Articles tagged as "Gender"

Global programmes and local discrimination: the inadequate support of women living with HIV in West Papua and its impact on PMTCT

(Not) getting political: indigenous women and preventing mother-to-child transmission of HIV in West Papua.

Munro J, McIntyre L. Cult Health Sex. 2015 Aug 25:1-16. [Epub ahead of print]

This paper builds on critiques that call for a more nuanced and contextualised understanding of conditions that affect HIV prevention by looking at West Papuan women's experiences of prevention of mother-to-child transmission services. Drawing on qualitative, ethnographic research with indigenous women and health workers, the paper demonstrates that women experience poor-quality HIV education and counselling, and that indigenous practices and concerns are largely not addressed by HIV services. We attribute this to a combination of national anti-indigenous and anti-separatist political concerns with donor-led interventions that result in limited localisation and reduced effectiveness of HIV prevention measures. In West Papua, services are needed that enhance cooperation and shared commitment, and that acknowledge and work to overcome existing inequalities, ethnic tensions and discrimination in the health system. Beyond Indonesia, donor-led HIV programmes and interventions need to balance avoidance of politically sensitive issues with complicity in perpetuating health inequalities. Translating global health interventions and donor priorities into locally compelling HIV prevention activities involves more than navigating local cultural and religious beliefs. Programme development and implementation strategies that entail confronting structural questions as well as social hierarchies, cleavages and silences are needed to render more effective services; strategies that are inherently political.

Abstract access 

Editor’s notes: West Papua is witnessing one of the fastest growing HIV epidemics in the world, especially among its indigenous populations (prevalence is 2.9%). Translation of HIV prevention programmes to the local situation is complicated by unequal, discriminatory and racialised relationships between the Indonesian government and indigenous Papuans. This is made worse by the exclusion of indigenous Papuans from health services management and governance. Tensions between Papuan HIV NGO staff and Indonesian healthcare workers create obstacles to delivery of health promotion and HIV testing. International HIV agency funders and representatives ignore these tensions for political reasons.

Indigenous people are stigmatised as ‘hypersexual’ and ‘wild’ which causes poor service design and delivery of prevention of mother-to-child transmission. Because of racial stereotypes, Papuan women receive inadequate education and support in the healthcare system. Many women do not fully understand prevention of mother-to-child transmission, antiretroviral therapy, infant feeding choices, and delivery choices. Women are uncomfortable with healthcare workers and do not trust their advice, which is inadequate and does not consider peoples’ views. Women often drop out of HIV care after testing. Women were very isolated, with their partners often working far away. Women disclose their HIV status to very few people even with their families and usually do not know other positive mothers. International donor agencies need to engage with existing local political tensions that result in poor quality treatment of service users. HIV prevention programmes can exacerbate local inequalities if these are not recognised in HIV policy and service provision. 

Asia
Indonesia
  • share
1 comments.

Risks and experiences of transgender women in Lebanon

Forms of safety and their impact on health: an exploration of HIV/AIDS-related risk and resilience among trans women in Lebanon.

Kaplan RL, Wagner GJ, Nehme S, Aunon F, Khouri D, Mokhbat J. Health Care Women Int. 2015 Aug;36(8):917-35. doi: 10.1080/07399332.2014.896012. Epub 2014 Apr 9.

Using minority stress theory, the authors investigated risk behaviors of transgender women (trans women) in Lebanon. Using semistructured interviews, the authors explored six areas: relationships with family and friends; openness about gender and sexuality; experiences with stigma; sexual behavior; attitudes and behaviors regarding HIV testing; and perceived HIV-related norms among transgender peers. Participants voiced the importance of different forms of safety: social/emotional, physical, sexual, and financial. Strategies for obtaining safety were negotiated differently depending on social, behavioral, and structural factors in the environment. In this article, we provide study findings from the perspectives of trans women, their exposure to stigma, and the necessary navigation of environments characterized by transphobia

Abstract access                     

Editor’s notes: Transgender women have a high risk of HIV acquisition / transmission, due to experiences of stigma, discrimination and transphobia. However there is a dearth of studies on transgender women from North Africa or the Middle East.

