Increase in condom use and decline in prevalence of sexually transmitted infections among high-risk men who have sex with men and transgender persons in Maharashtra, India: Avahan, the India AIDS Initiative

BMC Public Health

Mandar M Mainkar²  Ramesh S Paranjape²  Bitra George⁴  Rajatashuvra Adhikary¹  Prabuddhagopal Goswami⁴  Lakshmi Ramakrishnan⁴  Dilip B Pardeshi²  Abhishek Gautam³  Sucheta Deshpande²  Shreena Ramanathan⁴ 

[1] FHI 360 Headquarters, Washington, USA;National AIDS Research Institute (ICMR), Pune, Maharashtra, India;Formerly with FHI 360, New Delhi, India;FHI 360 India, H-5 Green Park Extension, New Delhi 110016, India

关键词: HIV;    STIs;    Condom use;    Avahan;    Maharashtra;    Transgender;    MSM;   

Others  :  1128833
DOI  :  10.1186/1471-2458-14-784

 received in 2013-05-20, accepted in 2014-07-23,  发布年份 2014

【 摘 要 】

Background

The present study assessed coverage, changes in condom use, and prevalence of HIV and other STIs among high-risk men who have sex with men (HR-MSM; highly visible, recruited from cruising sites/sex venues) and transgender (TG; male-to-female transgender persons, also called hijras) in the Indian state of Maharashtra.

Methods

Data from Avahan’s computerized management information system; two rounds of integrated behavioral and biological assessment (IBBA) surveys (Round 1 with 653 HR-MSM/TG and Round 2 with 652 HR-MSM/TG); and project-supported condom social marketing was used for the present analysis. Logistic regression models were used to assess changes in key indicators over these two rounds and to explore the association between exposure to Avahan interventions and condom use and STI prevalence in HR-MSM/TG.

Results

By December 2007, Avahan had reached about 90% of the estimated HR-MSM/TG population, and 83% of the estimated total population had visited STI clinics by March 2009. Free direct condom distribution by Avahan program NGOs and social marketing outlets in Maharashtra increased from about 2.7 million condoms in 2004 to 15.4 million in 2008. HR-MSM/TG were more likely to report higher consistent condom use (adjusted odds ratio [AOR]: 1.90; 95% confidence interval [CI] 1.01-3.58) with regular male partners (spouse/lover/boyfriend) in Round 2 of IBBA, compared to Round 1. HR-MSM/TG exposed to Avahan interventions were more likely to report consistent condom use with regular male partners (AOR: 2.46; CI 1.34-4.52) than those who were unexposed. Prevalence of reactive syphilis serology declined significantly from 8.8% in Round 1 to 1.1% in Round 2 (p = 0.001), while the observed change HIV prevalence (12.3% to 6.3%, p = 0.16) was insignificant.

Conclusion

The current evaluation provides evidence for successful scale up and coverage of target population by Avahan interventions in Maharashtra. The assessment findings showed improved accessibility to condoms and reduced risk behaviours with male sexual partners. Syphilis prevalence declined; however HIV prevalence did not change and is still a major concern. Continued strengthening of core programmatic strategies are needed to effectively improve condom use with all partner types and to help bring sustained reductions in HIV risk in HR-MSM/TG and its onward transmission.

【 授权许可】

   
2014 Ramanathan et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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