RESUMEN
OBJECTIVE: To assess the impact of the Avahan HIV prevention programme for female sex workers (FSWs) in south India on reducing syphilis prevalence among their clients, by comparing rates of syphilis over time as reported in two large-scale surveys of FSWs' clients. METHODS: A random-effect multilevel logistic regression analysis was performed using syphilis as the dependent variable, with individual independent variables (from the two survey rounds) at level 1 and the district-level programme (from the Avahan computerised monitoring and information system) and contextual variables (from Indian government datasets) at level 2. Programme variables included their 2006 value and their difference in value between 2008 and 2006, as well as the interaction between the latter and the study round. The analysis also controlled for baseline syphilis prevalence and its interaction with the study round. RESULTS: Syphilis decreased significantly among FSWs' clients, from 4.8% (round 1) to 2.6% (round 2), p<0.001. The OR of the interaction term between the difference in programme coverage of FSWs and the round was 0.98 (p=0.023), suggesting that increased coverage was associated with a reduced incidence of syphilis. CONCLUSIONS: This study suggests that the Avahan intervention programme among FSWs reduced syphilis rates among their clients.
Asunto(s)
Infecciones por VIH/prevención & control , Trabajo Sexual/estadística & datos numéricos , Trabajadores Sexuales , Sífilis/prevención & control , Adulto , Circuncisión Masculina/estadística & datos numéricos , Condones/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Incidencia , India/epidemiología , Modelos Logísticos , Masculino , Análisis Multinivel , Oportunidad Relativa , Prevalencia , Sexo Seguro/estadística & datos numéricos , Sífilis/epidemiología , Sexo Inseguro/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: As one way of assessing the impact of Avahan, the India AIDS Initiative of the Bill & Melinda Gates Foundation, we examined the association between HIV prevention program indicators and changes in HIV prevalence among female sex workers (FSWs) between 2005 and 2009. METHODS: We conducted a secondary data analysis from 2 large cross-sectional surveys (2005-2006 and 2008-2009) across 24 districts in south India (n = 11,000 per round). A random-effect multilevel logistic regression analysis was performed using HIV as the outcome, with individual independent variables (from both surveys) at level 1 and district-level FSW-specific program indicators and contextual variables at level 2. Program indicators included their 2006 value, the difference in their values between 2008 and 2006, and the interaction between this difference and study round. RESULTS: HIV prevalence among FSWs decreased from 17.0% to 14.2% (P < 0.001). This decline varied significantly (P = 0.006) across levels of difference in program coverage (% of FSWs contacted by the program in a given year). Odds ratios comparing HIV prevalence between rounds changed with the level of increase in coverage and were statistically significant with coverage increase ≥ quartile (Q) 1: odds ratio, 0.85 at Q1; 0.78 at Q2; 0.66 at Q3; and 0.51 at Q4. CONCLUSIONS: These findings suggest that increased program coverage was associated with declining HIV prevalence among FSWs covered by the Avahan program. The triangulation of our results with those from other approaches used in evaluating Avahan suggests a major impact of this intervention on the HIV epidemic in southern India.
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Infecciones por Chlamydia/prevención & control , Condones/estadística & datos numéricos , Gonorrea/prevención & control , Infecciones por VIH/prevención & control , Trabajadores Sexuales , Sífilis/prevención & control , Adolescente , Adulto , Infecciones por Chlamydia/epidemiología , Estudios Transversales , Femenino , Gonorrea/epidemiología , Infecciones por VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Humanos , India/epidemiología , Modelos Logísticos , Prevalencia , Evaluación de Programas y Proyectos de Salud , Sexo Seguro , Trabajadores Sexuales/psicología , Trabajadores Sexuales/estadística & datos numéricos , Encuestas y Cuestionarios , Sífilis/epidemiologíaRESUMEN
BACKGROUND: Community mobilization is a participatory intervention strategy used among Female Sex Workers (FSW's) to address HIV risks through behavior change and self empowerment. This study quantitatively measure and differentiate theoretically defined forms of FSW participation's and identify their contextual associated factors. METHOD: Data was derived from cross-sectional Integrated Bio Behavioral Assessment conducted among FSW's in Andhra Pradesh (AP) (n = 3370), Maharashtra (MH) (n = 3133) and Tamil Nadu (TN) (n = 2140) of India during 2009-2010. Information's about socio-demography, community mobilization and participation experiences were collected. Conceptual model for two contexts of mobilization entailing distinct FSW participations were defined as participation in "collective" and "public" spaces respectively. Bivariate and multiple regression analysis were used. RESULT: The level of participation in "collective" and "public" spaces was lowest in MH (43.9% & 11.7% respectively), higher in TN (82.2% & 22.5% respectively) and AP (64.7% & 33.1%). Bivariate and multivariate regression analysis highlighted the distinct nature of "participations" through their varied associations with FSW mobilization and background status.In MH, street FSWs showed significantly lower collective participation (36.5%) than brothel FSWs (46.8%) and street FSWs showed higher public participation (16.2%) than brothel FSWs (9.7%). In AP both collective and public participation were significantly high among street FSWs (62.7% and 34.7% respectively) than brothel FSW's (55.2% and 25.4% respectively).Regression analysis showed FSWs with "community identity", were more likely to participate in public spaces in TN and AP (AOR 2.4, 1.5-3.8 & AOR 4.9, CI 2.3-10.7) respectively. FSWs with "collective identity" were more likely to participate in collective spaces in TN, MH and AP (AOR 27.2 CI 13.7-53.9; AOR 7.3, CI 3.8-14.3; AOR 5.7 CI 3-10.9 respectively). FSWs exhibiting "collective agency" were more likely to participate in public spaces in TN, MH and AP (AOR 2.3 CI 1-3.4; AOR 4.5- CI 2.6-7.8; AOR 2.2 CI 1.5-3.1) respectively. CONCLUSION: Findings reveal FSWs participation as a dynamic process inherently evolving along with the community mobilization process in match with its contexts. Participation in "Collective" and Public spaces" is indicators, symbolizing FSWs passage from the disease prevention objectives towards empowerment, which would help better understand and evaluate community mobilization interventions.