Interviews with ten trans-women from Beirut were included in this qualitative study. The study findings highlight the extreme vulnerability of transgender women to stigma, discrimination, violence, mental ill-health, financial insecurity and HIV and STI risk. Social support and emotional security from family, friends, and the transgender community was frequently lacking. Mental ill-health (9/10) and suicide ideation / attempts was high (5/10). Stigma and discrimination by peers and teachers at school, and at the work-place were common. Many also reported verbal, physical and sexual abuse and violence in public spaces. Many participants were selling anal sex to reduce financial insecurity. Money was a key motivator for condom non-use. 

Programmes with transgender women should be multi-component to reflect the complexity of their needs. They should include HIV prevention, advocacy of laws to prevent discrimination, employment opportunities to enable economic independence, and treatment and support for mental ill-health.

Asia
Lebanon
  • share
0 comments.

Female migrants may be more at risk of HIV in Kazakhstan

Migrant workers in Kazakhstan: gender differences in HIV knowledge and sexual risk behaviors.

Zhussupov B, McNutt LA, Gilbert L, Terlikbayeva A, El-Bassel N. AIDS Behav. 2015 Jul;19(7):1298-304. doi: 10.1007/s10461-014-0914-9. AIDS Behav. 2015 Jul;19(7):1298-304. doi: 10.1007/s10461-014-0914-9.

This study compares sexual risk behaviors among male and female migrant market vendors in Almaty, Kazakhstan. From the Barakholka Market, 209 male and 213 female market vendors were randomly recruited. Self-reported data were collected through standardized face-to-face interviews. Dry blood spot was used as specimen for syphilis testing. Propensity score stratification was used to estimate adjusted prevalence or rate ratios by gender. Compared to male migrant workers, females had lower HIV knowledge and were less likely to have multiple sexual partners. There was no evidence of a gender difference for prevalence of syphilis, condom use with unsteady partners, and safe sex communication between couples. Associations between mobility patterns and engagement in multiple sexual partnerships were stronger among women than men. Efforts should be made to mitigate the gender differential in HIV knowledge among migrants, especially women. Such efforts need to be implemented in both home and host countries.

Abstract  Full-text [free] access

Editor’s notes: Migration and mobility have been shown to be contributing factors to increased risk of HIV around the world. This is due to a number of factors, but most common are lack of social support, little or no access to services, and language and legal issues. Depending on socio-economic contexts, women and men will often leave their homes for periods of time to trade or work in agriculture or construction in other domestic or international locations. This paper examines the relationship between gender and sexual risk behaviours in Almaty, the financial capital of Kazakhstan. Kazakhstan, and Almaty in particular, is a hub for trade migrants from all over Central Asia. The paper notes the lack of accurate statistics for gender distribution among migrants, but estimates indicate ahigh proportion are women. Overall, the study found that the migrant population surveyed was more likely to have multiple sexual partners than the general population, although the data used as the general population comparison was somewhat dated. Women were less likely to be educated about HIV than men, and while also less likely to have multiple sexual partners than men, the partnerships they did have were closely linked to their mobility and the time spent at market. This study provides important insights into the HIV and sexual risk contexts in this region, and highlights the importance of continuing research there in order to inform HIV prevention and care programmes which can better support population needs. 

Asia
Kazakhstan
  • share
0 comments.

DMPA contraception users more likely than NET-EN users to acquire HIV in South Africa

Risk of HIV-1 acquisition among women who use different types of injectable progestin contraception in South Africa: a prospective cohort study.

Noguchi LM, Richardson BA, Baeten JM, Hillier SL, Balkus JE, Chirenje ZM, Bunge K, Ramjee G, Nair G, Palanee-Phillips T, Selepe P, van der Straten A, Parikh UM, Gomez K, Piper JM, Watts DH, Marrazzo JM. Lancet HIV. 2015 Jul 1;2(7):e279-e287.

