Power, community mobilization, and condom use practices among female sex workers in Andhra Pradesh, India

Objectives: We used a structural interventions framework to analyse the associations between power and condom use among a sample of female sex workers (FSW), and how exposure to a local community mobilization intervention (CMI) affects these associations. Design: Data came from a cross-sectional survey of 812 FSW in the East Godavari district of Andhra Pradesh, India, recruited through respondent-driven sampling. Methods: We identified three types of power - collective power, control over work, and economic power, and three dimensions of collective power - collective identity, efficacy, and agency. Multivariate logistic regression analysis was used to analyse the relationship of these three types of power and exposure to a CMI with consistent condom use with clients. Results: A total of 803 respondents exchanged sex with an occasional or regular client in the 7 days before the interview. Multivariate logistic regression shows that control over both the type of sex [adjusted odds ratio (AOR) 1.70, 95% confidence interval (CI) 1.23-2.34] and the amount charged (AOR 1.56, 95% CI 1.12-2.16), and economic dependence (AOR 0.54, 95% CI 0.35-0.83) are associated with consistent condom use as is programme exposure (AOR 2.09, 95% CI 1.48-2.94). The interaction between programme exposure and collective agency was also significant (chi-square 6.62, P = 0.01). Among respondents who reported both programme exposure and high levels of collective agency, the odds ratio of consistent condom use was 2.5 times that of other FSW. Conclusion: A structural interventions framework is useful for understanding HIV risk among FSW. More needs to be done to promote FSW control over work and access to economic resources. (C) 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins