Background: In 2003 a large-scale HIV prevention program was launched for
key populations in six high HIV prevalence states of India. This paper assesses
the effect of exposure to the intervention on condom use with commercial
clients and experiences of sexually transmitted infection (STI) among female
sex workers (FSWs) in Tamilnadu, a southern Indian state, between 2006 and
2009. Methods: Data were drawn from two rounds of cross-sectional surveys
conducted in 2006 (N = 2010) and 2009 (N = 2500) among FSWs in Tamilnadu,
recruited through probability-based sampling. A series of multivariate
logistic regression models were constructed to examine the association between
exposure to the intervention and change over time with condom use
and self-reported STI. All the analyses were performed using STATA 11.1. Results: Overall, 48% of FSWs in 2006 and 90% in 2009 reported exposure to
the intervention. Compared to 2006, there was a considerable increase in the
proportion of FSWs reporting consistent condom use with regular and occasional
clients at follow-up (2009). Further, the increase in consistent condom
use over time with occasional (adjusted OR = 3.53, 95% CI: 2.47 - 5.05) and
regular clients (adjusted OR = 4.97, 95% CI: 3.43 - 7.16) was significantly
higher among FSWs exposed to the intervention than those not exposed. Additionally,
a significant decline was observed in self-reported STI overtime
among FSWs exposed to the intervention compared to their counterparts
(adjusted OR = 0.39, 95% CI: 0.26 - 0.59). Conclusion: The HIV prevention
program in Tamilnadu resulted in increased consistent condom use and a decrease in self-reported STI among FSWs exposed to intervention. These findings
suggest that HIV prevention programs should aim to saturate coverage
among key populations to sustain the gains achieved.
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