Abstract
BackgroundIndia has an estimated 2.0 million to 3.1 million people living with HIV; it has the highest number of HIV-positive people in Asia and ranks third in the world. The Frontiers Prevention Project (FPP) was implemented in 2002 to conduct targeted prevention intervention geared towards female sex workers (FSW) and men who have sex with men (MSM) in the state of Andhra Pradesh (AP). This paper reports the overall changes in behaviour and STI outcomes between 2003/4 and 2007 and also describes the changes attributed to the FPP.MethodsThe evaluation used two cross-sectional surveys among MSM and FSW at 24 sites in AP. Surveys were implemented using a similar methodology. Univariate analyses were conducted by comparing means: baseline vs. four-year follow-up and FPP vs. non-FPP. For both MSM and FSW, random and fixed-effects logit regression models at the site level were estimated for condom use with last partner, syphilis sero-positivity and HSV 2 sero-positivity. In addition, for FSW we estimated models for condom use with regular partner, and for MSM we estimated models for condom use with last female partner.ResultsAmong MSM, fixed-effects analysis revealed that FPP was positively correlated with the probability of condom use with last female sexual partner and negatively correlated with the individual probability of sero-positivity to syphilis and HSV 2. Among FSW, the FPP intervention was significantly correlated with increased condom use with regular partners and with lower probability of STI sero-positivity.DiscussionImportant changes in behaviours related to an increase in prevention activities translated to reductions in STI sero-prevalence in AP, India. In contrast with non-FPP sites, the FPP sites experienced an intense community approach as part of the FPP intervention, and the general increase in condom use and its effect on STI sero-prevalence reflected the efficacy of these intense prevention activities focused on key populations in AP.
Highlights
India has an estimated 2.0 million to 3.1 million people living with human immunodeficiency virus (HIV); it has the highest number of HIV-positive people in Asia and ranks third in the world
Because individual identifiers were not collected, we designed the analysis as a comparison of two crosssectional surveys conducted at the same sites with similar methodology
There was an emphasis on social capital building, network and support formation, empowerment, violence reduction, referrals for HIV testing and basic AIDS care services
Summary
India has an estimated 2.0 million to 3.1 million people living with HIV; it has the highest number of HIV-positive people in Asia and ranks third in the world. India has a reported 2.0 to 3.1 million people living with the human immunodeficiency virus (HIV), representing the highest number of HIV positive people in Asia and priority in its own right, and it is an effective way to protect the remaining population from infection, highlighting the importance of enduring effective prevention for these populations [1,2]. Andhra Pradesh (AP), with a total population of 76.2 million, is located in the south-eastern part of India. This state reported one of the fastest increasing HIV/ AIDS rates in India when the FPP began and is among the six states in India with the highest prevalence. The sentinel surveillance centre data suggest that the epidemic is not limited to urban areas and that there is little difference between the prevalence rates of migrants and non-migrants [3]
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