Background: Several observational studies have reported that HIV-1 acquisition seems to be higher in women who use depot medroxyprogesterone acetate (DMPA) than in those who do not use hormonal contraception. We aimed to assess whether two injectable progestin-only contraceptives, DMPA and norethisterone enanthate (NET-EN), confer different risks of HIV-1 acquisition.

Methods: We included data from South African women who used injectable contraception while participating in the VOICE study, a multisite, randomised, placebo-controlled trial that investigated the safety and efficacy of three formulations of tenofovir for prevention of HIV-1 infection in women between Sept 9, 2009, and Aug 13, 2012. Women were assessed monthly for contraceptive use and incident infection. We estimated the difference in incident HIV-1 infection between DMPA and NET-EN users by Cox proportional hazards regression analyses in this prospective cohort. The VOICE trial is registered with ClinicalTrials.gov, NCT00705679.

Findings: 3141 South African women using injectable contraception were included in the present analysis: 1788 (56.9%) solely used DMPA, 1097 (34.9%) solely used NET-EN, and 256 (8.2%) used both injectable types at different times during follow-up. During 2733.7 person-years of follow-up, 207 incident HIV-1 infections occurred (incidence 7.57 per 100 person-years, 95% CI 6.61-8.68). Risk of HIV-1 acquisition was higher among DMPA users (incidence 8.62 per 100 person-years, 95% CI 7.35-10.11) than among NET-EN users (5.67 per 100 person-years, 4.35-7.38; hazard ratio 1.53, 95% CI 1.12-2.08; p=0.007). This association persisted when adjusted for potential confounding variables (adjusted hazard ratio [aHR] 1.41, 95% CI 1.06-1.89; p=0.02). Among women seropositive for herpes simplex virus type 2 (HSV-2) at enrolment, the aHR was 2.02 (95% CI 1.26-3.24) compared with 1.09 (0.78-1.52) for HSV-2-seronegative women (pinteraction=0.07).

Interpretation: Although moderate associations in observational analyses should be interpreted with caution, these findings suggest that NET-EN might be an alternative injectable drug with a lower HIV risk than DMPA in high HIV-1 incidence settings where NET-EN is available.

Abstract access

Editor’s notes: In eastern and southern Africa, injectable methods are the most popular contraceptives. But evidence that the injectable progestin depot medroxyprogesterone acetate (DMPA) is associated with an increased risk of HIV-1 acquisition means that alternative injectable contraceptive methods are necessary. This large prospective study used data from the VOICE HIV prevention trial, analysing data from South Africa on 3141 women who had used one of two progestin methods for contraception. HIV incidence was high in the population (7.57/100 person-years overall), and participants who used DMPA were 40% more likely to become HIV positive than women who used norethisterone enanthate (NET-EN) after adjustment for demographic and behavioural confounding variables. Strengths of this study include the comparability across women using progestin methods, and its frequent follow up visits to assess HIV status, contraception use, sexual behaviour and the presence of reproductive tract infections. The results suggest NET-EN might be an alternative injectable contraceptive with a lower risk for HIV-1 acquisition than DMPA.

Africa
South Africa
  • share
0 comments.

Community health workers can improve emotional wellbeing of mothers in a high HIV prevalence setting

Alcohol use, partner violence, and depression: a cluster randomized controlled trial among urban South African mothers over 3 years.

Rotheram-Borus MJ, Tomlinson M, Roux IL, Stein JA. Am J Prev Med. 2015 Jul 28. pii: S0749-3797(15)00225-1. doi: 10.1016/j.amepre.2015.05.004. [Epub ahead of print]

Introduction: Pregnant South African women with histories of drinking alcohol, abuse by violent partners, depression, and living with HIV are likely to have their post-birth trajectories over 36 months significantly influenced by these risks.

Design: All pregnant women in 24 Cape Town neighborhoods were recruited into a cluster RCT by neighborhood to either: (1) a standard care condition (n=12 neighborhoods, n=594 mothers); or (2) a home-visiting intervention condition (n=12 neighborhoods, n=644 mothers).

Setting/participants: Pregnant women residing in urban, low-income neighborhoods in Cape Town, South Africa.

