Mo0PC09 03 Monika Doshi

Intrastate Mobility of Female Sex Workers in Southern Karnataka (India): Driving Factors and Implications on Project Design for HIV/AIDS Intervention/Prevention: 

Intrastate Mobility of Female Sex Workers in Southern Karnataka (India): Driving Factors and Implications on Project Design for HIV/AIDS Intervention/Prevention Monika Doshi, MPH University of Manitoba ICAAP 2007

Background-Karnataka: 

Background-Karnataka 1.7% of adult population HIV+ (ANC estimates 2002) Largely heterosexual epidemic Female sex work important component in transmission dynamics Sex work practices differ between northern (brothel- and home-based) and southern Karnataka (street-based) Mandya District (southern Karnataka) is the focus of the study

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MAP OF KARNATAKA

Background-Mandya District: 

Background-Mandya District Administrative district located in southern Karnataka Consists of 7 taluks (villages and municipalities) Main town is Mandya town (MT) Long history of sex work; primarily brothel based at first Displacement over the years resulted in women becoming highly mobile MT mostly serves as a solicitation point Estimated 250-300 FSWs operate in and around Mandya town BMGF funded program has been working in MT since 2004 Evidence that women in Mandya were highly mobile

Implications of Mobility: 

Implications of Mobility On transmission dynamics and the resulting epidemiological significance On intervention and outreach ** Qualitative study conducted to understand mobility of street-based FSWs in Mandya District

Study Objectives: 

Study Objectives Understand patterns of intrastate mobility Characterize mobility patterns (frequency, factors for mobility, origin and destination points) Provide information and suggest programming and intervention strategies for mobile sex workers

Study Design: 

Study Design Woman fall into 4 groups Group I: Solicit in Mandya town and provide services elsewhere Group II: Solicit outside Mandya town and provide services elsewhere Group III: Solicit in/out of Mandya town and provide services in/out of Mandya town Group IV: Solicit in Mandya town only and provide services in Mandya town only Research staff included PI and 3 field staff (two males and one female)

Methods: 

Methods Typical case or criteria-based sampling used to recruit women (N=70) Groups I and III: 25 each Groups II and IV: 10 each 3 data collection tools included Retrospective mobility diary Prospective mobility diary Semi-structured in-depth interviews

Results: 

Results Group I Top 3 solicitation points in Mandya town identified Change in solicitation point from one day to the next but an average of 4-5 overall points Police presence and/or harassment was found to be the major factor in how a woman selects solicitation point 33% of the women stated that they solicited in other towns and/or through their cell phones 13% were found to use their cell phones exclusively 67% of the women did not operate during the monsoons Majority provided services outside Mandya town; there were exceptions to this Problems with the police stated as the primary reason for leaving Mandya town Client type dictated venue for provision of services If given more money, a majority of women stated that they would go where the client wanted independent of client type For some women, if client ‘looked official and good’ they would go where he wanted

Results: 

Results Group III 87% of women preferred to solicit in Mandya town; most popular alternate site was found to be Maddur (others have been identified as well) Top 3 solicitation points in Mandya town identified (same as those in Group I) Change in solicitation point from one day to the next with very few women repeating the points from one week to the next Police presence and/or harassment was found to be the major factor in how a woman selects solicitation point 46% were found to use their cell phones exclusively 54% of the women did not operate during the monsoons 27% of the women worked through brokers/agents Majority provided services outside Mandya town; 53% listed one specific overnight lodge Police problems stated as the primary reason for leaving Mandya town Client type dictated venue for provision of services If given more money, a majority of women stated that they would go where the client wanted independent of client type

Recommendations: 

Recommendations Program purpose Services should be offered at both solicitation and provision of sexual service sites and not be solely based in the project drop-in center (MT) Incorporate strategies which go beyond individual focused behavior change to structural interventions in traditional and non-traditional sex work venues Research purpose – Further research, employing larger sample sizes and including more in-depth mapping is strongly suggested to ensure comprehensive coverage

Strengths and Limitations: 

Strengths and Limitations Strengths Unique study in that mobility is often a disregarded component of informed programming Identification and understanding of factors associated with solicitation and provision of sexual services Recognition of key stakeholders for initiation of structural interventions Limitations Utilization of small sample size Bias introduced in sample selection (not random) Qualitative study therefore compromises external validity

References: 

References 1. IOM. Mobility and HIV/AIDS in Southern Africa: A field study in South Africa, Zimbabwe and Mozambique. 2003, IOM, CARE & SIDA. http://www.iom.org.za/HIVAIDSPublications.html. 2. Parker, Richard., Easton, Delia & Klein, Charles (2000). Structural barriers and facilitators in HIV prevention: a review of international research. AIDS, 14(suppl 1):S22-S32. 3. UNAIDS. UNAIDS 2004 Report on the global AIDS epidemic - 4th global report. 2004, Geneva, UN. www.unaids.org/bangkok2004/ GAR2004_html/GAR2004_00_en.htm. 4. UNDP. Mapping for the health and well-being of mobile sex workers and the communities they serve: The case of Cambodia. 2004, UNDP. http://www.undp.org/hiv/pa_asia.htm. 5. UNDP. Migration and HIV in South Asia. 2004, UNDP. http://www.undp.org/hiv/pa_asia.htm. 6. UNDP. No safety signs here – research study on migration and HIV vulnerability from seven South and North East Asian countries. 2004, UNDP. http://www.undp.org/hiv/pa_asia.htm. 7. World Bank. Understanding and responding to a heterogeneous epidemic: South Asia Region Report (Draft 2005). 8. Wotton, Rachel (2005). The relationship between street-based sex workers and the police in the effectiveness of HIV prevention strategies. Research for Sex Work, 8.

Acknowledgements: 

Acknowledgements Research Staff: E. Madhusudana, Fathima Mary P., Venkatesh Sabnis Dr. James Blanchard, Dr. Kaveri Gurav, Dr. Carl Latkin, Dr. Sushena Reza-Paul, and Dr. Reynold Washington Funding Agency: Bill and Melinda Gates Foundation (Avahan) Special thanks to: Peer Educators of Mandya Distrcit Direct Implementation Project Mandya Sex Workers Collective All sex workers who participated in this study

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THANK YOU!