Assessing the Impact of Peer Educator Outreach on the Likelihood and Acceleration of Clinic Utilization among Sex Workers.

OBJECTIVE: Peer-led outreach is a critical element of HIV and STI-reduction interventions aimed at sex workers. We study the association between peer-led outreach to sex workers and the time to utilize health facilities for timely STI syndromic-detection and treatment. Using data on the timing of peer-outreach interventions and clinic visits, we utilize an Extended Cox model to assess whether peer educator outreach intensity is associated with accelerated clinic utilization among sex workers. METHODS: Our data comes from 2705 female sex workers registered into Pragati, a women-in-sex-work outreach program, and followed from 2008 through 2012. We analyze this data using an Extended Cox model with the density of peer educator visits in a 30-day rolling window as the key predictor, while controlling for the sex workers' age, client volume, location of sex work, and education level. The principal outcome of interest is the timing of the first voluntary clinic utilization. RESULTS: More frequent peer visit is associated with earlier first clinic visit (HR: 1.83, 95% CI, 1.75-1.91, p < .001). In addition, 18% of all syndrome-based STI detected come from clinic visits in which the sex worker reports no symptoms, underscoring the importance of inducing clinic visits in the detection of STI. Additional models to test the robustness of these findings indicate consistent beneficial effect of peer educator outreach. CONCLUSIONS: Peer outreach density is associated with increased likelihood of-and shortened duration to-clinic utilization among female sex workers, suggesting potential staff resourcing implications. Given the observational nature of our study, however, these findings should be interpreted as an association rather than as a causal relationship.

Female sex worker client behaviors lead to condom breakage: a prospective telephone-based survey in Bangalore, South India.

We examined condom breakage rates and predictors of breakage in a prospective telephone-based study of female sex workers (FSWs) in Bangalore, India. We obtained data on 3,257 condom-use sex acts, and breakage occurred in 2.1 % of these. Situational factors, especially those associated with male clients' behaviors, were the most important predictors of breakage, including sexual inexperience, roughness and violence. Breakage was also associated with having vaginal and anal sex at the same encounter and with poor-fitting condoms. Despite lower than expected breakage rates, the high client volume of FSWs means that there are many unprotected sex acts caused by breakage. Discussions should be held around new education messages, and how programs can respond quickly when sex workers encounter clients who are inebriated, violent or unusually sexually charged. More work is urgently needed with police, and on FSW empowerment, the use of help lines, and counseling for the most vulnerable women.

The feasibility of using mobile phone technology for sexual behaviour research in a population vulnerable to HIV: a prospective survey with female sex workers in South India.

Sexual behaviour studies are often challenged by sampling, participation and measurement biases, and may be unacceptable to participants. We invited 293 randomly selected female sex workers (FSWs) in Bangalore, India, to participate in a telephone survey, with condom breakage as the main outcome. Free cell phones were supplied and trained interviewers telephoned FSWs daily to ask about all sex acts the previous day. Later, we undertook focus groups to discuss the methodology with the participants. We evaluated technical and operational feasibility; data reliability and measurement error; emotional and fatigue effects; interviewer bias; survey reactivity effects; and user acceptability. Response rates were high, with 84% of invited participants complying fully with the protocol. The study ran smoothly, with little evidence of biases. The methodology was highly acceptable; the respondents enjoyed using a new telephone and being interviewed at times convenient to them. Other reasons for the success of the method were that the study was sanctioned and supported by the sex worker collective, and the interviewers were well trained and developed a strong rapport with the participants. The success of this methodology, and the wealth of data produced, indicates that it can be an important tool for conducting sexual behaviour research in low literacy, high sex volume populations.

Why do condoms break? A study of female sex workers in Bangalore, south India.

OBJECTIVES: The purpose of the study was to obtain a better understanding of the relative importance of personal factors, male partner factors and situational factors, in determining condom breakage in a population of female sex workers (FSWs) in Bangalore. METHODS: The authors conducted a cross-sectional study that included a face-to-face interview and condom application test, with 291 randomly selected FSWs in Bangalore, India, in early 2011. RESULTS: Ninety-seven per cent of respondents noted condom use at last sex; 34% reported a condom breakage in the last month. Combining individual, situational and partner aspects of condom breakage into one logistic regression model and also controlling for client load, the authors found that partner and situational factors were dominant since the only significant predictors of condom breakage included being a paying client (adjusted odds ratio 4.61, 95% CI 1.20 to 17.58, p=0.025), the condom being too small for the penis (adjusted odds ratio 2.29, 95% CI 0.97 to 5.40, p=0.056) or too big for the penis (adjusted odds ratio 4.29, 95% CI 1.43 to 12.80, p=0.009) and rough sex (adjusted odds ratio 6.39 CI 3.55 to 11.52, p<0.001). CONCLUSIONS: Condom use among Bangalore FSWs is now very high. However, condom breakage is still a not uncommon event and puts women and their clients at unnecessary risk of infection. It may be difficult to eliminate the problem completely, but every effort should be made to discuss with sex workers the findings of this survey that point to possible personal markers of risk seen in the univariate analysis and to highlight the importance of avoiding rough sex and of ensuring the condom fits the client.

Seroprevalence of human immunodeficiency virus, hepatitis B virus and hepatitis C virus among eye donors.

Blood specimens collected at the time of enucleation of the eyes from 483 consecutive eye donors were tested for sero-markers of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV). Antibodies to HIV1 were detected in 3 (0.62%), HBsAg in 17 (3.52%) and antibodies to HCV in 7 (1.45%).

Effect of short duration caffeine treatment on the jejunum of adult albino rats.

The effect of the short duration (21 days) of caffeine at two different doses (12 mg & 30 mg/kg body weight/day) on the activities of adenosine triphosphatases in jejunum was studied. The activity of Na+, K+ -dependent ATP-ase was reduced significantly in the upper jejunal mucosal and serosal layers of low an high dose groups. Such effect was observed only in the lower jejunal serosal layer while a marked reduction in the activity of Mg2+ATP -ase was seen in mucosal and serosal layers of the jejunum at both doses. There was a significant increase in the activities of Ca2+-dependent and HCO3-dependent ATP -ases in these regions of the lower jejunum.