p<0.005), two problems = 19% (p<0.001), and three to five problems = 38% (p<0.001). CONCLUSIONS: Interactions between two or more adverse conditions linked to physical, social, and economic environments increased the risk of unprotected sex among Nepalese FSWs.
Authors: Susan G Sherman; Catherine Tomko; Bradley E Silberzahn; Rebecca Hamilton White; Danielle Friedman Nestadt; Emily Clouse; Katherine Haney; Noya Galai Journal: BMC Public Health Date: 2021-12-11 Impact factor: 3.295