Research Article: The Intersection between Sex Work and Reproductive Health in Northern Karnataka, India: Identifying Gaps and Opportunities in the Context of HIV Prevention

Date Published: December 30, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Marissa Becker, Satyanarayana Ramanaik, Shiva Halli, James F. Blanchard, T. Raghavendra, Parinita Bhattacharjee, Stephen Moses, Lisa Avery, Sharmistha Mishra.


Objective. To examine the reproductive health practices of female sex workers (FSWs) in the context of an HIV prevention program in Karnataka, India.
Methods. Data obtained from a survey of 1,011 FSWs registered with an HIV prevention program. We examined reproductive health indicators, and performed multivariate logistic regression among primiparous FSWs to assess sex work during pregnancy and antenatal HIV testing.
Results. Among primiparous FSWs (N = 251), 92.0% continued sex work during pregnancy, and 55.4% received antenatal HIV testing. A longer duration in sex work (AOR 2.7, 95% CI: 1.0–7.5), rural residence (AOR 3.3, 95% CI: 1.2–8.9), and antenatal HIV testing (AOR 6.3, 95% CI: 2.0–20.1) were associated with continued sex work during pregnancy. Older FSWs (age >25 years, AOR 0.12, 95% CI: 0.05–0.33), who delivered at home (AOR 0.14, 95% CI: 0.09–0.34), were least likely to receive antenatal HIV testing. Antenatal HIV testing was associated with awareness of methods to prevent vertical HIV transmission (AOR 3.9, 95% CI: 1.9–14.1).
Conclusions. Antenatal HIV testing remains low in the context of ongoing sex work during pregnancy. Existing HIV prevention programs are well positioned to immediately integrate reproductive health care with HIV interventions targeted to FSWs.

Partial Text

There is growing recognition of the need to strengthen linkages between reproductive health and HIV prevention services for female sex workers (FSWs) [1–6]. This is especially important in regions where HIV is predominantly spread through heterosexual and vertical transmission, and where unprotected sex between FSWs and their clients are key drivers of the HIV epidemic [7]. To date, research and intervention programs have primarily focused on the burden of, and vulnerability to, sexually transmitted infections (STIs) and HIV in FSWs [8–10]. Meeting FSWs’ need for contraception and antenatal care alongside HIV/STI prevention is critical given their high rates of pregnancy, often unintended, [11–13] as well as high rates of HIV and STIs.

We documented considerable gaps in the reproductive health practices of FSWs new to sex work but registered with a targeted HIV prevention program. As in other resource-poor settings [1, 14–16], most FSWs had been pregnant at least once. While 92.0% of primiparous FSWs continued to practice sex work during pregnancy, only half received antenatal HIV testing, and 75.3% remained unaware of methods to prevent vertical HIV transmission. The findings have important implications for individual and public health in the region: among new FSWs, there may be an ongoing risk of vertical HIV transmission to newborns, especially in the setting of low antenatal HIV testing. The findings also suggest an immediate opportunity for integrating reproductive health services with targeted HIV prevention early in a FSWs’ career, because most FSWs (including new entrants) are already registered with HIV prevention programs.

We uncovered a substantial unmet need for HIV-related antenatal care for FSWs new to sex work and registered in an HIV/STI prevention program. The findings call for improved education and awareness of PMTCT tools and expanded HIV testing and retesting during pregnancy among FSWs—all of which could be addressed by integrating targeted HIV/STI prevention and general reproductive health services. Existing HIV/STI prevention programs provide an immediate opportunity to address this underexamined issue in maternal health and the prevention of vertical transmission of HIV and STIs among FSWs, particularly as programs transition into the public health sector.




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