This article is part of the supplement: Learning from large scale prevention efforts: findings from Avahan

Open Access Research

Condom use within non-commercial partnerships of female sex workers in southern India

Kathleen N Deering1*, Paranita Bhattacharjee2, Janet Bradley3, Stephen S Moses45, Kate Shannon6, Souradet Y Shaw5, Reynold Washington2, Catherine M Lowndes7, Marie-Claude Boily8, Banadakoppa M Ramesh2, S Rajaram2, Kaveri Gurav2 and Michel Alary3

Author affiliations

1 Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada

2 Karnataka Health Promotion Trust, Bangalore, India

3 URESP, Centre de recherche FRSQ du CHA universitaire de Québec, Québec, Canada

4 Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada

5 Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada

6 BC Centre for Excellence in HIV/AIDS, Faculty of Medicine, University of British Columbia, Vancouver, Canada

7 HIV and STI Department, Health Protection Services – Colindale, Health Protection Agency, London, UK

8 Department of Infectious Diseases Epidemiology, Imperial College, London, UK

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Citation and License

BMC Public Health 2011, 11(Suppl 6):S11  doi:10.1186/1471-2458-11-S6-S11

Published: 29 December 2011



Although female sex workers (FSWs) report high levels of condom use with commercial sex clients, particularly after targeted HIV preventive interventions have been implemented, condom use is often low with non-commercial partners. There is limited understanding regarding the factors that influence condom use with FSWs’ non-commercial partners, and of how programs can be designed to increase condom use with these partners. The main objectives of this study were therefore to describe FSWs’ self-reported non-commercial partners, along with interpersonal factors characterizing their non-commercial partnerships, and to examine the factors associated with consistent condom use (CCU) within non-commercial partnerships.


This study used data collected from cross-sectional questionnaires administered to 988 FSWs in four districts in Karnataka state in 2006-07. We used bivariate and multivariable logistic regression analysis to examine the relationship between CCU (i.e., ‘always’ compared to ‘never’, ‘sometimes’ or ‘frequently’) with non-commercial partners of FSWs (including the respondents’ husband or main cohabiting partner [if not married] and their most recent non-paying partner [who is neither a husband nor the main cohabiting partner, and with whom the FSW had sex within the previous year]) and interpersonal factors describing these partnerships, as well as social and environmental factors. Weighting and survey methods were used to account for the cluster sampling design.


Overall, 511 (51.8%) FSWs reported having a husband or cohabiting partner and 247 (23.7%) reported having a non-paying partner. CCU with these partners was low (22.6% and 40.3% respectively). In multivariable analysis, the odds of CCU with FSWs’ husband or cohabiting partner were 1.8-fold higher for FSWs whose partner knew she was a sex worker (adjusted odds ratio [AOR]: 1.84, 95% confidence intervals[CI]: 1.02-3.32) and almost 6-fold higher if the FSW was unmarried (AOR: 5.73, 95%CI: 2.79-11.76]. CCU with FSWs’ non-paying partner decreased by 18% for each one-year increase in the duration of the relationship (AOR: 0.82, 95%CI: 0.68-0.97).


This study revealed important patterns and interpersonal determinants of condom use within non-commercial partnerships of FSWs. Integrated structural and community-driven HIV/STI prevention programs that focus on gender and reduce sex work stigma should be investigated to increase condom use in non-commercial partnerships.