Publications – QualAnalytics · Letting Data Talk

Publications

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2026

Qualitative Analysis at Scale: A New Method With An Application to Aspirations in Cox's Bazaar, Bangladesh.Multisector Nutrition Plan

Ashwin, Julian, Vijayendra Rao, Monica Biradavolu, et al. The Economic Journal

Abstract

The qualitative analysis of open-ended interviews has vast potential in economics but has found limited use. This is partly because the interpretative, nuanced human reading of text and coding that it requires is labour intensive and very time consuming. This paper presents a method to simplify and shorten the coding process by extending a small sample of interpretative human-annotated interviews to a larger, representative, sample using supervised natural language processing. We extensively assess the robustness and reliability of this approach to show when and how it adds value, including an analysis of how many human-annotated documents are optimal for a budget constrained researcher. We apply this approach to analyse 2,200 open-ended interviews on parent’s aspirations for children with Rohingya refugees and their Bangladeshi hosts. We show that studying aspirations with open-ended interviews extends the economics focus on material goals to ideas from philosophy and anthropology that emphasize aspirations for moral and religious values, and the navigational capacity to achieve these aspirations. This approach allows us to identify several novel results including a new type of migrant selection; we show that Rohingya refugees are negatively selected on education but positively selected on navigational capacity.

2025

Is there an underside to economic growth? A mixed-methods analysis of Malaysia

Niaz Asadullah, Monica Biradavou, Vijayendra Rao, Ken Simler. World Bank Economic Review

Abstract

This paper sheds light on a Malaysian paradox that may have lessons for the rest of the world. Despite high GDP growth with concurrent sharp reductions in income poverty and inequality, there has been widespread discontent in the country. The paper first documents various dimensions of the Malaysian “miracle” with a diverse set of survey data. It then draws on a large sample of open-ended focus-group discussions to go below the surface of the data to analyze how middle-class and poor Malaysian citizens perceive these changes, the challenges they face, and their sources of discontent. The findings reveal a broad consensus that while material living standards have improved, they have been accompanied by an underside such as a large “imbalance” between income and expenses, a need to rely on dual incomes and multiple jobs, growing indebtedness, increased stress, and polarization across ethnic groups. Furthermore, people in poorer regions of Malaysia demonstrate that they care more about social status—with a preference for relative over absolute income—in comparison to people in richer regions, indicating that growth may reduce social connectedness. The paper then draws on the work of Karl Polanyi and Fred Hirsch to argue that the Malaysian paradox may reveal something more general about the social embeddedness of economic life and its implications for why some people may experience undersides to economic growth.

2023

Using machine learning and qualitative interviews to design a five-question women's agency index

Seema Jayachandran, Monica Biradavolu, & Cooper, J. World Development.

Abstract

Open-ended interview questions elicit rich information about people’s lives, but in large-scale surveys, social scientists often need to measure complex concepts using only a few close-ended questions. We propose a new method to design a short survey measure for such cases by combining mixed-methods data collection and machine learning. We identify the best survey questions based on how well they predict a benchmark measure of the concept derived from qualitative interviews. We apply the method to create a survey module and index for women’s agency. We measure agency for 209 married women in Haryana, India, first, through a semi-structured interview and, second, through a large set of close-ended questions. We use qualitative coding methods to score each woman’s agency based on the interview, which we use as a benchmark measure of agency. To determine the close-ended questions most predictive of the benchmark, we apply statistical algorithms that build on LASSO and random forest but constrain how many variables are selected for the model (five in our case). The resulting five-question index is as strongly correlated with the coded qualitative interview as is an index that uses all of the candidate questions. This approach of selecting survey questions based on their statistical correspondence to coded qualitative interviews could be used to design short survey modules for many other latent constructs.

2016

Prioritizing and Funding Nepal’s Multisector Nutrition Plan

Pomeroy-Stevens, Amanda, Madhukar B Shrestha, Monica Biradavolu, Kusum Hachhethu, Robin Houston, Indu Sharma and Jolene Wun. Food and Nutrition Bulletin, 37(4), S151-S169.

Abstract

Background: Nepal has a long tradition of designing good multisectoral nutrition policy. However, success of policy implementation has varied. More evidence on how to successfully carry out multisector nutrition policy is needed.