Intervention: Home visiting included prenatal and postnatal visits by community health workers (Mentor Mothers) focusing on general maternal and child health, HIV/tuberculosis, alcohol use, and nutrition.

Main outcome measures: Mothers were assessed in pregnancy and at 18 and 36 months post birth: 80.6% of mothers completed all assessments between 2009 and 2014 and were included in these analyses performed in 2014. Longitudinal structural equation modeling examined alcohol use, partner violence, and depression at the baseline and 18-month interviews as predictors of maternal outcomes at 36 months post birth.

Results: Relative to standard care, intervention mothers were significantly less likely to report depressive symptoms and more positive quality of life at 36 months. Alcohol use was significantly related to use over time, but was also related to depression and HIV status at each assessment and partner violence at 36 months.

Conclusions: Alcohol, partner violence, and depression are significantly related over time. A home-visiting intervention improved the emotional health of low-income mothers even when depression was not initially targeted.

Abstract  Full-text [free] access

Editor’s notes: This study evaluates the use of community health workers (CHW) to implement a programme to improve maternal wellbeing among low-income mothers in Cape Town, South Africa from pregnancy until 36 months after birth. This is a setting with high prevalence of HIV (about 30% of pregnant women are HIV positive in the Western Cape), and the programme followed a behaviour-change model focused on alcohol and HIV (but not intimate partner violence [IPV] or depression). The programme was associated with improved maternal emotional health at 36 months. However, there was relatively little change in alcohol use or IPV.  Overall, the study underlines the inter-relationships between alcohol use, intimate partner violence, HIV and depression. Further, it suggests that future programmes should train CHWs to expand their activities to depression and IPV as well as HIV, and alcohol.

Africa
South Africa
  • share
0 comments.

Valuable lessons can be learned from repeat PEP use in female sex workers

Repeat use of post-exposure prophylaxis for HIV among Nairobi-based female sex workers following sexual exposure.

Izulla P, McKinnon LR, Munyao J, Ireri N, Nagelkerke N, Gakii G, Gelmon L, Nangami M, Kaul R, Kimani J. AIDS Behav. 2015 May 13. [Epub ahead of print]

As ART-based prevention becomes available, effectively targeting these interventions to key populations such as female sex workers (FSW) will be critical. In this study we analyze patterns of repeated post-exposure prophylaxis (PEP) access in the context of a large FSW program in Nairobi. During close to 6000 person-years of follow-up, 20% of participants (n = 1119) requested PEP at least once and 3.7% requested PEP more than once. Repeat PEP users were younger, had a higher casual partner volume, and were more likely to use condoms with casual and regular partners, have a regular partner, and test for HIV prior to enrolment. Barriers to PEP included stigma, side effects, and lack of knowledge, suggesting repeated promotion may be required for higher rates of uptake. A small subset of FSW, potentially those with heightened risk perception, showed a higher frequency of PEP use; these individuals may be most amenable to rollout of pre-exposure prophylaxis.

Abstract access

Editor’s notes: Antiretroviral therapy based HIV prevention is growing, particularly the use of Pre-exposure prophylaxis (PrEP) which is effective when adherence is high. However, given the challenges associated with adherence, other options are essential. Post-exposure prophylaxis (PEP) following sexual exposure to HIV is an HIV prevention strategy that could be of benefit in some situations, and is recommended for risky exposure settings. This paper describes PEP use among sex workers in Nairobi. In particular, this paper examined repeat PEP use and the characteristics of female sex workers returning for additional courses of PEP. Interestingly, repeat PEP users seemed to perceive that they were at increased risk of HIV and were also more aware of PEP as a prevention option. Individuals who did not use PEP knew little to nothing about it, were afraid of stigma from community members and health care providers, and were concerned about side effects which they knew about from people on HIV treatment. These are essential factors to take into account when developing an implementation programme for future programmes, and especially PrEP which can learn from the past but will undoubtedly forge new paths in HIV prevention implementation and programming. 

Africa
Kenya
  • share
0 comments.

