Anal sex and associated HIV-related sexual risk factors among female sex workers in Andhra Pradesh, India

Background: This study aims to understand the correlates of anal sex practices among female sex workers (FSWs) and examine the association of anal sex with HIV-related sexual risk factors in Andhra Pradesh, India. Methods: A cross-sectional behavioural survey was conducted in 2011 among 795 FSWs aged 18 years or older. Probability-based cluster sampling was used to select respondents from sex work hotspots. Results: One-quarter (23%) of FSWs had practiced anal sex in the last year. The odds of practicing anal sex were higher among FSWs aged 35 years or more than in those aged less than 25 years (adjusted odds ratio (AOR): 2.05, P < 0.05), in those formerly married compared to those currently married (AOR: 1.88, P < 0.01), in those having an income only from sex work compared to those having additional sources of income (AOR: 1.54, P < 0.05), those reporting heavy alcohol consumption compared to those who did not (AOR: 2.80, P < 0.01) and those who experienced violence compared to those who had not (AOR: 2.80, P < 0.01). FSWs practicing anal sex were more likely to experience sexually transmissible infection (STI) related symptoms than those practicing only vaginal sex. There was no association between anal sex practice and condom use. Conclusions: Anal sex is associated with STI symptoms, a factor for HIV risk. HIV intervention programmes need to educate FSWs about the risks associated with anal sex.