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Micro-level social and structural factors act synergistically to increase HIV risk among Nepalese female sex workers.

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Deuba K, Anderson S, Ekström AM, Pandey SR, Shrestha R, Karki DK, Marrone G,


Deuba K, Anderson S, Ekström AM, Pandey SR, Shrestha R, Karki DK, Marrone G, (click to view)

Deuba K, Anderson S, Ekström AM, Pandey SR, Shrestha R, Karki DK, Marrone G,

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International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2016 6 13() pii 10.1016/j.ijid.2016.06.007

Abstract
OBJECTIVES
Sex workers face stigma, discrimination and violence across the globe and are almost 14 times more likely to be HIV infected than other women in low-and middle income countries. In Asia, condom campaigns at brothels have been effective in some settings, but for preventive interventions it is important to understand micro-level social and structural factors that influence sexual behaviors of sex workers to be sustainable. This study assesses the syndemic effects of micro-level social and structural factors of unprotected sex and the prevalence of HIV among female sex workers in Nepal.

METHODS
This quantitative study included 610 female sex workers that were recruited using two-stage cluster sampling from September to November 2012 in 22 Terai highway districts of Nepal. Rapid HIV tests and face-to-face interviews were conducted to collect biological and behavioral information. A count of physical (sexual violence and other undesirable events), social (poor social support and condom negotiation skills) and economic (unprotected sex to make more money) factors that operate at the micro-level was calculated to test the additive relationship to unprotected sex.

RESULTS
The HIV prevalence was 1% and this is presumably representative with a large sample of female sex workers in Nepal. The prevalence of unprotected sex with client was high (24%). For each additional adverse physical, social and economic condition, the probability of non-use of condoms with clients increased substantially: 1 problem=12%, p-value 0.005; 2 problems=19%, p-value <0.001; 3-5 problems= 38%, p-value <0.001. CONCLUSIONS
Interactions between two or more adverse conditions linked to physical, social and economic environment increased the risk of unprotected sex among Nepalese female sex workers.

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