Indian men's use of commercial sex workers: Prevalence, condom use, and related gender attitudes

Background/Objectives: Commercial sex represents a critical context for HIV transmission within India and elsewhere. Despite research and programmatic attention to commercial sex workers (CSWs), less is known concerning the male CSW clients considered a bridge population for HIV transmission to the general population and thought to drive demand for the sex trafficking of women and girls. The current study assesses the prevalence of past year CSW contact, condom nonuse therein, and associations with demographic characteristics and gendered attitudes among a national sample of Indian men. Methods: The nationally representative Indian National Family Health Survey-3 was conducted across all Indian states in 2005-2006; the current sample was limited to 46,961 sexually active men. Analyses calculated the prevalence of past year CSW contact and inconsistent condom use; adjusted logistic regression models were used to evaluate associations of demographic characteristics, sexual entitlement and justification of wife abuse with past year CSW contact, and inconsistent condom use. Results: Approximately 1 in 100 Indian men (0.9%) reported past year CSW contact; over half of such men reported inconsistent condom use with CSWs. CSW contact was most common among men ages 15-24 (3.6%) and never married men (9.9%). Men's CSW contact related to higher levels of sexual entitlement (adjusted odds ratio = 1.64; 95% confidence interval 1.24 to 2.17) and justification of violence against wives (adjusted odds ratio = 1.41; 95% confidence interval: 1.03 to 1.93). Conclusions: Men's past year CSW contact was concentrated among young and unmarried Indian men; condom nonuse with CSWs was common. Traditional gender ideologies seemed to support men's CSW contact, bolstering consideration of this behavior as a gendered form of HIV risk. Findings provide direction for interventions to reduce men's CSW contact in the Indian context by describing high-risk subpopulations and indicating that gender ideologies should be addressed.