Asunto(s)
Infecciones por VIH/prevención & control , Conductas Relacionadas con la Salud , Poder Psicológico , Características de la Residencia , Trabajo Sexual , Trabajadores Sexuales , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , India , Riesgo , Adulto JovenRESUMEN
BACKGROUND: The HIV epidemic is very heterogeneous at the district level in the four Southern states of India most affected by the epidemic and where transmission is mainly heterosexual. The authors carried out an ecological study of the relationship between high-risk population parameters and HIV prevalence among pregnant women (ANC HIV prevalence). METHODS: The data used in this study included: ANC HIV prevalence available from the National AIDS Control Organization (dependent variable); data on prevalence of HIV and other sexually transmitted infections among female sex workers (FSWs), their clients and high-risk men who have sex with men (HR-MSM) from studies carried out in 24 districts under Avahan; data on clients' volume reported by FSWs and on the size estimates of FSWs and HR-MSM in each district; and census data. The latter two sets of data were used to estimate the percentage of female (male) adults who are FSWs (HR-MSM). The latter was also multiplied by HIV prevalence in FSWs (HR-MSM) to obtain the percentage of HIV-positive FSWs (HR-MSM) in the adult female (male) population. Linear regression was used for statistical analyses. RESULTS: In univariate analyses, HIV (r=0.59, p=0.002) and HSV-2 (r=0.49, p=0.014) prevalence among FSWs and mean number of clients in the last week reported by FSWs (r=0.43, p=0.036) were significant predictors of ANC HIV prevalence. In multivariate analysis, only FSW HIV prevalence remained significant. CONCLUSIONS: This ecological study suggests that there is a link between HIV prevalence among FSWs and the spread of HIV to the general population in Southern India. Such an observation supports the rationale of interventions targeted at the sex industry.
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Infecciones por VIH/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Adulto , Brotes de Enfermedades , Métodos Epidemiológicos , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Homosexualidad Masculina/estadística & datos numéricos , Humanos , India/epidemiología , Masculino , Embarazo , Trabajo Sexual/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/transmisiónRESUMEN
OBJECTIVE: This paper evaluates Avahan programme's coverage of female sex workers (FSWs), focus on high-risk FSWs and intermediate outcomes. METHODS: First round of cross-sectional survey data, Integrated Behavioral and Biological Assessments (IBBA), conducted in 22 districts, were aggregated into district categories: Solo, where Avahan was the sole service provider covering all FSWs and Major or Minor where Avahan was not the sole provider, but intended coverage was >50% or
Asunto(s)
Condones/estadística & datos numéricos , Infecciones por VIH/prevención & control , Sexo Seguro/estadística & datos numéricos , Trabajo Sexual/estadística & datos numéricos , Adolescente , Adulto , Métodos Epidemiológicos , Femenino , Infecciones por VIH/transmisión , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/métodos , Humanos , India/epidemiología , Masculino , Evaluación de Programas y Proyectos de Salud , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/terapia , Factores Socioeconómicos , Adulto JovenRESUMEN
OBJECTIVES: Self-reported anal intercourse by female sex workers (FSWs) documented in recent studies from India range between 11.9% and 22%. However, comparable data on anal intercourse and condom use from male clients of FSWs is lacking. Using data from a bio-behavioural survey (2009-2010), we examined prevalence of anal intercourse, male clients' self-reported inconsistent condom use during anal intercourse with FSWs, and correlates of this behaviour in India's high HIV prevalence southern states (Andhra Pradesh, Maharashtra and Tamil Nadu combined). METHODS: Using two-stage time location cluster sampling, we recruited 4803 clients of FSWs, ages 18-60â years, who had purchased sex from an FSW in the past month. After obtaining informed consent, respondents were interviewed and tested for HIV and sexually transmitted infections (syphilis, gonorrhoea and chlamydia). Logistic regression analysis was used to identify the factors associated with inconsistent condom use during anal intercourse (in the past 6â months) with FSWs. RESULTS: Overall, 12.3% clients reported anal intercourse in the past 6â months, of whom 48.4% used condoms inconsistently. Clients of FSWs who were ages 26â years or older (AOR 2.68, p=0.032); employed as manual labourers (AOR 2.43, p=0.013); consumed alcohol (AOR 2.63, p=0.001); reported five or more sex acts with FSWs in the past month (AOR 2.53, p=0.031); and perceived themselves to be at higher risk for HIV (AOR 4.82, p=0.001) were more likely to inconsistently use condoms during anal intercourse. CONCLUSIONS: The results suggest that sex workers and their clients commonly practice anal intercourse, but a relatively high proportion of clients do not consistently use condoms, leading to a greater risk of acquiring HIV and its further transmission to other male and female sexual partners. Given the multidirectional risk, safer sex communication on heterosexual anal intercourse must be incorporated into HIV prevention programmes.