Background HIV transmission in India is concentrated among high-risk groups. Female sex workers (FSWs) and Clients of FSWs are the most vulnerable groups at risk for HIV. This paper presents the prevalence of sexually transmitted infections (STIs) and HIV among FSWs and their clients in the states of Andhra Pradesh (AP), Tamil Nadu (TN) and Maharashtra (MH) from repeated, cross-sectional, bio-behavioural surveys.
Methods Data from two rounds of Integrated Behavioural and Biological Assessments conducted in 2005 (R1) and 2009 (R2) among 15 632 FSWs (R1-7828, R2-7804) and 9624 clients of FSWs (R1-4821, R2-4803) were analysed to observe the changes in STI and HIV prevalence among each group. Respondents' behaviour was assessed and blood and urine samples were collected to test for STIs [Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), syphilis and HIV]. Analysis at both the aggregate and state level was done. Adjusted ORs were obtained by including all socio-demographic variables associated with rounds of survey in multivariate models.
Results At the aggregate level, among FSWs, prevalence of syphilis declined from 10.8% in R1 to 5.0% in R2 (AOR 0.39, p=0.001) and no significant change was observed in prevalence of HIV, NG or CT. Among FSW clients, STI prevalence was low in R1 (syphilis 4.7%, NG 0.4% and CT 2.4%) and no significant change was observed in R2. The state-wide trend shows that for FSWs in AP, a significant decline occurred in prevalence of both HIV (AOR 0.68, p<0.01) and syphilis (AOR 0.39, p<0.001) whereas in TN, only syphilis prevalence declined (AOR 0.20, p<0.001). The trend in MH differs from the other two states. In MH, prevalence of bacterial STIs (syphilis, NG and CT) declined significantly whereas HIV prevalence increased significantly (AOR 1.29, p=0.04). Among FSW clients, STI prevalence was low in MH (syphilis 4.3%, NG 0.7%, and CT 4.2%) and TN (syphilis 4.1%, NG 0.0%, and CT 0.8%) in R1 and remained unchanged in R2. However, a significant decline occurred in HIV prevalence in both states [MH: AOR-0.25, p=0.002; TN: AOR-2.3, p<0.05]. In AP, only prevalence of syphilis (AOR 0.18, p<0.001) declined and no change was observed in other STIs.
Conclusion The prevalence of syphilis declined among both FSWs and their clients in all three states whereas no change was seen in other bacterial STI prevalence (NG or CT). Among FSW clients in MH and TN, STI prevalence remained unaltered. Tailored and sustained programmatic efforts are needed to address the disparity in prevalence of STIs and HIV in the three states.
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