Figure 1 Conceptual framework of factors related with inconsisten

Figure 1 Conceptual framework of factors related with inconsistent condom use during anal intercourse. Inconsistent condom use during anal intercourse was the dependent variable. The independent type 2 diabetes variables were selected based on their contextual relation with

the dependent variable. Based on prior research, individual factors such as risk perception, alcohol use,23–25 frequency of commercial sex, volume of sex acts,14 26 having male/transgender partners,27 place of soliciting FSWs5 and having HIV/STIs,18 which are widely seen to influence condom use among different high-risk population groups, were included. We hypothesised that clients who were married, consumed alcohol, solicited FSWs from public places and had a higher number of FSW partners were more likely to be inconsistent condom users. These clients were also more likely to have experienced anal sex with a man. Most current interventions for clients of FSWs are limited to condom promotion and distribution, and no intervention for FSWs or their clients currently addresses heterosexual anal intercourse, which has significant implications for HIV prevention programming. Based on the rationale described above, we grouped the different indicators into two categories: (1) sociodemographic and (2) HIV-related

sexual risk behaviours. Measures Dependent variable Inconsistent condom use during anal intercourse—This behaviour was assessed by asking: “How often did you use a condom while having anal intercourse with your regular and occasional FSWs in the past

six months?” The clients who reported using condoms most of the time, sometimes or never were considered inconsistent condom users (coded as ‘1’), while those who reported using condoms every time during anal intercourse were considered consistent condom users (coded as ‘0’). Independent variables The independent variables included age in completed years; education (illiterate, can read only, can read and write); occupation (pre-coded as unemployed, student, domestic servant, agricultural labour, non-agricultural/casual labour, skilled/semiskilled labour, petty businessman/shop owner, large Dacomitinib businessman/shop owner, bus/truck driver/helper, other transport worker, service and others); marital status (currently married, separated, divorced, widowed, never married, no answer); place of soliciting FSWs (pre-coded as bar/nightclub, public place, street, park, railway station, agent, brothel, hotel/lodge, home, dhaba, by telephone, other); number of FSWs they had sex with in the past month; number of sex acts with FSWs in the past month; ever had anal intercourse with a man/transgender (yes/no); self-risk perception (yes/no); alcohol consumption (every day, at least once a week, less than once a week, never, no answer); and having HIV or any STI (those having HIV, syphilis, gonorrhoea or chlamydia were grouped into positive and the rest as negative).

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