Objective: We tracked the influence of Nepal's multisectoral nutrition plan (MSNP) on the process of priority setting and budgeting from 2014 to 2016.

Methods: This study used a mixed-method longitudinal design to track qualitative and budgetary changes related to MSNP processes nationally as well as in 3 districts. Qualitative changes in each study area were assessed through interviews, observation, news content, and meeting notes. Changes in allocations and expenditures were calculated based on budget documents, work plans, and validation interviews.

Results: Improved understanding of the MSNP was documented nationally and in study districts but not in VDCs. Human resources, ownership, bottom-up planning, coordination, advocacy, and sustainable structures all emerged as important factors within the enabling environment. Evidence suggests the MSNP influenced improvements in the last 3 factors. We also found notable increases in activities and financing for nutrition-allocations increased steadily between FY 2013-2014 and FY 2015-2016, and 28% of total nutrition allocations in the final year came from new or expanded MSNP-affiliated activities. Data from 3 districts highlight challenges linking local planning and budgeting to central-level structures.

Conclusions: The MSNP appears to have strengthened the nutrition system in Nepal and increased priority and funding for nutrition. Next steps include strengthening linkages to the districts and below. Other countries can learn from the MSNP's success in increasing investment for nutrition.

Keywords: Nepal; financing; multisectoral nutrition; nutrition policy; southeast Asia.

2016

Factors Influencing the Delivery of HIV-Related Services to Severely Mentally Ill Individuals: The Providers’ Perspective

Biradavolu, Monica, Keenan Withers, Yujiang Jia and Suad Kapetanovic. Psychosomatics, 57(1), 64-70.

Abstract

Background: Nepal has a long tradition of designing good multisectoral nutrition policy. However, success of policy implementation has varied. More evidence on how to successfully carry out multisector nutrition policy is needed.
Objective: We tracked the influence of Nepal's multisectoral nutrition plan (MSNP) on the process of priority setting and budgeting from 2014 to 2016.
Methods: This study used a mixed-method longitudinal design to track qualitative and budgetary changes related to MSNP processes nationally as well as in 3 districts. Qualitative changes in each study area were assessed through interviews, observation, news content, and meeting notes. Changes in allocations and expenditures were calculated based on budget documents, work plans, and validation interviews.
Results: Improved understanding of the MSNP was documented nationally and in study districts but not in VDCs. Human resources, ownership, bottom-up planning, coordination, advocacy, and sustainable structures all emerged as important factors within the enabling environment. Evidence suggests the MSNP influenced improvements in the last 3 factors. We also found notable increases in activities and financing for nutrition-allocations increased steadily between FY 2013-2014 and FY 2015-2016, and 28% of total nutrition allocations in the final year came from new or expanded MSNP-affiliated activities. Data from 3 districts highlight challenges linking local planning and budgeting to central-level structures.
Conclusions: The MSNP appears to have strengthened the nutrition system in Nepal and increased priority and funding for nutrition. Next steps include strengthening linkages to the districts and below. Other countries can learn from the MSNP's success in increasing investment for nutrition.

2016

How Locally-Specific Factors May Impact the Delivery of HIV-Related Services to the Severely Mentally Ill in Washington, DC

Keenan Withers, Monica Biradavolu, Yujiang Jia and Suad Kapetanovic. Letter to the Editor, AIDS Patient Care and STDs, 30(2), 49-50.

Abstract

Background: Individuals with severe mental illnesses (SMI) are disproportionately vulnerable to HIV infection but are not consistently engaged in HIV-related services.

Objective: To understand factors influencing implementation of HIV-related services to individuals with SMI, we conducted a series of focus groups with multidisciplinary clinicians and staff serving individuals with SMI in outpatient, emergency, acute inpatient, and chronic inpatient levels of care.

Method: Six focus groups with 30 participants were conducted, audiotaped, and transcribed. Our qualitative analysis drew on Grounded Theory. Using NVivo Version 9, coding was conducted by the first and senior authors; interrater reliability was verified by running Coding Comparison queries.

