Abstract
BackgroundA decline in HIV prevalence among female sex workers (FSWs) has been reported from the Indian state of Andhra Pradesh between the two rounds of integrated biological and behavioural assessment (IBBA) surveys in 2005–06 and 2009, the first of these around the time of start of the Avahan HIV prevention intervention. In order to facilitate further planning of FSW interventions, we report the factors associated with HIV prevalence among street-based FSWs.MethodsBehavioural data from the two rounds of IBBA surveys, district-level FSW HIV prevention program data, and urbanisation data from the Census of India were utilized. A multilevel logistic model was used to investigate factors associated with inter-district variations in HIV positivity among street-based FSWs in the districts by fitting a two-level model.ResultsThe estimated HIV prevalence among street-based FSWs changed from 16% (95% confidence interval [CI] 14.2 – 17.7%) to 12.9% (95% CI 11.5 – 14.2%) from 2005–06 to 2009. HIV positivity was significantly higher in districts with a high proportion of FSWs registered with targeted interventions (odds ratio [OR] 2.02; 95% CI 1.18-3.45), and in districts with medium (OR 2.54; 95% CI 1.58-4.08) or high (OR 1.55; 95% CI 1.05-2.29) proportion of urban population. Districts which had met the condom requirement targets for FSWs had significantly lower HIV positivity (OR 0.50; 95% CI 0.26-0.97). In round 2 survey, the districts with medium level urbanisation had significantly higher proportion of FSWs registered with HIV intervention programmes and also reported higher consistent condom use with regular partner (p < 0.001).ConclusionsVariations in HIV positivity among street-based FSWs were seen at the district level in relation to HIV intervention programs and the degree of urbanization. These findings could be used to enhance program planning to further reduce HIV transmission in this population.
Highlights
A decline in HIV prevalence among female sex workers (FSWs) has been reported from the Indian state of Andhra Pradesh between the two rounds of integrated biological and behavioural assessment (IBBA) surveys in 2005–06 and 2009, the first of these around the time of start of the Avahan HIV prevention intervention
The Avahan program was aimed at reducing HIV prevalence among high risk groups in India including FSWs in geographic areas most affected including those in the Indian state of Andhra Pradesh [6]
We studied street-based FSWs as they comprise the highest proportion among FSWs in Andhra Pradesh, and they are exposed to HIV risk through their work on the street
Summary
A decline in HIV prevalence among female sex workers (FSWs) has been reported from the Indian state of Andhra Pradesh between the two rounds of integrated biological and behavioural assessment (IBBA) surveys in 2005–06 and 2009, the first of these around the time of start of the Avahan HIV prevention intervention. The Avahan program was aimed at reducing HIV prevalence among high risk groups in India including FSWs in geographic areas most affected including those in the Indian state of Andhra Pradesh [6]. Two independent rounds of Integrated Behavioural and Biological Assessment (IBBA) surveys were conducted to measure the potential impact of Avahan interventions on HIV prevalence and related risk behavior among FSWs [14]. A beneficial effect in reducing HIV prevalence at the population level over 5 years of Avahan program implementation in some of the states including Andhra Pradesh has been reported [15,16]
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