Alcohol use, Partner Violence and Sexual
risk among South Indian Sex Workers:
Implications for Interventions
Maria Ekstrand1, Gopal Krishnan2, D. Solomon3, R Solomon3, AK SriKrishnan4,
Vasudevan CK4, Sethulakshmi Johnson4, & N Kumarasamy4
1 University of California, San Francisco & Berkeley, & St John’s Research Institute, Bengaluru;
2 Shelter, Calicut; 3 SHADOWS, Chirala; 4 Y.R.Gaitonde Centre for AIDS Education, Chennai;
Research funded by NIH/NIAAA grant: R01AA015298
Stigma, poverty, and violence all contribute to the lack of
power and vulnerability of female sex workers.
Female sex workers in India found more likely to use alcohol
than the general female population.
Global literature suggests link between alcohol and
unprotected sex, but specific drinking patterns and role of
alcohol in sex among Indian sex workers are less clear.
Not known how these factors influence risk among different
types of sex workers and with different types of partners.
To examine:
1) patterns and contexts of alcohol consumption among
different types of female sex workers in Andhra Pradesh
and Kerala as well as their perceptions of the drinking
behaviors of their clients
2) Their experience with client and partner violence and
the role of alcohol in this violence
3) The relationship between alcohol consumption,
violence and sexual risk, with both paying and non-paying
partners in this population.
Female sex workers in Calicut, Kerala (n=534) and Chirala, Andhra
Pradesh (n=601), recruited via referrals from key informants and
snowball sampling, to ensure adequate representation from different
subgroups of FSW; street-based, home-based, brothel-based sex and
sex in lodges (typically with repeat clients or those referred by phone).
Face-to-face interviews assessed:
•demographics
•alcohol use patterns and contexts
•sexual practices with different partner types
•intimate partner/client violence experiences
•and other relevant psycho-social factors
Calicut (n = 534) Chirala (n = 601) p
% %
Marital status
Married 28 53 3 days/wk 5 26
Asked of drinkers only n = 121 n = 500
Number drinks/typical day % % 8 30 45 999
Ever get drunk 1.58 4.85 1.17-29.64
Drunk men insist on sex without condoms 0.93 2.54 0.95-7.07
Condoms unnecessary with trusted partners 1.05 2.86 1.18-7.14
Risky peer norms 0.58 1.78 1.26-2.59
•Set up peer networks for home-based sex workers
•Explore potential emergency contact systems
•Collaborate with local NGOs on violence prevention
•Work with clients and partners!
Work with peer networks, NGOs and FSW to:
•Address binge/heavy drinking
• Develop strategies to avoid drunk clients?
•Strategies to deal with unavoidable drunk clients
• Work with clients and partners!
Skills and perceptions to be targeted:
•Address risky peer norms in group or
community setting
•Reduce condom discomfort through skills
training (female & male condoms)
•Address issues of “trusted” partners
•Work with clients and partners!