Measuring vulnerability among female sex workers in India using a multidimensional framework

Measuring vulnerability and identifying determinants of vulnerability are key to designing interventions for marginalized groups like sex workers. The current study introduces a new approach of measuring vulnerability among female sex workers (FSWs) by adopting a multidimensional poverty measurement framework. A multidimensional vulnerability index was created from four dimensions and 16 indicators using a dual cut-off approach. The study found that 55% of FSWs were multidimensionally vulnerable with 48% of intensity in vulnerability. The overall value of multidimensional vulnerability index was 0.265. FSWs in Maharashtra were most vulnerable (82%). Lack of financial security contributed mostly to FSWs’ vulnerability. Further, compared to less vulnerable FSWs, multidimensionally vulnerable ones were more to engage in behaviors that put them at risk such as inconsistent use of condoms with clients, alcohol consumption, engaging in anal sex with clients and experiencing sexually transmitted infections. Findings suggest that structural, social and financial vulnerabilities of FSWs need to be addressed concurrently.

[1]  P. Prabhakar,et al.  Knowledge and exercise of human rights, and barriers and facilitators to claiming rights: a cross-sectional study of female sex workers and high-risk men who have sex with men in Andhra Pradesh, India , 2016, BMC International Health and Human Rights.

[2]  S. K. Patel,et al.  Food Insufficiency, Violence and HIV Risk Behaviors among Female Sex Workers in India , 2016 .

[3]  P. Prabhakar,et al.  Relationship between Community Collectivization and Financial Vulnerability of Female Sex Workers in Southern India , 2016, PloS one.

[4]  C. Campbell,et al.  The impact of Community Mobilisation on HIV Prevention in Middle and Low Income Countries: A Systematic Review and Critique , 2014, AIDS and Behavior.

[5]  B. Mahapatra,et al.  Non-paying partnerships and its association with HIV risk behavior, program exposure and service utilization among female sex workers in India , 2014, BMC Public Health.

[6]  S. Goldenberg,et al.  HIV infection among female sex workers in concentrated and high prevalence epidemics: why a structural determinants framework is needed , 2014, Current opinion in HIV and AIDS.

[7]  S. Ramesh,et al.  Addressing vulnerabilities of female sex workers in an HIV prevention intervention in Mumbai and Thane: experiences from the Aastha project , 2014, HIV/AIDS.

[8]  C. Rajkumar Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial , 2013 .

[9]  S. Bharat,et al.  Are Female Sex Workers Able to Negotiate Condom Use with Male Clients? The Case of Mobile FSWs in Four High HIV Prevalence States of India , 2013, PloS one.

[10]  Maria Emma Santos,et al.  Measuring Acute Poverty in the Developing World: Robustness and Scope of the Multidimensional Poverty Index , 2013 .

[11]  S. Ramesh,et al.  Relationship between mobility, violence and HIV/STI among female sex workers in Andhra Pradesh, India , 2012, BMC Public Health.

[12]  P. Pelto,et al.  Community mobilisation programme for female sex workers in coastal Andhra Pradesh, India: processes and their effects , 2012, Journal of Epidemiology & Community Health.

[13]  N. Saggurti,et al.  How effective is community mobilisation in HIV prevention among highly diverse sex workers in urban settings? The Aastha intervention experience in Mumbai and Thane districts, India , 2012, Journal of Epidemiology & Community Health.

[14]  M. Chersich,et al.  Socio-Demographic Characteristics and Behavioral Risk Factors of Female Sex Workers in Sub-Saharan Africa: A Systematic Review , 2012, AIDS and Behavior.

[15]  R. Mishra,et al.  Community advocacy groups as a means to address the social environment of female sex workers: a case study in Andhra Pradesh, India , 2012, Journal of Epidemiology & Community Health.

[16]  R. Mishra,et al.  Mobilising community collectivisation among female sex workers to promote STI service utilisation from the government healthcare system in Andhra Pradesh, India , 2012, Journal of Epidemiology & Community Health.

[17]  Tara S. Beattie,et al.  An integrated structural intervention to reduce vulnerability to HIV and sexually transmitted infections among female sex workers in Karnataka state, south India , 2011, BMC public health.

[18]  Rajendra Singh,et al.  MOTIVATIONS FOR ENTRY INTO SEX WORK AND HIV RISK AMONG MOBILE FEMALE SEX WORKERS IN INDIA , 2011, Journal of Biosocial Science.

[19]  Rajendra Singh,et al.  Indicators of Mobility, Socio-Economic Vulnerabilities and HIV Risk Behaviours Among Mobile Female Sex Workers in India , 2011, AIDS and Behavior.

[20]  S. Alkire,et al.  Counting and Multidimensional Poverty Measurement , 2010 .

[21]  C. Evans,et al.  What makes a structural intervention? Reducing vulnerability to HIV in community settings, with particular reference to sex work , 2010, Global public health.

[22]  S. Sarkar,et al.  Risk and vulnerability: do socioeconomic factors influence the risk of acquiring HIV in Asia? , 2010, AIDS.

[23]  K. Blankenship,et al.  The Context of Economic Insecurity and its Relation to Violence and Risk Factors for HIV among Female Sex Workers in Andhra Pradesh, India , 2010, Public health reports.

[24]  S. Moses,et al.  Determinants of HIV prevalence among female sex workers in four south Indian states: analysis of cross-sectional surveys in twenty-three districts , 2008, AIDS.

[25]  K. Blankenship,et al.  Power, community mobilization, and condom use practices among female sex workers in Andhra Pradesh, India , 2008, AIDS.

[26]  P. Aggleton,et al.  Structural approaches to HIV prevention , 2008, The Lancet.

[27]  V. Patel,et al.  The burden and determinants of HIV and sexually transmitted infections in a population-based sample of female sex workers in Goa, India , 2008, Sexually Transmitted Infections.

[28]  Vikram Patel,et al.  Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review , 2008, Tropical medicine & international health : TM & IH.

[29]  S. Alkire Choosing Dimensions: The Capability Approach and Multidimensional Poverty , 2007 .

[30]  L. Niccolai,et al.  Unprotected intercourse for extra money among commercial sex workers in Kinshasa, Democratic Republic of Congo , 2006, AIDS care.

[31]  S. Niyogi,et al.  Young age is a risk factor for HIV among female sex workers--an experience from India. , 2006, The Journal of infection.

[32]  K. Blankenship,et al.  Structural Interventions: Concepts, Challenges and Opportunities for Research , 2006, Journal of Urban Health.

[33]  L. Dandona,et al.  High risk of HIV in non-brothel based female sex workers in India , 2005, BMC public health.

[34]  C. Koopman,et al.  Multilevel Analysis of Women's Empowerment and HIV Prevention: Quantitative Survey Results from a Preliminary Study in Botswana , 2003, AIDS and Behavior.

[35]  Kai-yuen Tsui,et al.  Multidimensional poverty indices , 2002, Soc. Choice Welf..

[36]  A. D. Guzman Reducing social vulnerability to HIV/AIDS: Models of care and their impact in resource-poor settings , 2001 .

[37]  E. Fridell,et al.  The mechanism for NOx storage , 2000 .

[38]  S. Jana,et al.  Beyond medical model of STD intervention--lessons from Sonagachi. , 1995, Indian journal of public health.

[39]  Economic Strengthening for Female Sex Workers: A Review of the Literature , 2014 .

[40]  S. Isac,et al.  Impact of two vulnerability reduction strategies - collectivisation and participation in savings activities - on HIV risk reduction among female sex workers , 2012 .