Patterns of Sexual Mixing and STIs in Intimate Partner Relationships among Female Sex Workers in Nepal

Abstract

Background and objective: Varying degrees of sexual mixing in an intimate partner relationship which provides emotional support and social security, in addition to the economic benefits to female sex workers (FSWs)-often results in risky sexual behaviour (for example, unprotected sex), hence increasing the vulnerability of FSWs to sexually transmitted infections (STIs). This paper analyses the pattern of sexual mixing and the major covariates of STIs in intimate partner sexual relationships among FSWs in Nepal. Method: The findings are based on information collected from 2901 FSWs, selected by using the modified time-location cluster sampling as part of mapping and size estimation of MARPs across different districts of Nepal in year 2010-11. Results: Findings reveal that almost 40 percent or two-fifths of FSWs in Nepal have commercial as well as noncommercial sexual partners. Further, 5.2 percent of the FSWs reported having more than one non-commercial partner along with commercial partners. Half of the FSWs in intimate partner relationships reported their last sexual encounter as unprotected, which was further lower among those currently married. Adjusted effects of socio-demographic and behavioural correlates portray that being married (p<0.01) and having a higher client load-a proxy of poverty and powerlessness (p<0.05)-are significant determinants of unprotected sex, which may also be attributed to a lack of risk perception in intimate relationships. A higher incidence of unprotected sex further leads to substantially higher prevalence of STIs (35%), which is disproportionately higher among those aged 30 and above, and among those having no formal education. Conclusion: Findings of this study highlight the requirement of strategies to address sexual rights of FSWs within intimate partner relationships, in addition to the need for occupational empowerment of FSWs in order to combat prevalence of STIs and improving their quality of life.