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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2008.149930v1 99/7/1239    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Shahmanesh, M. Articles by Patel, V. PubMed PubMed Citation Articles by Shahmanesh, M. Articles by Patel, V. Related Collections Epidemiology Global Health Mental Health Sexual Health Women's Health

Maryam Shahmanesh, MSc, MRCP, Sonali Wayal, MSc, Frances Cowan, MD, FRCP, David Mabey, DM, FRCP, Andrew Copas, PhD and Vikram Patel, PhD, MRCPsych

At the time of the study, Maryam Shahmanesh was with the Centre for Sexual Health and HIV Research, University College London, London, England, and Positive People, Goa, India. Sonali Wayal was with Positive People, Goa. Frances M. Cowan and Andrew Copas were with the Centre for Sexual Health and HIV Research, University College London, London. David Mabey was with the Department of Infection and Tropical Disease, London School of Hygiene and Tropical Medicine, London. Vikram Patel was with the Department of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, and Sangath, Porvorim, Goa, and Positive People, Goa.

Correspondence: Requests for reprints should be sent to Dr Maryam Shahmanesh, Centre for Sexual Health and HIV Research, University College London, 3rd floor Mortimer Market Centre, off Caper St, London WC1E 6AU UK (e-mail:bamaryjoon{at}yahoo.co.uk).

Objectives. We sought to study suicidal behavior prevalence and its association with social and gender disadvantage, sex work, and health factors among female sex workers in Goa, India.

Methods. Using respondent-driven sampling, we recruited 326 sex workers in Goa for an interviewer-administered questionnaire regarding self-harming behaviors, sociodemographics, sex work, gender disadvantage, and health. Participants were tested for sexually transmitted infections. We used multivariate analysis to define suicide attempt determinants.

Results. Nineteen percent of sex workers in the sample reported attempted suicide in the past 3 months. Attempts were independently associated with intimate partner violence (adjusted odds ratio [AOR] = 2.70; 95% confidence interval [CI] = 1.38, 5.28), violence from others (AOR = 2.26; 95% CI = 1.15, 4.45), entrapment (AOR = 2.76; 95% CI = 1.11, 6.83), regular customers (AOR = 3.20; 95% CI = 1.61, 6.35), and worsening mental health (AOR = 1.05; 95% CI = 1.01, 1.11). Lower suicide attempt likelihood was associated with Kannad ethnicity, HIV prevention services, and having a child.

Conclusions. Suicidal behaviors among sex workers were common and associated with gender disadvantage and poor mental health. India's widespread HIV-prevention programs for sex workers provide an opportunity for community-based interventions against gender-based violence and for mental health services delivery.