Increases in self-reported consistent condom use among male clients of female sex workers following exposure to an integrated behaviour change programme in four states in southern India
- 1Population Services International, Research Department, Washington DC, USA
- 2Population Services International, Research Department, New Delhi, India
- 3National AIDS Control Organisation, Ministry of Health & Family Welfare, New Delhi, India
- Correspondence to Amajit Mukherjee, Population Services International, Tower A, Building No. 10, DLF Cyber City, Gurgaon, India;
Contributors VL developed the concept for the paper; conducted literature review; primary author of the text; provided technical input and guidance for data analyses. AM participated in data collection and monitoring of field work; reviewer of the text; conducted preliminary data analyses. DN participated in data collection and monitoring of field work; provided support to data analyses. PM initiated quantitative surveys under the Avahan project. AS participated in data collection and monitoring of field work; provided support to data analyses. KPR participated in data collection and monitoring of field work; provided input into secondary literature review and conducted primary analyses for the paper.
- Accepted 28 October 2009
Purpose As part of the Avahan India AIDS Initiative, a behaviour change communication programme sought to increase consistent condom use (CCU) among male clients of female sex workers (FSWs) in four Indian states through the use of outdoor static promotional materials, interpersonal communication and mid-media activities. This paper presents key findings related to programme coverage levels, trends over time in self-reported condom use, and correlations between levels of exposure to programme activities and self-reported condom use.
Methods Five stratified two-stage cluster sample surveys were conducted between April 2006 and November 2008 (sample sizes ranged from 1741 to 2041). The independent samples were composed of clients of FSWs in selected clusters. Multivariate logistic regression was used to model whether behavioural outcomes varied between baseline and endline, and whether they varied with levels of exposure to the intervention.
Results Over two-thirds of men in each survey round recalled one or two of the main intervention channels. An increase in CCU with FSWs was found between baseline and endline (63.6% vs 86.5; p<0.01). Men exposed to two intervention channels reported higher CCU than men exposed to none or only static outdoor media (89.4% vs 82.0%, p<0.05). This trend was sustained for condom use at last sex (96.2% vs 92.6%, p<0.05).
Conclusion Evaluation suggests that a multi-channel behavioural intervention delivered at sites where FSWs are solicited can increase CCU among male clients of FSWs. Further research is needed on the dynamics of exposure to multiple communication channels and the contributions of complementary interventions.
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.
Ethics approval This study was conducted with the approval of the Indian Council of Medical Research.
Provenance and peer review Not commissioned; externally peer reviewed.