Journal Article

Food insufficiency, violence and HIV risk behaviors among female sex workers in India

Background
Food insufficiency is one of the important contributing factors among female sex workers (FSWs) to engage in risky sexual behaviors and cause of HIV infection in developing countries. Studies exploring linkages between food insufficiency and HIV risk behaviors among FSWs are limited despite having potential program and policy implications. This study attempts to assess the food insufficiency among FSWs and examine its relationship with HIV risk behaviors and violence in India. 

Materials and Methods
Data were drawn from the Avahan-III baseline evaluation survey- 2015, conducted among FSWs (n=4098) using a three-stage cluster sampling approach in four states of India. Multivariate logistic regression (with adjusted odds ratios (AOR) and their 95% confidence intervals (CI)), bivariate analysis and frequency were used to assess the relationships between food insufficiency, HIV risk behaviors and violence. 

Results
Nearly one-fifth of FSWs (17%) reported of facing food insufficiency in past 6 months. More than 35% of FSWs had entertained more clients to cope with the situation of food insufficiency followed by defaulted on loans (24%), borrowed money from informal sources (20%) and had sex without condoms (7%). The likelihood of consistent condom use with non-regular (67% vs. 77%; AOR: 0.6; 95% CI: 0.4-0.9) and regular partner (22% vs. 51%; AOR: 0.3; 95% CI: 0.2-0.4) were significantly lower among FSWs who reported food insufficiency than among those who did not. The likelihood of consistent condom use with occasional (90% vs. 95%; AOR: 0.5; 95% CI: 0.4-0.7) and regular clients (88% vs. 91%; AOR: 0.8; 95% CI: 0.6-0.9) were significantly lower among FSWs who reported food insufficiency compared to those who did not. FSWs who reported food insufficiency were also significantly more likely to report STI symptoms (28% vs. 13%; AOR: 2.7) and any violence (16% vs. 9%; AOR: 2.1) than their counterparts.

Conclusions
The findings of the study highlight that FSW’s food insufficiency is significantly associated with HIV risk behaviors and violence. This study underscores the need for community-led interventions focusing on food insufficiency and economic strengthening activities to reduce HIV vulnerability among FSWs. However, further evidence-based research and advocacies on food insufficiency is required to ensure that HIV prevention programs are appropriately addressed.