Abstract
BackgroundThe Avahan intervention promotes consistent (100%) condom use amongst men who have sex with men in southern India. We assessed how condom use varies with intervention exposure for men who have sex with men in Bangalore.MethodsSelf-reported condom use and intervention exposure data were derived from a cross-sectional survey. Consistent condom use and condom use at last sex act with all, main, and casual male sex partners were assessed. Binary and continuous variables reflecting intervention exposure (including contact(s) with intervention staff, receiving condoms and seeing condom demonstrations) were used. Multivariable logistic regression was employed to assess the relationship between condom use with each type of partner and each exposure variable independently, controlling for socio-demographic and behavioural factors associated with condom use or intervention exposure.ResultsCondom use with all partners was higher among those who had ever been contacted by, received condoms from, or seen a condom demonstration by intervention staff (adjusted odds ratio >2, p < 0.02 for all). Consistent condom use with all types of partner increased with the number of condom demonstrations seen in the last month (adjusted odds ratio = 2.1 per demonstration, p < 0.025), while condom use at last sex act with a casual (but not main) partner increased with the number of condoms received from the intervention (adjusted odds ratio = 1.4 per condom, p = 0.04).ConclusionsDirect contact with Avahan program staff is associated with increased reported condom use among men who have sex with men in Bangalore. Reported consistent condom use and condom use at last sex act are associated with contacts involving demonstrations of correct condom use, and with receiving condoms, respectively.
Highlights
The Avahan intervention promotes consistent (100%) condom use amongst men who have sex with men in southern India
Since the previous study amongst female sex workers (FSWs) suggested that different exposure measures, reflecting different aspects of the intervention, may vary in their relationship with condom use [16], we looked at a number of different measures of intervention exposure to identify the particular components of contact with the Avahan intervention which were associated with increased self-reported condom use by men who have sex with men (MSM)
Unadjusted and adjusted associations with intervention exposure In unadjusted analyses, consistent condom use (CCU) with all partners was significantly higher among those who had been contacted by the Avahan intervention (77% versus 55%), those who had received condoms from the intervention (79% versus 55%) and those who had seen a condom demonstration (85% versus 54%) (Figure 1a-c)
Summary
The Avahan intervention promotes consistent (100%) condom use amongst men who have sex with men in southern India. The India AIDS Initiative (Avahan) of the Bill & Melinda Gates Foundation, an HIV prevention program which targets populations at high risk of HIV acquisition in the highest HIV prevalence states in India, aims to directly reduce HIV transmission among and from these high-risk groups by treating bacterial sexually transmitted infections (STIs) and promoting consistent condom use (CCU) [5,6]. One of the high-risk groups targeted is men who have sex with men (MSM), a marginalised group in southern India, known to have high HIV prevalence (7-21% in different districts of Andhra Pradesh, Maharashtra, Tamil Nadu and Karnataka states [7,8,9,10]). It should be noted that these surveys tend to capture higher-risk MSM, and so they are likely to overestimate the true proportion of MSM who sell sex [11]
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