The impact of cash transfers on orphans and other children made vulnerable by HIV

Effects of cash transfers on children's health and social protection in sub-Saharan Africa: differences in outcomes based on orphan status and household assets.

Crea TM, Reynolds AD, Sinha A, Eaton JW, Robertson LA, Mushati P, Dumba L, Mavise G, Makoni JC, Schumacher CM, Nyamukapa CA, Gregson S. BMC Public Health. 2015 May 28;15:511. doi: 10.1186/s12889-015-1857-4.

Background: Unconditional and conditional cash transfer programmes (UCT and CCT) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS (OVC). We address the gap in current understanding about the extent to which household-based cash transfers differentially impact individual children's outcomes, according to risk or protective factors such as orphan status and household assets.

Methods: Data were obtained from a cluster-randomised controlled trial in eastern Zimbabwe, with random assignment to three study arms - UCT, CCT or control. The sample included 5331 children ages 6-17 from 1697 households. Generalized linear mixed models were specified to predict OVC health vulnerability (child chronic illness and disability) and social protection (birth registration and 90% school attendance). Models included child-level risk factors (age, orphan status); household risk factors (adults with chronic illnesses and disabilities, greater household size); and household protective factors (including asset-holding). Interactions were systematically tested.

Results: Orphan status was associated with decreased likelihood for birth registration, and paternal orphans and children for whom both parents' survival status was unknown were less likely to attend school. In the UCT arm, paternal orphans fared better in likelihood of birth registration compared with non-paternal orphans. Effects of study arms on outcomes were not moderated by any other risk or protective factors. High household asset-holding was associated with decreased likelihood of child's chronic illness and increased birth registration and school attendance, but household assets did not moderate the effects of cash transfers on risk or protective factors.

Conclusion: Orphaned children are at higher risk for poor social protection outcomes even when cared for in family-based settings. UCT and CCT each produced direct effects on children's social protection which are not moderated by other child- and household-level risk factors, but orphans are less likely to attend school or obtain birth registration. The effects of UCT and CCT are not moderated by asset-holding, but greater household assets predict greater social protection outcomes. Intervention efforts need to focus on ameliorating the additional risk burden carried by orphaned children. These efforts might include caregiver education, and additional incentives based on efforts made specifically for orphaned children.

Abstract  Full-text [free] access

Editor’s notes: In sub-Saharan Africa, there is growing evidence on the impact of cash transfers on youth HIV risk, health outcomes of orphans and other children made vulnerable by HIV and on social protection outcomes such as school attendance. Using data from a cluster randomised controlled trial in Zimbabwe, the authors sought to understand the extent to which individual level children’s risk factors and household asset accumulation influence the effects of cash transfers on child health (chronic illness and disability) and child social protection (birth registration status and school attendance) outcomes.

There was no evidence to illustrate that the type of orphan status, maternal or paternal or both, was associated with child disability or chronic illness. There was some evidence that suggested that orphan status predicted social vulnerability, i.e., risk for not obtaining birth registration. However the receipt of an unconditional cash transfer buffered this risk for paternal orphans, suggesting birth registration being a gendered activity and that mothers of paternal orphans might use cash incentives to invest in the human capital of their children. Results also demonstrate that cash transfers, both unconditional and conditional, and household accumulation of assets have positive effects on social protection outcomes including birth registration and school attendance, separately. But the effect of cash transfers is not influenced by the amount of assets held by a household. Furthermore, in contrast to other studies, there is no evidence from these findings to illustrate that cash transfers have an effect on health outcomes. However, asset holding seems to have a weak, but positive effect on children’s chronic illness, but no effect on chronic disability. This suggests that households with some assets are able to use these assets to access health care services to treat chronic illness. Furthermore these households with greater assets may also experience better living conditions which perhaps contribute to better health outcomes.

Given the financial burden of HIV on households caring for orphan and vulnerable children, programme efforts for HIV prevention should focus on addressing this burden. This study contributes to the evidence base from other countries in sub-Saharan Africa.  Findings from Malawi and Kenya, for example, have illustrated that the provision of cash transfers to HIV affected households provide a substantial boost that is effective in improving outcomes among vulnerable children, in particular certain social protection outcomes, such as school attendance.

