Association Between Mobility, Violence and STI/ HIV Among Female Sex Workers in Urban Andhra Pradesh, India

Background:  Violence and mobility are increasingly being recognized as critical risk factors contributing to the spread of HIV and STI worldwide. The study aims to assess the independent and combined associations of mobility and physical violence with sexual risk behaviors and HIV, STI prevalence among female sex workers (FSWs) in urban Andhra Pradesh, India.

Methods:  To study the association between Mobility, Physical violence and STI/HIV, a cross-sectional survey the Behavioral Tracking Survey (BTS) –2014 conducted with key populations FSWs (N=2400), in undivided Andhra Pradesh state in India was used here. Bivariate, Chi-square and Binary logistic regression were used for analysis.

Results:  Approximately 18 % of FSWs in urban Andhra Pradesh reported Ever experienced physical violence, out of them, 69 % experienced physical violence in the past one year and 52% travelled outside for sex work in the past one year. Mobile FSWs were more likely to report physical violence compared to their counterparts (72% vs. 62%, p < 0.048).  Mobile FSWs were significantly associated with sociodemographic, alcohol, duration of sex work, have regular non-paying partner, condom use in last sex with regular non-paying partner and place for entertaining clients.  Approximately 14% reported that they are HIV positive.  FSWs facing physical violence were more likely to have STI and HIV (4.177 & 3.127) as compared to their counterparts. Although FSWs facing both mobility and physical violence were not significantly associated, are 2 times more likely to have HIV seropositive. 

Conclusions:  The findings conclude that mobility and violence were independently associated with sociodemographic, risky sexual behaviour and STI/HIV infection. Remarkably, the combined association of mobility and violence posed greater STI/HIV risk than their independent effect. These results indicate that there is need for the provision of an enabling environment and safe spaces for FSWs who are mobile, to enhance existing efforts to reduce the spread of HIV/AIDS.