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Programme coverage, condom use and STI treatment among FSWs in a large-scale HIV prevention programme: results from cross-sectional surveys in 22 districts in southern India
  1. Lakshmi Ramakrishnan1,
  2. Abhishek Gautam1,
  3. Prabuddhagopal Goswami1,
  4. Srinivasan Kallam1,
  5. Rajatashuvra Adhikary1,
  6. Mandar K Mainkar2,
  7. Banadakoppa M Ramesh3,4,
  8. Guy Morineau5,
  9. Bitra George1,
  10. Ramesh S Paranjape3,4
  1. 1Family Health International, New Delhi, India
  2. 2National AIDS Research Institute, ICMR, Pune, India
  3. 3Karnataka Health Promotion Trust, Bangalore, India
  4. 4Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
  5. 5Family Health International, Bangkok, Asia Pacific Regional Office, Bangkok, Thailand
  1. Correspondence to Ms Lakshmi Ramakrishnan, No 2 T2 Shivaji's Maniram Apt. Gandhi Mandapam Road, Kotturpuram, Chennai 600 085, India; lramakrishnan{at}


Objective This paper evaluates Avahan programme's coverage of female sex workers (FSWs), focus on high-risk FSWs and intermediate outcomes.

Methods First round of cross-sectional survey data, Integrated Behavioral and Biological Assessments (IBBA), conducted in 22 districts, were aggregated into district categories: Solo, where Avahan was the sole service provider covering all FSWs and Major or Minor where Avahan was not the sole provider, but intended coverage was >50% or ≤ 50% of FSWs respectively. Multivariate logistic regression was applied to compare exposure by district categories, vulnerability factors and intermediate outcomes associated with exposure.

Results Reported exposure, evaluated on basis of having received any of three core services, was higher in Solo (75%) compared with Minor (66%) districts. Logistic regression showed that FSWs in solo districts were more likely to be exposed (adjusted odds ratio (AOR)=1.5; 95% CI 1.20 to 1.86) compared with FSWs in Minor districts. Multivariate analysis in Solo districts revealed that FSW with ≥15 clients in the past week had a higher chance of being exposed to core services (AOR=1.56; 95% CI 1.03 to 2.35). Exposure to the three services in Solo Avahan districts was significantly associated with correct knowledge on condom use (AOR=1.36; 95% CI 1.05 to 1.78), consistent condom use with occasional clients (AOR=3.17; 95% CI 2.17 to 4.63) and regular clients (AOR=2.47; 95% CI 1.86 to 3.28) and STI treatment-seeking behaviour (AOR=3.00; 95% CI 1.94 to 4.65).

Conclusions Higher coverage of FSWs was achieved in districts where Avahan was the only intervention compared with districts having multiple and longstanding non-Avahan programmes. Exposure in Solo districts was associated with intermediate outcomes; this need to be further evaluated in comparison with non Avahan areas and substantiated through data from next IBBA.

  • IBBA
  • coverage
  • exposure
  • cross-sectional survey
  • outcomes
  • FSW
  • evaluation
  • India
  • condom use
  • STIs
  • condoms
  • prevention
  • programme evaluation
  • risk behaviours
  • sexual behaviour

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  • Funding This research and the Avahan programme were funded by The Bill & Melinda Gates Foundation. The funding agency did not have any role in collection, analysis or interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

    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 Ethics approval was provided by the India and USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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