Shiva S. Halli

The role of collectives in STI and HIV / AIDS prevention among female sex workers in Karnataka India.

Abstract This paper evaluates the role of female sex worker (FSW) collectives in the state of Karnataka, India, regarding their facilitating effect in increasing knowledge and promoting change towards safer sexual behaviour. In 2002 a state-wide survey of FSWs was administered to a stratified sample of 1,512 women. Following the survey, a collectivization index was developed to measure the degree of involvement of FSWs in collective-related activities. The results indicate that a higher degree of collectivization was associated with increased knowledge and higher reported condom use. Reported condom use was higher with commercial clients than with regular partners or husbands among all women and a gradient was observed in most outcome variables between women with low, medium and high collectivization index scores. Collectivization seems to have a positive impact in increasing knowledge and in empowering FSWs in Karnataka to adopt safer sex practices, particularly with commercial clients. While these results are encouraging, they may be confounded by social desirability, selection and other biases. More longitudinal and qualitative studies are required to better understand the nature of sex worker collectives and the benefits that they can provide.

Hiv risk behaviours among contracted and non-contracted male migrant workers in India: potential role of labour contractors and contractual systems in Hiv prevention

Objective(s):To assess the HIV risk behaviours of male migrant contracted and non-contracted labourers in India and to understand the role of contract labour systems for use in HIV prevention efforts. Methods:Cross-sectional surveys (N = 11 219) were conducted with male migrant workers, aged 18–49 years from 21 districts in four high HIV prevalence states of India. Analyses involved data from the subsample of contracted labour (n = 3880; 35% of total sample) to assess the prevalence of HIV risk behaviours and sexually transmitted infection (STI) symptoms and further comparisons with non-contracted labourers. Results:Contracted male labourers are largely young; 70% were between the ages of 18 and 29 years. Over half (55%) were married, and a third (34%) resided away from their wives because of migrant work. More than one in six contract labourers (17%) reported having sex with a sex worker, and two-fifths of these reported an inconsistent use of condoms. One in 10 reported sex with both sex workers and non-spousal unpaid female partners in the past year in the places they had migrated to, and 31% reported sex with either a sex worker or non-spousal unpaid female partner in their places of origin over the past 2 years. After adjustment for sociodemographic characteristics, the contracted labourers were significantly more likely to report alcohol use and HIV risk behaviours than non-contracted labourers. Conclusion:The existence of a wide network of labour contractors and a structured infrastructure of the contract system provides opportunities for effective and sustained worksite HIV prevention programmes among contracted male migrant workers in India.

Labor Market Experiences of Canadian Immigrants with Focus on Foreign Education and Experience

Recent Canadian immigrants have increasing education levels but decreasing earnings, partly due to the devaluation of foreign education and work experience. This study uses 2002 Ethnic Diversity Survey data and examines the value attributed to foreign education for immigrants based on their duration of stay in Canada, which proves to be an important methodological distinction. Immigrants from developing countries experience the most acute devaluation. The findings outline the limitations of human capital theory in explaining the labor market experience of Canadian immigrants and have implications for the current “point system” used to select immigrants to Canada.

Prevalence and determinants of HIV infection in South India : a heterogeneous, rural epidemic

Objectives: To assess the prevalence and determinants of HIV infection in the general population in Bagalkot district, a largely rural district in the southern Indian state of Karnataka. Methods: Approximately 6700 individuals aged 15–49 years were randomly sampled from 10 villages and six towns, from three of Bagalkots six sub-districts. Each consenting respondent was administered a questionnaire, followed by blood collection and testing for HIV, syphilis, and herpes simplex virus type 2 (HSV-2) on a 25% sub-sample. Results: HIV prevalence was 2.9% overall, 2.4% in urban areas and 3.6% in rural areas [odds ratio (OR), 0.65; 95% confidence interval (CI), 0.45–0.95]. Significant differences in HIV prevalence were seen between the three sub-districts, with prevalences of 1.1, 3.0 and 6.4% (P < 0.05), and HIV prevalence in the 10 villages ranged from 0 to 8.2%. Reported multiple sexual partners, receiving money for sex and a history of medical injections were significantly associated with HIV infection, as were older age, being widowed, divorced, separated or deserted, lower education levels and being a woman of a lower caste. There was a strong association between HSV-2 and HIV infection (OR, 5.2; 95% CI, 2.3–11.5). Conclusions: The rural nature of this epidemic has important implications for prevention and care programs. The striking differentials observed in HIV prevalence between sub-districts and even villages suggest that risk and vulnerability for HIV are highly heterogeneous. Further research is required to understand the individual and community-level factors behind these differentials, so that preventive interventions can be directed to where they are most needed.

Double jeopardy?: Violence against immigrant women in Canada

Using a theoretical synthesis based in Nested Ecological Theory, the study fills a gap in the extant literature through an investigation of the prevalence and causes of violence against immigrant women in Canada. Based on a representative sample of 7,115 women, the results show that immigrant women from developing countries have the highest prevalence of violence. The analyses demonstrate that several variables operate differently in the production of violence against immigrant women from developed and developing nations. However, the key difference in explaining the higher prevalence of violence among those from developing countries is the sexually proprietary behavior exhibited by their partners. The results further show that sexual jealousy interacts with high female education and low male education levels in the prediction of violence among immigrant women from developing countries. Implications for future research are identified.