Results: The providers’ narratives highlighted (1) patient-related factors, (2) stigma, and (3) administrative factors as themes particularly relevant to the delivery of HIV-related services to individuals with SMI. The reported relevance of these factors ranged across levels of care, from creating multiple barriers in the outpatient care to relatively seamless and effective delivery of full continuum of HIV-related services in the chronic inpatient environment, where adequate structural support is provided.

Conclusion: Providers’ narratives suggest that effective delivery of HIV-related services for individuals with SMI requires sustained structural support that is coordinated across levels of psychiatric care and tailored to individual patient’s needs. The narratives also suggest that such support is currently not available.

2015

Brokers and the Earnings of Female Sex Workers in India

Brady, David, Monica Biradavolu, and Kim M. Blankenship. American Sociological Review, 80(6), 1123-1149.

Abstract

This study examines whether working with a broker increases or reduces the payment received for the last client among female sex workers. Building on research on the informal economy and sex work, we formulate a positive embeddedness hypothesis, expecting a positive association, and an exploitation hypothesis, expecting a negative association. We analyze a large survey combined with intensive interview data on female sex workers in Andhra Pradesh, India. These data uniquely distinguish between the amount the sex worker actually received and the amount the client paid. The analyses show that brokers are associated with significantly lower last payment received. Although brokers are associated with a greater number of clients in the past week, this does not result in significantly higher total earnings in the past week. Further analyses suggest that much of the negative relationship with earnings is due to the fact that brokers lead to a lack of control over the amount clients are charged. At the same time, the results fail to show that brokers actually provide services of value. Ultimately, the results support the exploitation hypothesis. We conclude by encouraging the refinement of theories of embeddedness and exploitation and calling for greater research on workers in the informal economy of developing countries.

2015

Unintended Consequences of Community-based Monitoring Systems: Lessons from an HIV Prevention Intervention for Sex workers in South India

Biradavolu, Monica, Kim M. Blankenship, Annie George and Nimesh Dhungana. World Development, 67, 1-10.

Abstract

Studies have examined whether community-based monitoring systems impact desired program outcomes, but few provide field-based evidence on the implementation process itself. This paper fills the gap using ethnographic data on the community-based monitoring tools developed by an HIV prevention NGO for sex workers in south India. The tool was well conceptualized, with potential to enhance community participation in program design. Yet, despite best intentions, our findings show that the quantification process undermined community ownership, discredited existing and locally informed sex work practices and, rather than empowering, monitoring became a means to discipline and judge sex worker peer educators.

2015

Sex workers in HIV Prevention: From social change agents to peer educators

George, Annie, Monica Biradavolu, Kim M. Blankenship, Nimesh Dhungana and Nehanda Tankasala. Global Public Health, 10(1), 28-40.

Abstract

We utilised a comparative ethnographic approach to study the implementation of a community mobilisation intervention addressing HIV risk among female sex workers (FSWs) in India, as implemented first by an non-governmental organisation and after oversight of the intervention was transitioned to the government. We demonstrate that the work of peer outreach workers changed from Social Change Agents within a community-led structural intervention (CLSI) to Peer Educators within a targeted intervention (TI). In the CLSI approach, built on the assumption that FSW risk for HIV is rooted in power inequality and structural vulnerability, peer outreach workers mobilised their peers through community-based organisations to address underlying conditions of inequality and vulnerability. In contrast, the TI approach, which views FSW risk as a function of limited knowledge and barriers to services, addressed peers' access to information and health services. Analysis of changes in the function of peer outreach workers reveals critical differences of which we discuss four: assumptions about conditions that produce HIV risk; degree of emphasis placed on collective mobilising and building collective power; extent to which community mobilisation and HIV prevention goals are linked; and the intervention's use of peer input. We discuss the implications of these findings for HIV prevention programming.

2015

Non-barrier Contraceptive Use and Relation to Condom Use Behaviour by Partner Type Among Female Sex workers in Andhra Pradesh, India

Reed, Elizabeth, Jennifer Toller Erausquin, Argentina E. Servin, Monica Biradavolu, and Kim M. Blankenship. Journal of Family Planning and Reproductive Health Care, doi:10.1136/jfprhc-2014-100918.

Abstract

Objective The study assessed non-barrier contraceptive use among female sex workers (FSW) in Andhra Pradesh, India and relation to inconsistent condom use among commercial and non-commercial male sexual partners.

