HIV prevalence and risk behaviour within these self-identified MSM communities in south India is high. Moreover, a significant proportion of them had female partners, both regular and commercial. The national programme's focus on HIV prevention services for these high-risk MSM is justified.

BackgroundAvahan, the India AIDS initiative began HIV prevention interventions in 2003 in Andhra Pradesh (AP) among high-risk groups including female sex workers (FSWs), to help contain the HIV epidemic. This manuscript describes an assessment of this intervention using the published Avahan evaluation framework and assesses the coverage, outcomes and changes in STI and HIV prevalence among FSWs.MethodologyMultiple data sources were utilized including Avahan routine program monitoring data, two rounds of cross-sectional survey data (in 2006 and 2009) and STI clinical quality monitoring assessments. Bi-variate and multivariate analyses, Wald Chi-square tests and multivariate logistic regressions were used to measure changes in behavioural and biological outcomes over time and their association.ResultsAvahan scaled up in conjunction with the Government program to operate in all districts in AP by March 2009. By March 2009, 80% of the FSWs were being contacted monthly and 21% were coming to STI services monthly. Survey data confirmed an increase in peer educator contacts with the mean number increasing from 2.9 in 2006 to 5.3 in 2009. By 2008 free and Avahan-supported socially marketed condoms were adequate to cover the estimated number of commercial sex acts, at 45 condoms/FSW/month. Consistent condom use was reported to increase with regular (63.6% to 83.4%; AOR=2.98; p<0.001) and occasional clients (70.8% to 83.7%; AOR=2.20; p<0.001). The prevalence of lifetime syphilis decreased (10.8% to 6.1%; AOR=0.39; p<0.001) and HIV prevalence decreased in all districts combined (17.7% to 13.2%; AOR 0.68; p<0.01). Prevalence of HIV among younger FSWs (aged 18 to 20 years) decreased (17.7% to 8.2%, p=0.008). A significant increase in condom use at last sex with occasional and regular clients and consistent condom use with occasional clients was observed among FSWs exposed to the Avahan program. There was no association between exposure and HIV or STIs, although numbers were small.ConclusionsThe absence of control groups is a limitation of this study and does not allow attribution of changes in outcomes and declines in HIV and STI to the Avahan program. However, the large scale implementation, high coverage, intermediate outcomes and association of these outcomes to the Avahan program provide plausible evidence that the declines were likely associated with Avahan. Declining HIV prevalence among the general population in Andhra Pradesh points towards a combined impact of Avahan and government interventions.

ObjectivesTo assess a large-scale intervention, the Avahan intervention, using an evaluation framework that included programme coverage, condom use and changes in sexually transmitted infection (STI) and HIV prevalence among high-risk men who have sex with men/transgender (HR-MSM/TG) in the state of Andhra Pradesh, India.DesignProgramme monitoring data and results from two rounds of cross-sectional integrated biological and behavioural assessment (IBBA) in 2006 (Round 1) and 2009 (Round 2) were used for current analysis.SettingProgramme monitoring data and cross-sectional surveys from Andhra Pradesh, India.ParticipantsData from 1218 and 1203 participants in Rounds 1 and 2 of the IBBA, respectively, and field level programme monitoring data from the intervention districts.Primary and secondary outcomes(1) Assess the reach of intervention in the HR-MSM/TG population; (2) evaluate the association between intervention and the intermediate outcomes (such as condom use and STIs) and (3) assess the association between HIV/STIs and the intervention.ResultsBy July 2008, the intervention contacted 83% of the estimated HR-MSM/TG population monthly and 16% were attending the STI clinic monthly. HR-MSM/TG exposed to the intervention were significantly more likely to use condom consistently with a regular male partner (adjusted OR 4.62, 95% CI 1.40 to 15.22). Consistent condom use with all types of male partners increased significantly in survey Round 2 compared with Round 1. The proportion of HR-MSM/TG who tested positive for HIV-1 antibodies was similar in both rounds (15.5% in Round 1 vs 17.3% in Round 2, p=0.52).ConclusionThe Avahan intervention achieved a good population coverage, and delivered high-intensity peer and STI clinical services in Andhra Pradesh in the highly mobile target population of HR-MSM/TG; this also resulted in positive behavioural outcomes including increased condom use. However, the high prevalence of HIV in this group is an important public health priority.

Background: Maternal and child under nutrition remain extensive in low and middle-income population groups. Safe delivery practices and adequate nutrition during infancy is essential to ensure health, growth, and development of a child. Early under nutrition has a long-lasting effect on physical and cognitive growth. So it is essential to assess and promote the healthy child feeding & caring practices in the vulnerable groups.Methods: Community-based cross-sectional study was conducted to enrol 160 mothers of infants by probability proportional to size (PPS) sampling procedure for 5 months in the field practicing areas of GSL Medical College. Primary data was collected through a validated questionnaire with variables of socio-demography, intra-natal, and infant feeding practices. Secondary data was obtained from MCP cards. The analysis was done using SPSS trial version 18, results were expressed as percentages and proportions and Chi-square test was used to assess the association.Results: Majorities (90%) of the deliveries are institutional and the proportion of low birth weight was found to be 12.5%. Breastfeeding was initiated within 1st hour after delivery among 75.6% infants and 79.1% of the infants of 6-11m were reportedly exclusively breast fed. Working status and literacy status of mother are significantly associated with infant feeding practices.Conclusions: In spite of many programmes targeted for promoting safe intra natal and infant feeding practices this study finds a relatively high proportion of faulty practices prevalent in rural areas.

The study aimed to assess the impact of Avahan intervention program on risk behaviors. Knowledge of HIV/STIs and their prevalence among self-identified men who have sex with men (MSM) in four select districts of Andhra Pradesh, India, covers about 1600 respondents in each of the two rounds. The response rates of MSM in R1 and R2 were about 70%. Higher numbers of MSM in R2 had literacy level of ≥10th class, were either students, self-employed/business men and belonged to 20-24 years. Higher proportion of MSM in R2 reportedly had knowledge of HIV and its prevention, at least two signs/symptoms of STIs in men. Significantly higher numbers of MSM in R2 were exposed to programme interventions and consistent condom users. HIV prevalence declined significantly in one district, increased in one and remained similar in two districts. The prevalence of STIs decreased significantly in two districts, while remained similar in the other.