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International AIDS Conference Vienna July 18-23, 2010

Increased condom use and decreased HIV/STI prevalence among female sex workers following a targeted prevention program in Karnataka, India . Shajy Isac 1 Moses S 1,2 , Ramesh BM 1,2 , Beattie T, Reza-Paul S 2 , Kudur PH 1 , Washington RG 1,2 , Blanchard JF 1,2

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International AIDS Conference Vienna July 18-23, 2010

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  1. Increased condom use and decreased HIV/STI prevalence among female sex workers following a targeted prevention program in Karnataka, India Shajy Isac1 Moses S1,2, Ramesh BM1,2, Beattie T, Reza-Paul S2, Kudur PH1, Washington RG1,2, Blanchard JF1,2 1Karnataka Health Promotion Trust 2University of Manitoba Acknowledgements: KHPT Team, Partner NGOs, Community members, Field researchers International AIDS Conference Vienna July 18-23, 2010

  2. Background • The India AIDS Initiative (Avahan), funded by Bill and Melinda Gates Foundation is implemented in 6 high-prevalence Indian states • The program is implemented by University of Manitoba in 18 of the 27 districts of the southern state of Karnataka since 2004 • As part of program evaluation, two rounds of integrated biological and behavioural survey was conducted among FSWs in 5 program districts in Karnataka • 5 districts selected based on state’s socio-cultural regions and estimated number of FSWs • A baseline IBBA was conducted among FSWs in 5 districts within 8-16 months of intervention start-up • A follow-up IBBA was conducted 27-37 months after baseline in five districts • These 5 districts together have about 30,000 FSWs Karnataka • 18 UM/KHPT Districts: • 64,000 FSWs • 21,000 MSM

  3. Methodology • The target sample was fixed at 400 per district per IBBA round, except in Bangalore Urban where the target sample was fixed at 800 (400 street-based and 400 others) • Total 2282 and 2387 respondents interviewed in Round 1 and Round 2, with response rate of 81% and 96%. • Of the 2387 respondents in the follow-up survey, 17% had participated in the baseline survey • Sampling • Two-stage cluster sampling • 85 clusters in each district, 5 completed interviews in each cluster • Interviews and biological sample collection • Informed written consent • Interview by trained field researchers • Venus blood / dry blood spots and urine samples • Tests • Serum: Detect and confirmed by Genedia • DBS: Detect and confirmed by Genedia • Urine: Calypte EIA confirmed by Western Blot

  4. Program Exposure Multivariate models for the state were adjusted for the following variables: (1) survey round, (2) age, (3) marital status, (4) residency, (5) age at start sex work, (6) place where sex is solicited, (7) charge per sex act, (8) weekly sex work income, (9) proportion of clients who were new, and (10) regular partner

  5. Duration in the Program and Exposure to Different Program Elements p=0.05 p=0.001 p<0.001 Exposure: <12 months (n=2284); 12-23 months (n=464); 24-33 months (n=489); 34+ months (n=834)

  6. Condom-Related Outcomes (1) Multivariate model adjusted for same variables as used in Program Exposure outcome

  7. Condom-Related Outcomes (2) Multivariate model adjusted for same variables as used in Program Exposure outcome

  8. Duration of Program Exposure and Condom Use (1) P<0.001 p<0.001 p<0.001 P<0.001 Not exposed (n=641); <12 months (n=2284); 12-23 months (n=464); 24-33 months (n=489); 34+ months (n=834)

  9. Duration of Program Exposure and Condom Use (2) p<0.001 p<0.001 p<0.001 Not exposed (n=641); <12 months (n=2284); 12-23 months (n=464); 24-33 months (n=489); 34+ months (n=834)

  10. Causal Pathways Analyses ** ** ** ** ** ** ** ** ** ** **p ≤0.001 *p≤0.05 ** * ** *

  11. STI Prevalence Multivariate models for the state were adjusted for the following variables: (1) survey round, (2) age, (3) marital status, (4) residency, (5) age at start sex work, (6) place where sex is solicited, (7) charge per sex act, (8) weekly sex work income, (9) proportion of clients who were new, and (10) regular partner

  12. Discussion (1) • Substantial increases were observed in all indices of program exposure and condom use between the two IBBA rounds. • Longer duration of program exposure was associated with increased program and service utilization, and increased condom use. • Duration of one year or more between program initiation and Round 1 IBBA likely resulted in already very high levels of reported condom use in Round 1.

  13. Discussion (2) • Significant reduction in HIV, high-titre syphilis, gonorrhea and chlamydial infection prevalence between the two IBBA rounds. • A significant reduction was seen in trichomoniasis between the two rounds (tested only in one study area). • Reductions in the prevalence of several STIs were significantly associated with increased condom use, contact by a peer educator, and program clinic attendance • Condom use with last occasional and repeat clients and with regular partner were strongly associated with exposure to virtually all key program elements examined.

  14. THANKS

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