Methods FSW at least 18 years of age (n=2338) were recruited through respondent-driven sampling for an HIV risk survey. Analysis was restricted to women of childbearing age (n=2197). Crude and adjusted logistic regression models were used to assess non-barrier contraceptive use and relation to inconsistent condom use with husbands or regular male partners (i.e. non-clients), regular clients and occasional clients.

Results Non-barrier methods of contraception included contraceptive pills (3.8%) and sterilisation (68.4%). In logistic regression models adjusted for relevant demographics, FSW using contraceptive pills were more likely to report inconsistent condom use with a regular client (past week) [adjusted odds ratio (AOR) 2.2, 95% confidence interval (CI) 1.2–4.0] and with an occasional client (past week) (AOR 2.6, 95% CI 1.6–5.3), as well as accepting more money for sex without a condom (past 30 days) (AOR 2.5, 95% CI 1.5–4.3). No significant associations were found between pill use and inconsistent condom use among women's non-client partners, potentially related to small sample sizes within these subgroups. Reporting sterilisation, which was more common among FSW who were older in age, was not associated with inconsistent condom use with client or non-client sexual partners.

Conclusions Findings document potential unmet need for modern, spacing contraceptives (i.e. pill, intrauterine device), but also indicate the importance for family planning services, particularly those promoting modern contraceptive methods to be provided alongside HIV prevention among FSW in Andhra Pradesh, India.

2013

Motherhood and HIV Risk Among Female Sex workers in Andhra Pradesh, India: The Need to Consider Women’s Life Contexts

Reed, Elizabeth, Jay G. Silverman, Barbara Stein, Jennifer Toller Erausquin, Monica Biradavolu, Alana Rosenberg, and Kim M. Blankenship. AIDS and Behavior, 17(2): 543-550.

Abstract

This study examines whether the challenges of motherhood among female sex workers (FSW) are linked with vulnerability to sexual risk factors for HIV. FSW at least 18 years of age (n = 850) were recruited through respondent driven sampling for a survey on HIV risk in the Rajahmundry area of Andhra Pradesh, India. Logistic regression models adjusted for demographic characteristics were used to assess the relation between reported caretaking challenges and sexual risk indicators for HIV. In adjusted logistic regression models, FSW who reported three or more children in their household or current child health concerns were significantly less likely to report consistent condom use (adjusted odds ratios (AORs) range: 0.5–0.6) and more likely to take more money for sex without a condom (both AORs: 2.5). Women who reported current child health concerns were also more likely to report an STI symptom in the past 6 months (AOR = 1.6; 95 % confidence interval: 1.1–2.3). Findings suggest that challenging responsibilities related to caretaking of children are associated with heightened vulnerability to HIV risk among FSW. Such findings add to the cumulating evidence urging for the implementation of HIV prevention interventions that consider the multiple challenges across various domains of women’s lives.

2012

Structural Stigma, Sex Work and HIV: Contradictions and Lessons Learned from a Community-led Structural Intervention in Southern India

Biradavolu, Monica, Kim M. Blankenship, Asima Jena and Nimesh Dhungana. Journal of Epidemiology and Community Health, 2012; 66: ii95-ii99.

Abstract

Background Recent theorisation has pushed stigma research in new directions, arguing for a need to challenge the unequal power relations that impact groups most at risk for HIV-related stigma rather than locate stigma in the individual. Such a conceptualisation resonates with the growing emphasis on structural interventions for HIV prevention that attempt to alter the social context of risk.

Methods The paper predominantly relies on longitudinal interviews conducted three times over a 2-year period with sex workers with varying degrees of involvement with the non-governmental organisation (NGO) and community-based organisation.

Results Recognising that stigma is socially constructed and structurally reproduced, the NGO helped mobilise marginalised and hitherto scattered female sex workers to form community-based organisations to challenge their disadvantaged status in society. The authors show how stigma alleviation strategies presented a contradiction: emboldening one group of female sex workers to self-identify as sex workers while making others reluctant to access the intervention-run clinic.

