Journal Article

HIV risk behaviors among female sex workers using cell phone for client solicitation in India

Background
With the emerging technological revolution in India, the use of cell phone among female sex workers (FSWs) for client solicitation has increased rapidly in the recent past. This study examines the association between FSWs’ cell phone use and their HIV risk behaviors.

Methods
Data were drawn from a cross-sectional behavioral survey conducted across 22 districts of southern and western India during 2007–08. The analytical sample consisted of 3028 FSWs. Bivariate and multivariate methods were used to examine the association between use of cell phone and HIV risk behaviors.

Results
One-fourth (25%) FSWs used cell phones to solicit clients. Results from the multivariate analyses suggest that FSWs who use cell phones than those who do not use cell phones, were more likely to report inconsistent condom use with occasional clients (Adjusted Odds Ratio (AOR):1.9, 95% confidence interval (CI):1.5–2.3), inconsistent condom use with regular clients (AOR:1.6, 95% CI:1.3–2.0), experience of STI-related symptoms (AOR:2.4, 95% CI:1.9–3.1), consumption of alcohol prior to sex (AOR:1.7, 95% CI:1.4–2.0) and difficulty in negotiating condom use with clients (AOR:2.1, 95% CI:1.7–2.6). Except for home-based, the use of cell phone had a multifold effect on FSWs’ HIV risk behaviors in other typologies of sex work.

Conclusion
Use of cell phone is associated with increased HIV risk behaviors among FSWs, independent of their place of solicitation. These findings document the need for developing new strategies to reach FSWs, particularly those who use cell phones or newer technologies for client solicitation.