Assessment of the scale, coverage and outcomes of the Avahan HIV prevention program for female sex workers in Tamil Nadu, India: is there evidence of an effect?

Abstract

BackgroundAvahan, the India AIDS Initiative, a large-scale HIV prevention program, using peer-mediated approaches and STI services, was implemented for high-risk groups for HIV in six states in India. This paper describes the assessment of the program among female sex workers (FSWs) in the southern state of Tamil Nadu.MethodsAn analytical framework based on the Avahan impact evaluation design was used. Routine program monitoring data, two rounds of cross-sectional biological and behavioural surveys among FSWs in 2006 (Round 1) and 2009 (Round 2) and quality assessments of clinical services for sexually transmitted infections (STIs) were used to assess trends in coverage, condom use and prevalence of STIs, HIV and their association with program exposure. Logistic regression analysis was used to examine trends in intermediate outcomes and their associations with intervention exposure.ResultsThe Avahan program in Tamil Nadu was scaled up and achieved monthly reported coverage of 79% within four years of implementation. The cross-sectional survey data showed an increasing proportion of FSWs being reached by Avahan, 54% in Round 1 and 86% in Round 2 [AOR=4.7;p=0.001]. Quality assessments of STI clinical services showed consistent improvement in quality scores (3.0 in 2005 to 4.5 in 2008). Condom distribution by the program rose to cover all estimated commercial sex acts. Reported consistent condom use increased between Round 1 and Round 2 with occasional (72% to 93%; AOR=5.5; p=0.001) and regular clients (68% to 89%; AOR=4.3; p=0.001) while reactive syphilis serology declined significantly (9.7% to 2.2% AOR=0.2; p=0.001). HIV prevalence remained stable at 6.1% between rounds. There was a strong association between Avahan exposure and consistent condom use with commercial clients; however no association was seen with declines in STIs.ConclusionsThe Avahan program in Tamil Nadu achieved high coverage of FSWs, resulting in outcomes of improved condom use, declining syphilis and stabilizing HIV prevalence. These expected outcomes following the program logic model and declining HIV prevalence among general population groups suggest potential impact of high risk group interventions on HIV epidemic in Tamil Nadu.

The relationship between social, policy and physical venue features and social cohesion on condom use for pregnancy prevention among sex workers: a safer indoor work environment scale

“…However, these data are almost exclusively drawn from LMICs, such as Brazil, Dominican Republic and India. These are settings where there has been significant investment in resources to support these features among SW communities 24 31 35. Such investments have not been nearly as prevalent in higher income settings (including Canadian communities) and point to an area where evidence-informed investment in novel actions and supports for SW communities could be beneficial, from a health and safety perspective.…”

Global epidemiology of HIV among female sex workers: influence of structural determinants

“…Where FSWs report adequate access to condoms, sexual health care (eg, STI testing and contraceptives) and HIV care (eg, HIV testing, ART, and sex worker-tailored clinics), increases are noted in condom use and reduced condom breakage, 39, 40, 32, 44, 47, 67, 79, 95, 96, 97, 98, 99 and lower HIV prevalence. 100, 101 Condom coverage must include condom access (eg, free or subsidised condoms at the workplace, the ability to carry condoms while working, and contact with peer condom distribution), availability and affordability, linked to reduced HIV acquisition and transmission among FSWs 25, 30, 39, 40, 44, 47, 68, 70, 79, 82, 84, 87, 93, 95, 97, 98, 99, 102, 103, 104, 105, 106, 107…”

Path Analysis on the Factors Affecting People’s Behavior in HIV/AIDS Countermeasure on People Living with HIV/AIDS (PLWHA) in Solo Plus Peer Support Group, Surakarta

“…Providing information and knowledge regarding HIV and AIDS basic knowledge, how to open up to others about their medical status, ARV medication, and other science development that would help in improving PLWHA quality of life. Thilakavathi et al, (2011) mentions that there is not any relation between peer support and HIV/AIDS countermeasure behavior. This caused by the lack of peer support for example informative support.…”