Conclusion The paper builds on a growing body of research that acknowledges the struggles in implementing structural interventions, particularly for NGOs working in regions with a diverse population of sex workers with varying needs. The authors argue that intervention goals of reducing stigma and increasing the use of sexually transmitted infection services do not have to conflict and, in fact, must go hand-in-hand for an implementation to be considered a structural intervention.

2012

Trends in condom use among female sex workers in Andhra Pradesh, India: The impact of a community mobilization intervention

Toller Erausquin, Jennifer, Monica Biradavolu, Elizabeth Reed, Rebekah Buroway and Kim M. Blankenship. Journal of Epidemiology and Community Health, 2012; 66: ii49-ii54.

Abstract

Background: Community mobilisation interventions for HIV prevention among female sex workers (FSWs) aim to organise FSWs for collective action and challenge the structures of power that underlie HIV risk. Assessing intervention impact is challenging because the importance of direct individual exposure to intervention components may decrease over time as change occurs at social-normative, policy and other structural levels. In this paper, the authors examine changes over time in consistent condom use among FSWs in Rajahmundry, Andhra Pradesh, the location of a long-standing community mobilisation intervention.

Methods: The authors analyse cross-sectional data collected among FSWs at three time points (n=2276) using respondent-driven sampling. Multiple logistic regression was used to assess the association of programme exposure with consistent condom use and whether this association varied over time.

Results: The proportion of FSWs having no exposure or only receptive exposure to the intervention decreased over time, while active utilisation increased from 19.4% in 2006 to 48.5% in 2009–2010. Consistent condom use with clients also increased from 56.3% in 2006 to 75.3% in 2009–2010. Multivariate analysis showed that age, age at start of sex work, venue, living conditions and programme exposure were significantly associated with condom use. The positive association between programme exposure and consistent condom use did not vary significantly over time.

Conclusion: Findings indicate improvements in HIV risk reduction behaviour among FSWs and suggest that the intervention has substantial reach in the FSW population. The intervention's strategies may be contributing to population-level HIV risk reduction among FSWs.

2011

The Role of Housing in Determining HIV Risk Among Female Sex Workers in Andhra Pradesh, India: Considering Women’s Life Contexts

Reed, Elizabeth, Jhumka Gupta, Monica Biradavolu, Vasavi Devireddy and Kim M. Blankenship. Social Science and Medicine, 72(5): 710-716

Abstract

Recent research on HIV prevention, regardless of the population, has increasingly recognized the relevance of contextual factors in determining HIV risk. Investigating such factors among female sex workers (FSW) is especially relevant in the South Indian state of Andhra Pradesh, where HIV rates are among the highest across Indian states and where HIV has largely affected FSW. Stable housing is a particular contextual challenge experienced by female sex workers in this region (as well as elsewhere); however, local studies have not examined the impact of this issue on HIV risk. In this paper, we examine residential instability, defined as a high frequency of reported evictions, among FSW and relation to experiences of violence (as a factor increasing risk for HIV) and sexual risk factors for HIV. Women were recruited through respondent-driven sampling for a survey on HIV risk. Using logistic regression models, we assessed: (1) residential instability and association with HIV sexual risk variables (including unprotected sex, reported STIs, and recent physical and sexual victimization) and (2) whether the association between residential instability and reported STI (as an indicator of HIV risk) was attenuated by individual risk behaviors and violence. In adjusted logistic regression models, FSW who reported residential instability were more likely to report: sexual violence, physical violence, accepting more money for unprotected sex, and a recent STI symptom. Violence associated with residential instability contributed to reported STIs; however, residential instability remained significantly associated with STIs beyond the influence of both violence and unprotected sex with clients. Findings highlight the interrelation among residential instability, violence, and HIV risk. Residential instability appears to be associated with women’s HIV risk, above and beyond its association with individual risky sexual behaviors.

2010

The Context of Economic Insecurity & Relation to Violence and Risk Factors for HIV Among Female Sex Workers in Andhra Pradesh, India

Reed, Elizabeth, Jhumka Gupta, Monica Biradavolu, Vasavi Devireddy and Kim M. Blankenship. Public Health Reports, 125 (4), 81-90.

Abstract

Objective: We examined the context of economic insecurity and debt among female sex workers (FSWs), how this context varies among FSWs, and its association with experiences of violence and sexual risk factors for human immunodeficiency virus (HIV).

