Community and Family-Based Sexual Health Communication Intervention with Sex Worker Mothers: A Pilot Study

Background: Worldwide, 2,400 youth are infected with HIV daily (UNAIDS, 2012). Specifically in India, youth between the ages of 15 to 24 comprise 25% of India’s population, but account for 31% of all HIV cases (NACO, 2009). This is a serious public health issue that impacts certain sub-sections of the population more severely than others. Children of sex workers (CSW) confront a number of challenges that exacerbate their risk of HIV infection, such as initiation of sex at young ages, high levels of stigma, and conditions marked by poverty and violence (Sinha, 2009). Given this context of high risk, it is alarming that no intervention has addressed the needs of CSW.

Community and family-based sexual health communication interventions (CFSHCI) have been shown to increase family discussions about sexual health and reduce sexual risk behaviors that lead to HIV infection among adolescents (Pequegnat & Bell, 2012). We examine the preliminary efficacy and feasibility of a pilot CFSHCI conducted with sex worker mothers (SWM) in improving the frequency and comfort levels about sexual health communication with their children.

Methods: We collaborated with a sex workers’ collective in Kolkata, India to pilot test the CFSHCI. We employed a one group pre-test, post-test design with 41 SWM to test the preliminary efficacy and feasibility of the intervention. In consultation with community stakeholders, CFSHCI was adapted from an evidence-based intervention and tailored to the community context. The intervention was implemented over four sessions with SWM who had children between the ages of 10 and 18. Participants were recruited at health clinics and were assessed at baseline and post-1 month. Analyses included descriptive statistics and paired sample t-tests.

Results: The average age of participants was 36 years and 88% were single mothers. Most women (80%) had two or more children and the average age of the children was 13 years. Compared to pre-test, participants at post-test reported increased frequency of communication about condoms (p = .04) and increased comfort levels regarding HIV/AIDS (p = .02), condoms (p = .03) and sex work (p = .04) with their children. Involving community stakeholders in the development, implementation and evaluation processes ensured high acceptability and attendance for the sessions, making this an eminently feasible intervention.

Conclusion: CFSHCI for SWM is the first of its kind, catering to the specific needs of a high risk yet underserved group. While this pilot study did not employ a randomized control design and had limited follow up, it does have promising findings. This intervention was successful in changing mothers’ frequency and comfort levels of sexual health communication topics with their children. Context specific sessions about sex work disclosure along with encouragement to use existing knowledge about HIV and health helped mothers to gain confidence in initiating sexual health communications with their children.  

In the context of social work intervention research, it is essential to pilot test interventions on a smaller scale, especially when adapting evidence based practice in a different cultural context and engage community members in all stages of the research.