1. IS MENTAL DEPRESSION A SERIOUS ISSUE AMONG FEMALE SEX WORKERS? EVIDENCE FROM SOUTHERN INDIA Sangram Kishor Patel 1, Niranjan Saggurti 1, Saroj Pachauri 1, Parimi Prabhakar 2 1 HIV and AIDS Program, Population Council, New Delhi, India; 2 India HIV/AIDS Alliance, Hyderabad, India Session: THAB01; Track B: Time: 16:30-18:00 PM; 24 th July, 2014 20th International AIDS Society Conference, Melbourne, Australia

2. Context of sex workers in India Poverty/Financial debt Trafficked into sex work Mobility/Migration Violence HIV risk Social exclusion Working and living environment Lack of supporting policies

3. Rationale of the study Mental health-related disorders contribute to nearly 13% of the total global disease burden (MHA, 2011) Life time prevalence of mental health disorders in India: 10-12% (NIMH, 2012) With HIV epidemiological transition, new challenges are emerging: e.g. NCD (including depression) Mental health among female sex workers is a largely neglected issue in India

4. Objectives Understand the prevalence of major mental depression among female sex workers in southern India. Examine the factors associated with major depression among female sex workers.

5. Data and methods Cross-sectional Behavioural Tracking Survey (2010) (N=1986 female sex workers) in selected districts of Andhra Pradesh Depression accessed using Patient Health Questionnaire-2 (PHQ-2) (<3: No/low depression; ≥3: Major depression) (Kroenke, Spitzer and Williams, 2003) Descriptive statistics, Frequency, Bivariate analysis and Multiple logistic regression analysis conducted using Stata 11.2

6. Results

7. Background characteristics Age: Mean = 29.2 years (SD=5.3 years) Marital status: – 57% currently married – 34% widowed/deserted/divorced/separated – 9% never married Typology of sex work: – 64% public places/street-based – 28% home based – 8% brothel- and lodge-based 44% had no formal education and most (85%) were currently under financial debt >11% had faced physical violence in 6 months prior to the survey

8. PHQ-2 and mental health status as reported by sex workers in southern India, 2010 Major depression No/Low depression

9. Who are more likely to report major depression? Sex workers:  living with non-family members  under financial debt  mobile for sex work  arrested by police  who do not want to report their HIV status Background characteristics% Major depression (% Ref.) AOR (95% CI) Living with others (male partner/friends/ co-sex workers) (Ref: spouse/family member) 52.3 (36.7)1.7 (1.0-2.7) Living alone (Ref: spouse/family member 42.6 (36.7) 1.1 (0.8-1.6) Under Financial debt (Ref: No)40.5 (31.2)1.5 (1.0-2.1) Mobile for sex work outside district (Ref: No) 49.0 (33.1) 1.7 (1.3-2.3) Experienced physical violence in past 6 months (Ref: No) 45.5 (37.8) 1.2 (0.8-1.7) Experienced arrest from police (Ref: No) 55.3 (36.3) 1.8 (1.2-2.6) Experience of any STI symptoms, past 6 months ( Ref: No) 46.1 (38.1)1.3 (0.9-1.9) HIV status (self reported): Positive (Ref: Negative) 30.0 (36.1) 0.5 (0.1-2.0) Did not want to share (Ref: HIV Negative) 46.3 (36.1)1.8 (1.3-2.4) Feeling ashamed of being a sex worker (Ref: No) 41.3 (37.2)1.2 (0.9-1.6) Note: CI: Confidence Interval; AOR: Adjusted Odds Ratio; AOR are adjusted for age, education, marital status, typology, usual place of practicing sex work and reasons for entry into sex work

10. Summary and Recommendations A significant proportion (two-fifths) of female sex workers have reported major mental depression. Sex workers’ financial vulnerability and sex work contexts are significantly associated with poor mental health. Financial security and creating enabling environment at local level should be prioritized to improve mental health of this marginalized group. HIV prevention interventions could expand to implement mental health counselling as part of the programme to build self-efficacy in the short-term, and to achieve healthy communities in the long-term.

11. For more information: Sangram Kishor Patel, PhD HIV and AIDS Program, Population Council New Delhi, INDIA Email: skpatel@popcouncil.org http://www.popcouncil.org Thank You… Acknowledgements Avahan, the India AIDS initiative of the Bill & Melinda Gates Foundation

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