Pre-exposure prophylaxis: awareness, acceptability and risk compensation behaviour among men who have sex with men and the transgender population.

OBJECTIVES: This exploratory study examined the facilitators of and barriers to acceptance of pre-exposure prophylaxis (PrEP) and potential risk compensation behaviour emerging from its use among men who have sex with men (MSM) and transgender individuals (TGs) in India. METHODS: A questionnaire was administered to 400 individuals registered with a targeted intervention programme. Logistic regression models were used to identify facilitators of and barriers to PrEP acceptance. RESULTS: The respondents consisted of 68% MSM and 32% TGs. Risk behaviour categorization identified 40% as low risk, 41% as medium risk and, 19% as high risk for HIV infection. About 93% of the respondents were unaware of PrEP, but once informed about it, 99% were willing to use PrEP. The facilitators of PrEP acceptance were some schooling [odds ratio (OR) 2.16; P = 0.51], being married or in a live-in relationship (OR 2.08; P = 0.46), having a high calculated risk (OR 3.12; P = 0.33), and having a high self-perceived risk (OR 1.8; P = 0.35). Increasing age (OR 2.12; P = 0.04) was a significant barrier. TGs had higher odds of acceptance of PrEP under conditions of additional cost (OR 2.12; P = 0.02) and once-daily pill (OR 2.85; P = 0.04). Individuals identified as low risk for HIV infection showed lower odds of potential risk compensation, defined as more sexual partners (OR 0.8; P = 0.35), unsafe sex with new partners (OR 0.71; P = 0.16), and decreased condom use with regular partners (OR 0.95; P = 0.84), as compared with medium-risk individuals. The associations, although not statistically significant, are nevertheless important for public health action given the limited scientific evidence on PrEP use among MSM and TGs in India. CONCLUSIONS: With high acceptability and a low likelihood of risk compensation behaviour, PrEP can be considered as an effective prevention strategy for HIV infection among MSM and TGs in India.

General hygiene, sexual risk behaviour and HIV prevalence in truck drivers from Andhra Pradesh, South India: implications for prevention interventions.

The relationships between hygiene, sexual behaviour and HIV infection are poorly understood. We examine these relationships in Indian truck drivers, a group at high risk for HIV infection. Truck drivers (n = 189) were recruited into an integrated HIV and hygiene Information Motivation (IM) programme. Sociodemographic characteristics, sexual and hygiene behaviour and HIV prevalence were determined. Multivariate logistic regression and linear generalized estimating equation models were utilized. At baseline, 2.1% of drivers were HIV infected and 34% who reported having contact with female sex workers (FSWs) had contact within the previous six months. Those who washed their hands postdefecation were less likely to report genital symptoms (OR 0.02; P = 0.01) and have sex with an FSW (OR [odds ratio] 0.21; P = 0.05). After an IM intervention, there were no changes in sexual risk-taking behaviour (coefficient -0.15 to -0.02; P = 0.13-0.75); however, hygiene behaviour improved from baseline (coefficient 0.09-0.31; P < 0.01 to P = 0.03). Personal hygiene habits, like handwashing, seem to be a modifiable behaviour after a modest intervention, whereas HIV risk-taking behaviour was not. The association between hygiene and HIV risk-taking suggests the need for further evaluation of the relationship and that of other hygiene practices in high-risk men in India.

HIV infection dynamics in rural Andhra Pradesh south India: a sexual-network analysis exploratory study.

The southern state of Andhra Pradesh (AP) has one of the highest rates of HIV-1 infection in India. Estimates of HIV infection in rural areas have begun to approximate the urban. Methods of HIV transmission in rural India are poorly understood. We examined risk factors for HIV transmission in a group of rural villages in AP through the use of a sexual-network analysis survey - the Indian Health and Family Life Survey (IHFLS). The study sample included 20 HIV-positive and 40 HIV-negative matched controls randomly selected from a population-based, voluntary counselling and testing program in rural AP. HIV-1 status was confirmed by Western Blot. The 405-item IHFLS is based upon the National Health and Life Survey which has been validated in the US and China. The sample mean age was 37 years and 22% were of a tribal caste. Among female respondents, none were commercial sex workers (CSWs) and there were no significant social or behavioral associations with HIV infection. Among male respondents, ever having bought sex and having more than one lifetime partner were found to be significantly associated with HIV infection (p=0.002 and p=0.017). Amongst sub-populations, all men who had sex with men (MSM) were married. Tribals were more likely to report a concurrent sexual relationship (p=0.04). All high-risk men, including MSM, men who buy sex and men with multiple lifetime female partners did not use condoms. Public health interventions aimed at reducing HIV transmission in rural AP should consider targeting sub-populations of men who engage in covert MSM or CSW, high-risk tribal caste members and at-risk wives.