"They assume by having sex, they are a husband": How Indian Female Sex Workers navigate relationship fluidity and sexual risk

There is limited evidence that highlights female sex workers (FSWs) agency in negotiating HIV risk in the context of multiple sexual relationships. Using a Gendered Vulnerability framework, this study employed a phenomenological approach to explore the FSWs active navigation of concurrent sexual relationships and their perceptions and assessments of HIV risk and sexual negotiation. Sixty (60) FSWs participated in the study. Data were collected through semi-structured interviews and focus group discussions. ATLAS.ti provided an interpretive framework for data analysis. Findings revealed that FSWs navigate a complex landscape of multiple sexual relationships that influenced their condom use decisions. Despite possessing accurate HIV knowledge, FSWs in this study indicated that multiple circumstances (e.g., economic constraints, damaging gender norms, merely paying transactional relationships with some clients, emotional attachments with others, gender-role bound relationships, and instances of sexual victimization) influenced their perceptions of power and their desires and perceived capacities for HIV risk and prevention decisions. A nuanced understanding of FSWs concurrent fluid relationships and the cultural contexts in which Indian FSWs work are vital when planning programs and policies for HIV prevention.