Abstract #115  -  Alcohol and sexual risk in South India: Perspectives of female sex workers and clients
Authors:   Presenting Author:   Dr Maria Ekstrand - University of California, San Francisco
Additional Authors:  Ms Daniela Rodriguez, Mr AK Srikrishnan, Dr N Kumarasamy, Dr Gopal Krishnan, Dr Davidson Solomon, Mr Raja Solomon, Ms Sethulakshmi Johnson, Mr  Vasudevan CK,
Aim: Although the prevalence of alcohol consumption in India is low among the general population, higher rates have been reported by vulnerable groups, including male migrant workers (MMW) and female sex workers (FSW), who are also at disproportionate risk for HIV. Little is currently known about the patterns of alcohol use in these two populations, how their consumption affects sexual risk, and whether they are a potential bridge of HIV infection to the general population. The present study was designed to examine these issues in two South Indian states.
Method / Issue: These results are based on the qualitative phase of a larger quantitative study, designed to evaluate the relationship between alcohol use and sexual risk-taking among MMWs and FSW in the South Indian states of Kerala and Andhra Pradesh. In-depth interviews were conducted with 80 MMWs and 80 FSWs, discussing their alcohol use, sexual behavior patterns, and contextual issues. This analysis focuses on a comparison of the different perspectives of the two groups on transactional sex, including the initial contact between the FSW and client, negotiation of payment and condom use, alcohol consumption, other contextual factors, and sexual behaviors.
Results / Comments: The FSWs in this study reported a wide range of power in their sexual encounters. Some told stories of being sold into sex work and of abuse, while others stated that they were able to refuse clients and objectionable behaviors, and to set the price. FSWs acknowledged both alcohol use and unprotected sex, but most also described using coping strategies to prevent difficult situations and sexual risk. These included avoiding alcohol use during sex work and avoiding intoxicated clients to reduce the potential for violence, the length of the sexual encounter, and difficulties negotiating safer sex. FSWs also described using female condoms surreptitiously with clients who refused male condoms and rushing clients in order to avoid police raids. MMW clients reported frequent use of alcohol before picking up female sex workers to enhance their libidos, boost their confidence and to prolong the sexual encounter. Several men talked about watching pornographic or “blue” movies and wanting to recreate some of those scenes with the FSWs. The MMWs also reported that they were more comfortable drinking before sex with a FSW than before sex with their wives, because of the negative social and interpersonal consequences of being intoxicated at home. Much of the information gathered was confirmed by both partners, but the value assigned to the events (such as the length of the sexual encounter) was often different for the two groups.
Discussion: Alcohol appeared to play an important role in all stages of sexual encounters between the FSWs and MMW clients interviewed in this study. To increase the chances of success, future prevention programs should target both partner groups. Intervention programs need to include both knowledge and skills building components that address the role of alcohol in sexual risk, as well as alternative ways of meeting the needs of both partners, while reducing the risk of both STI/HIV transmission and violence.
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