High -risk sexual behavior and condom use among textile workers in Tamil Nadu, India

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a rapidly growing problem in India, with a 2002 estimate of over four million infected persons. The magnitude of the epidemic varies widely among the different Indian states but is predominantly from heterosexual transmission nationwide. In Tamil Nadu, the infection rates among the general population are now above 1%. Most prevention and control activities are restricted to mass information, education, and communication and targeted programs for the highest risk groups. With an increasingly generalized HIV epidemic, the need to respond to the HIV risk faced by lower risk populations assumes more importance. An assessment undertaken by the Society for AIDS Awareness and Prevention, in Tirupur, Tamil Nadu, identified textile workers as a sub-population vulnerable to sexual acquisition of HIV.;Our study was undertaken in January 2001 to gain a better understanding of the risk for sexually transmitted diseases (STD) including HIV among 240 female and 161 male textile factory workers in 20 factories. We also studied the utility of the Transtheoretical Model of Change (TMC) for measuring condom use, seeking to validate this behavior change theory to design interventions in this Indian sub-population. Lifetime STDs were reported by 12.5% of women and 18.6% of men. Among men, increased risk of STDs was associated significantly with sex with sex workers, non-regular partner in the last 6 months, and non-use of a condom in the last sex with the non-regular partner. Among women, STDs were associated with workplace sexual coercion, sex in exchange of money, and number of sex partners. This study showed similar findings in applying the TMC to predict condom use with regular partner, as did results from United States studies, suggesting a global applicability of this model. Participants in higher stages of behavior change rated the benefits of using condoms more and have higher self-efficacy than those in the lower stages of change. The presence of HIV/AIDS and STD risk factors among these textile workers suggests the need for behavior change intervention programs that could be built upon the conceptual platform of the TMC, validated in a non-Western population.