Background A number of studies in the context of HIV/STI epidemic and related vulnerability have focused on the risk reduction of HIV/STI prevalence and condom use among female sex workers (FSWs). However, such studies focusing the men having sex with men (MSM) and transgender remains limited. Since the risk reduction of HIV/STI vulnerability among MSM-T are equally important, a systematic study is required to identify the critical programme indicators which increases the condom use and reduces HIV/STI prevalence among MSM-Ts.
Methods Two rounds of IBBA data collected from the urban parts of the Bangalore district are used. Bi-variate analysis is used to cross-classify the outcome measures by those who are exposed to the programme than those who are not, whereas the application of binary logistic regression analysis is done to get the adjusted effect of programme indicators on condom related outcomes (condom breakage in past 1 month, zero unprotected sex acts with commercial clients in past 1 month, condom use at last sex with occasional clients/repeat partner/regular partner) and HIV/STI prevalence.
Results The sample includes 1432 MSM-T of which 56% belonged to the baseline while remaining to the follow-up survey. The mean age at sexual debut was lower and weekly client volume was higher among the MSM-Ts interviewed in the first round of survey which has shown a significant shift in positive direction in the second round of the survey. In context of programme exposure, higher percentage of MSM-T (about 75% vs 70%) reported project STI clinic visit, visit to DIC (68% vs 14%) than the baseline survey whereas the peer contact remained around 85% in both the rounds. The increased level of clinic/DIC visit found to be positively associated with higher proportion zero unprotected sex with commercial clients, consistent condom use with commercial clients/ repeat partner and with the regular partners in follow-up survey. The crude and adjusted OR shows a significantly less chances of HIV/STI among those who were contacted by peer (OR=0.78, 95% CI 0.67 to 0.99) and visited to clinic (0.82, 95% CI 0.79 to 0.96) compared to their respective counterparts after adjusting the effects of other confounders in the two rounds of the survey. The prevalence was significantly lower among those MSM-T who used condom with different type of partners at different occasions.
Conclusions The extent of peer-led outreach remain more or less over the period of time, however, a significant improvement in clinic/DIC visit found as the critical component in reducing the HIV/STI prevalence through increased means of condom use with different types of partners.