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Increased condom use and decreased HIV/STI prevalence among female sex workers following a targeted prevention program in Karnataka, South India
Presented by Shajy Isac (India).
S. Moses1, B.M. Ramesh2, T. Beattie3, S. Isac2, S. Reza-Paul1, P. Kudur2, R. Washington2, J. Blanchard1
1University of Manitoba, Winnipeg, Canada, 2Karnataka Health Promotion Trust, Bangalore, India, 3London School of Hygiene and Tropical Medicine, London, United Kingdom
Background: We assessed the impact of a large-scale, targeted HIV prevention program among female sex workers (FSWs) in Karnataka state, south India.
Methods: In the context of an HIV prevention program involving 18 districts, funded by the Avahan initiative of the Bill & Melinda Gates Foundation, we conducted initial and follow-up integrated behavioural and biological assessments involving random samples of FSWs in five districts. Surveys were at 7-19 months following program commencement, and again 28-37 months later.
Results: 2,312 FSWs participated in initial surveys, and 2,400 at follow-up. At follow-up, >85% of FSWs reported contact by a peer educator and having visited a project STI clinic. Compared with baseline, there were reductions in the prevalence of HIV (19.6% vs. 16.4%, adjusted odds ratio (AOR) 0.81, 95% CI 0.67-0.99, p=0.04); high-titre syphilis (5.9% vs. 3.4%, AOR 0.53, 95% CI 0.37-0.77, p=0.001); and chlamydia and/or gonorrhea (8.9% vs. 7.0%, AOR 0.72, 95% CI 0.54-0.94, p=0.02). Trichomoniasis, which was assessed in only one district, declined from 32.9% to 13.5% (AOR 0.3, 95% CI 0.2-0.4, p< 0.001). Reported condom use at last sex increased significantly for repeat clients (66.1% vs. 84.1%, AOR 1.98, 95% CI 1.6-2.5, p< 0.001), and marginally for occasional clients (82.9% vs. 88.0%, AOR 1.22, 95% CI 0.89-1.66, p=0.2), but remained stable for regular partners (32%). Condom use was strongly associated with peer educator contact and attendance at a program clinic. Compared with street- and home-based FSWs, brothel-based FSWs were at highest risk of HIV and STIs, despite high levels of reported condom use.
Conclusions: This large-scale HIV prevention program for FSWs achieved reductions in HIV and STI prevalence, high rates of condom use with clients, and high rates of program coverage. Improved strategies to increase condom use with regular partners and reduce the vulnerability of brothel-based FSWs to HIV are required.
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