Changes in risk behaviours and prevalence of sexually transmitted infections following HIV preventive interventions among female sex workers in five districts in Karnataka state, south India
- B M Ramesh1,2,
- Tara S H Beattie3,
- Isac Shajy2,
- Reynold Washington1,2,4,
- Latta Jagannathan5,
- Sushena Reza-Paul1,
- James F Blanchard1,
- Stephen Moses1,6
- 1Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- 2Karnataka Health Promotion Trust, Bangalore, India
- 3Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- 4St John's Medical College and Hospital, Bangalore, India
- 5Bangalore Medical Services Trust, Bangalore, India
- 6Departments of Medical Microbiology and Medicine, University of Manitoba, Winnipeg, Canada
- Correspondence to Dr B M Ramesh, Karnataka Health Promotion Trust, IT/BT Park, 5th Floor, No 1–4, Rajajinagar Industrial Area, Behind KSSIDC Administrative Office, Rajajinagar, Bangalore 560 044, India;
Contributors BMR designed and supervised the cross-sectional, integrated behavioural and biological assessment (IBBA) surveys, performed analyses and contributed to writing the paper. TSHB performed analyses and wrote the first draft of the paper. SI co-designed and supervised the IBBA surveys and contributed to writing the paper. RW designed and supervised the implementation of the intervention programme and contributed to writing the paper. LJ supervised the laboratory testing. SR-P supervised the IBBA surveys and the implementation of the intervention programme, and contributed to writing the paper. JFB and SM designed the study and contributed to writing the paper.
- Accepted 26 October 2009
Objectives To examine the impact of a large-scale HIV prevention programme for female sex workers (FSW) in Karnataka state, south India, on the prevalence of HIV/sexually transmitted infections (STI), condom use and programme coverage.
Methods Baseline and follow-up integrated biological and behavioural surveys were conducted on random samples of FSW in five districts in Karnataka between 2004 and 2009.
Results 4712 FSW participated in the study (baseline 2312; follow-up 2400), with follow-up surveys conducted 28–37 months after baseline. By follow-up, over 85% of FSW 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 to 0.99, p=0.04); high-titre syphilis (5.9% vs 3.4%, AOR 0.53, 95% CI 0.37 to 0.77, p=0.001); and chlamydia and/or gonorrhoea (8.9% vs 7.0%, AOR 0.72, 95% CI 0.54 to 0.94, p=0.02). Reported condom use at last sex increased significantly for repeat clients (66.1% vs 84.1%, AOR 1.98, 95% CI 1.58 to 2.48, p<0.001) and marginally for occasional clients (82.9% vs 88.0%, AOR 1.22, 95% CI 0.89 to 1.66, p=0.2), but remained stable for regular partners (32%). Compared with street and home-based FSW, brothel-based FSW were at highest risk of HIV and STI, despite high levels of reported condom use.
Conclusions This large-scale HIV prevention programme for FSW achieved reductions in HIV and STI prevalence, high rates of condom use with clients and high rates of programme coverage. Improved strategies to increase condom use with regular partners and reduce the vulnerability of brothel-based FSW to HIV are required.
- intervention studies
- sexual behaviour
- sexually transmitted infection
- sex work
Funding This research was funded by the Bill & Melinda Gates Foundation. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Bill & Melinda Gates Foundation.
Competing interests None.
Ethical approval Statutory approval for the conduct of the IBBA and their protocols was obtained by the Government of India's Health Ministry Screening Committee. The study was approved by the Institutional Ethical Review Board of St John's Medical College, Bangalore, India and the Health Research Ethics Board of the University of Manitoba, Winnipeg, Canada.
Provenance and peer review Not commissioned; externally peer reviewed.