Methods: We recruited FSWs aged >=18 years (n=673) through respondent-driven sampling for a survey on HIV risk in this region. Using logistic regression models (adjusted for partner status, education, financial support, and literacy), we assessed the relation between debt and sexual and physical victimization as well as sexual risk. We also conducted qualitative interviews with a subsample of the survey participants and examined these for related themes.

Results. In adjusted logistic regression models, FSWs who reported debt were more likely to report the following: recent physical violence (adjusted odds ratio [AOR] = 2.4, 95% confidence interval [CI] 1.5, 3.9), unprotected sex with occasional clients in the past week (AOR=2.3, 95% CI 1.2, 4.3), anal sex with clients in the past 30 days (AOR=2.0, 95% CI 1.1, 3.9), and at least one sexually transmitted infection symptom in the past six months (AOR=1.6, 95% CI 1.1, 2.4). FSWs with debt were more likely to report current husbands or other male partners, and less likely to report condom use with these partners, further increasing their sexual risk. Qualitative data elaborated on these findings.

Conclusion. Findings indicate the violence- and HIV-related vulnerability of FSWs who report debt and further highlight how male partners may contribute to the debt and economic insecurity of FSWs.

2010

Challenging the Stigmatization of Female Sex Workers Through a Community-led Structural Intervention: Learning from a Case Study of a Female Sex Worker Intervention in Andhra Pradesh, India

Blankenship, Kim M., Monica Biradavolu, Annie George and Asima Jena. AIDS Care, 22(1): 1629-1636.

Abstract

Structural interventions represent a potentially powerful approach to HIV prevention among female sex workers (FSW) that focus on changing the social context of risk rather than individual behavior. Community-led structural interventions (CLSI) represent a particular form of structural interventions whereby the collective energy of FSW is directed toward action to address the contextual factors that promote their risk. Among these different contextual factors that may be the target of CLSI, are social norms that stigmatize FSW and their work. Drawing from ethnographic data collected as part of an ongoing analysis of the implementation and impact of a CLSI in coastal Andhra Pradesh, India, we present a case study of the challenges and opportunities faced by a CLSI seeking to confront stigmatization of FSW through its interactions with a government-sponsored AIDS education program targeted to the general public. The government program promoted slogans that stigmatized FSW by attributing HIV/AIDS to them. Through participation in the program, the CLSI was complicit in promoting this same stigmatization. Yet it also used participation in the program as an opportunity to raise awareness among FSW of the CLSI and to mobilize FSW. In addition, the CLSI organized an alternative public rally, outside of but parallel to the government program, where they reframed FSW not as the carriers of HIV but as public health workers combating it. With this case study, we suggest that CLSI for HIV prevention among FSW are implemented in a context of inequality that constrains their actions, but they can still employ strategies that have the potential to transform that context.

2009

Can Sex Workers Regulate Police? Learning from an HIV Prevention Project for Sex Workers in Southern India

Biradavolu, Monica R., Scott Burris, Annie George, Asima Jena and Kim M. Blankenship. Social Science & Medicine, 68(8): 1541-1547.

Abstract

There is an argument that policing practices exacerbate HIV risk, particularly for female sex workers. Interventions that mobilize sex workers to seek changes in laws and law enforcement practices have been prominent in India and have received considerable scholarly attention. Yet, there are few studies on the strategies sex worker advocates use to modify police behavior or the struggles they face in challenging state institutions. This paper draws upon contemporary theories of governance and non-state regulation to analyze the evolving strategies of an HIV prevention non-governmental organization (NGO) and female sex worker community-based organizations (CBOs) to reform police practices in southern India. Using detailed ethnographic observations of NGO and CBO activities over a two year period, and key informant interviews with various actors in the sex trade, this paper shows how a powerless group of marginalized and stigmatized women were able to leverage the combined forces of community empowerment, collective action and network-based governance to regulate a powerful state actor, and considers the impact of the advocacy strategies on sex worker well-being.

2008

Power, Community Mobilization and Condom Use Practices Among Female Sex Workers in Andhra Pradesh, India

Blankenship, Kim M., Brooke S. West, Trace S. Kershaw and Monica R. Biradavolu. AIDS, 22(Supplement 5): S109-S116.

