Clients of female sex workers (FSWs) possess a high potential of transmitting HIV and other sexually transmitted infections from high risk FSWs to the general population. Promotion of safer sex practices among the clients is essential to limit the spread of HIV/AIDS epidemic. The aim of this study is to estimate the prevalence of consistent condom use (CCU) among clients of FSWs and to assess the factors associated with CCU in Tamil Nadu. 146 male respondents were recruited from the hotspots who reportedly had sex with FSWs in exchange for cash at least once in the past one month. Data were analyzed using bivariate and multivariate methods. Overall, 48.6 and 0.8 percent clients consistently used condoms in the past 12 months with FSWs and regular partners, respectively. Logistic regression showed that factors such as education, peers’ use of condoms, and alcohol consumption significantly influenced clients’ CCU with FSWs. Strategies for safe sex-behaviour are needed among clients of FSWs in order to limit the spread of HIV/AIDS epidemic in the general population. The role of peer-educators in experience sharing and awareness generation must also be emphasized. 1. Introduction Clients of female sex workers (FSWs), also known as the “bridge population”, act as a bridge between the high risk group of FSWs and the general population [1]. It is estimated that in India, there are as many as 8.5 million male clients of FSWs between 15 and 49 years and of these men, 55 percent are married [2]. There is evidence to show that multiple partners and inconsistent condom use among the clients lead to the spread of sexually transmitted infections (STIs) among their other sexual partners such as wives and lovers [3–6]. Although the HIV prevalence in Tamil Nadu has been showing a declining trend with it currently being 0.38 percent as estimated by sentinel surveillance, the HIV prevalence among the clients of FSWs ranged from as high as 2 to 4.2 percent in Tamil Nadu [7, 8]. The behavioural surveillance survey (BSS) carried out in 2006 was performed to assess risk behaviour in specific population groups in India and to measure behavioural changes from BSS 2001 to BSS 2006. The report on female sex workers (FSWs) and their clients detailed the observations of the national BSS 2006 among the FSWs and their clients, which was conducted in all states and union territories of the country. Nearly 96 percent of clients of FSWs in Tamil Nadu were aware of the role of consistent condom use (CCU) in preventing HIV/AIDS, yet a much lower 58.2 percent of clients consistently used
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