Devising a female sex work typology using data from Karnataka, India

BACKGROUND We examine the extent to which an existing sex work typology captures human immunodeficiency virus (HIV) risk in Karnataka and propose a systematic approach for devising evidence-based typologies. METHODS The proposed approach has four stages: (i) identifying main places of solicitation and places of sex; (ii) constructing possible typologies based on either or both of these criteria; (iii) analysing variations in indicators of risk, such as HIV/sexually transmitted infection (STI) prevalence and client volume, across the categories of the typologies; and (iv) identifying the simplest typology that captures the risk variation experienced by female sex workers (FSWs) across different settings. Analysis is based on data from 2312 participants in integrated biological and behavioural assessments of FSWs conducted in Karnataka, India. Logistic regression was used to predict HIV/STI status (high-titre syphilis, gonorrhea or chlamydia) and linear regression to predict client volume. RESULTS Our analysis suggests that the most appropriate typology in Karnataka consists of the following categories: brothel to brothel (i.e. solicit and have sex in brothels) (11% of sampled FSWs); home to home (32%), street to home (11%), street to rented room (9%), street to lodge (22%), street to street (9%) and other FSWs (8%). Street to lodge FSWs had high HIV (30%) and STI prevalence (27%), followed by brothel to brothel FSWs (34 and 13%, respectively). CONCLUSIONS The proposed typology identifies street to lodge FSWs as being at particularly high risk, which was obscured by the existing typology that distinguishes between FSWs based on place of solicitation alone.

Migration and HIV transmission in rural South India: An ethnographic study

There is a widespread assumption in Northern Karnataka, India that HIV transmission is due to the large volume of male seasonal labour out‐migration. In order to examine this issue, an ethnographic study was conducted in one of the Northern Karnataka districts using a combination of quantitative and qualitative methods. Findings indicate that migration does not seem to be a key factor affecting sexual behaviour among married men. Nearly 35% of married migrant men reported being involved in extramarital sex and 40% of unmarried migrant men were involved in premarital sex. While earlier in the epidemic there was a strong correlation between HIV infection and migration, more recently the correlation seems to be getting weaker. More innovative HIV prevention programmes which take into account the social and cultural characteristics of this region are urgently needed to curtail the rapid development of the epidemic.

Variability in the sexual structure in a rural Indian setting: implications for HIV prevention strategies

Objectives: To describe the sexual structure, including numbers and distribution of female sex workers (FSWs) and male sexual behaviours in the Bagalkot district of the state of Karnataka in south India. Methods: Village health workers and peer educators enumerated FSWs in each village by interviewing key informants and FSWs. Urban FSW populations were estimated using systematic interviews with key informants to identify sex work sites and then validating FSW populations at each sex work site. Male sexual behaviours were measured through confidential polling booth surveys in randomly selected villages. HIV prevalence was estimated through a community-based survey using randomised cluster sampling. Lorenz curves and Gini coefficients were used to describe the degree of clustering of FSW populations. Results: Of an estimated 7280 FSWs in Bagalkot district (17.1/1000 adult males), 87% live and work in rural areas. The relative size of the FSW population varies from 9.6 to 30.5/1000 adult males in the six subdistrict administrative areas (talukas). The FSW population was highest in the three talukas with more irrigated land and fewer and larger villages. FSW populations are highly clustered; 93 (15%) of the villages accounted for 54% of all rural FSWs. There is a high degree of FSW clustering in all talukas, and talukas with fewer and larger villages have larger clusters and more FSWs overall. General population HIV prevalence is highest in the taluka with the highest relative FSW population. Conclusions: Prevention programmes in India should be scaled up to reach FSWs in rural areas. These programmes should be focused on those districts and subdistrict areas with large concentrations of FSWs. More research is required to determine the distribution of FSWs in rural areas in other regions of India.

Understanding Male Partner Violence Against Cohabiting and Married Women: An Empirical Investigation with a Synthesized Model

Based on research consistently showing that cohabitors are more likely to be violent than married couples, it is argued that the practice of equating these two marital status groups may obfuscate our understanding of the etiology of male partner violence against women. A synthesized model for understanding marital status differences is presented and tested on a large-scale representative sample of Canadian women. The results show little support for most existing explanations and suggest that unique processes are operating in the production of violence for different marital status groups. In addition to disaggregation by marital status, other directions for future research are discussed.

“Living in sin” and sinful living: Toward filling a gap in the explanation of violence against women

The present article argues that the failure of most family violence researchers to analyse cohabiting relationships separately from marital unions constitutes a major gap in our understanding of violence against women. The review of available evidence indicates that violence by men in cohabiting relationships is more common and more likely to be severe. Research is therefore needed to identify the causal pathways leading to violence for marrieds and cohabitors separately. Recognising a lack of theoretical application, a number of explanatory frameworks that may be used to study marital status differences in violence are articulated. An application of Berger and Kellners phenomenological thesis to the study of selection and relationship factors appears particularly promising. As part of an agenda for future research in this area, several problems of past studies that need to be overcome are identified along with possible solutions.