Abstract

Objectives: We used a structural interventions framework to analyse the associations between power and condom use among a sample of female sex workers (FSW), and how exposure to a local community mobilization intervention (CMI) affects these associations.

Design: Data came from a cross-sectional survey of 812 FSW in the East Godavari district of Andhra Pradesh, India, recruited through respondent-driven sampling.

Methods: We identified three types of power - collective power, control over work, and economic power, and three dimensions of collective power - collective identity, efficacy, and agency. Multivariate logistic regression analysis was used to analyse the relationship of these three types of power and exposure to a CMI with consistent condom use with clients.

Results: A total of 803 respondents exchanged sex with an occasional or regular client in the 7 days before the interview. Multivariate logistic regression shows that control over both the type of sex [adjusted odds ratio (AOR) 1.70, 95% confidence interval (CI) 1.23-2.34] and the amount charged (AOR 1.56, 95% CI 1.12-2.16), and economic dependence (AOR 0.54, 95% CI 0.35-0.83) are associated with consistent condom use as is programme exposure (AOR 2.09, 95% CI 1.48-2.94). The interaction between programme exposure and collective agency was also significant (chi-square 6.62, P = 0.01). Among respondents who reported both programme exposure and high levels of collective agency, the odds ratio of consistent condom use was 2.5 times that of other FSW.

Conclusion: A structural interventions framework is useful for understanding HIV risk among FSW. More needs to be done to promote FSW control over work and access to economic resources.

2001

Informing Women About Their Breast Cancer Risk: Truth and Consequences

Lipkus, Isaac, Monica Biradavolu, Kathryn Fenn, Punam Keller and Barbara Rimer. Health Communication. 13(2): 205-226.

Abstract

We assessed the extent to which informing women about their risk for breast cancer affected their perceived 10-year and lifetime risks for getting breast cancer, their emotional reactions toward getting breast cancer, and their intentions to get mammograms. In a pre- to posttest design, 121 women were given their 10-year risk of getting breast cancer with or without being compared with women their age and race at lowest risk. Women's perceptions of their 10-year risks became more congruent (i.e., more accurate) with their actual risk. Participants were more accurate when they received their own risk without being compared with women at lowest risk. Women who received only their own risk estimate reported being at lower risk than other women. Overall, women reported that obtaining their 10-year risk estimate either did not affect or increased their intentions to get mammograms. These results suggest that giving women their individual risk of getting breast cancer improves accuracy while also enhancing their feelings that they are at lower risk than other women. Counter to many theories of health behavior, reducing women's perceived risk of breast cancer did not lower their intentions to get mammograms. Implications for the communication of breast cancer risk are discussed.

1999

Testing Different Formats for Communicating Colorectal Cancer Risk

Lipkus, Isaac, Yancey Crawford, Kathryn Fenn, Monica Biradavolu, Ruth Ann Binder, Al Marcus and Mondi Mason. Journal of Health Communication: International Perspectives. 4:311- 324.

Abstract

This study assessed the extent to which different formats of informing men and women age 50 and over of the risks of colorectal cancer (CRC) affected their perceptions of their absolute and comparative (self versus other) 10-year and lifetime risks; emotional reactions about getting CRC; and screening intentions. Forty-four men and 78 women received information about the absolute lifetime risk of getting CRC. In addition, participants either did or did not receive information about (1) lifetime risk of getting CRC compared with other cancers, and (2) risk factors for CRC (age and polyps). Participants who received risk factors information were more likely to increase their perceived absolute 10-year and lifetime risks of getting CRC compared with participants who did not receive risk factors information. In addition, participants who received risk factors information were more likely to believe age was related to getting CRC and felt at greater risk for having polyps compared with participants who did not receive this information. None of the experimental conditions affected how worried, anxious, and fearful participants felt about getting CRC, nor did they affect screening intentions. Independent of experimental condition, participants tended to increase their intentions to get screened for CRC in the next year or two. Intention to be screened was more pronounced among participants who had been screened via a fecal occult blood test (FOBT) or sigmoidoscopy (SIG). Implications for the design of interventions involving the communication of CRC risks are discussed.