Africa
Zimbabwe
  • share
0 comments.

Good dads stay healthy!

" . . . I should maintain a healthy life now and not just live as I please . . . ": men's health and fatherhood in rural South Africa.

Hosegood V, Richter L, Clarke L. Am J Mens Health. 2015 May 25. pii: 1557988315586440. [Epub ahead of print]

This study examines the social context of men's health and health behaviors in rural KwaZulu-Natal, South Africa, particularly in relationship to fathering and fatherhood. Individual interviews and focus groups were conducted with 51 Zulu-speaking men. Three themes related to men's health emerged from the analysis of transcripts: (a) the interweaving of health status and health behaviors in descriptions of "good" and "bad" fathers, (b) the dominance of positive accounts of health and health status in men's own accounts, and (c) fathers' narratives of transformations and positive reinforcement in health behaviors. The study reveals the pervasiveness of an ideal of healthy fathers, one in which the health of men has practical and symbolic importance not only for men themselves but also for others in the family and community. The study also suggests that men hold in esteem fathers who manage to be involved with their biological children who are not coresident or who are playing a fathering role for nonbiological children (social fathers). In South Africa, men's health interventions have predominantly focused on issues related to HIV and sexual health. The new insights obtained from the perspective of men indicate that there is likely to be a positive response to health interventions that incorporate acknowledgment of, and support for, men's aspirations and lived experiences of social and biological fatherhood. Furthermore, the findings indicate the value of data on men's involvement in families for men's health research in sub-Saharan Africa.

Abstract access 

Editor’s notes: As the authors of this paper note, a lot of research has looked at men’s sexual and health-associated behaviour as risk factors for HIV infection of their partners and themselves. Far less attention has been paid to men’s family situation and how this, and how they view their family role, shapes their health behaviours. This paper begins to fill that gap. Using data from in-depth interviews and group discussions with 51 men in KwaZulu-Natal, South Africa, the authors describe how men view themselves as ‘fathers’ and how this affects what they do. Each of the men set out what this role means for how they behave and believe other fathers should behave. While the authors note that the sample would have been biased towards men happy to talk about being a father, the results are quite striking. The men frequently described the positive things they did for their children and wanted to do for their families. They claimed their own health behaviours to be exemplary. The men compared ‘good’ fathers with ‘bad’ fathers’, men who drank and were sexually promiscuous. All the respondents were ‘good’ fathers. Not one of the men disclosed their HIV-status during the interviews. The authors note that the men were much freer discussing diet, weight, smoking and alcohol than HIV. Given HIV-associated stigma and the negative stereotypes of promiscuous men spreading infection, it is hardly surprising that men constructed a positive identity through their narratives and distanced themselves from personal HIV-associated discussion. Tailored health messages which reinforce the behaviour of ‘good fathers’ are likely to have a greater impact on these men’s sexual behaviour than messages that aim to scare.

Africa
South Africa
  • share
0 comments.

HIV and sexuality curricula programmes that address gender or power are five times more effective than those that do not

The case for addressing gender and power in sexuality and HIV education: a comprehensive review of evaluation studies.

Haberland NA. Int Perspect Sex Reprod Health. 2015 Mar;41(1):31-42. doi: 10.1363/4103115.

Context: Curriculum-based sexuality and HIV education is a mainstay of interventions to prevent STIs, HIV and unintended pregnancy among young people. Evidence links traditional gender norms, unequal power in sexual relationships and intimate partner violence with negative sexual and reproductive health outcomes. However, little attention has been paid to analyzing whether addressing gender and power in sexuality education curricula is associated with better outcomes.

Methods: To explore whether the inclusion of content on gender and power matters for program efficacy, electronic and hand searches were conducted to identify rigorous sexuality and HIV education evaluations from developed and developing countries published between 1990 and 2012. Intervention and study design characteristics of the included interventions were disaggregated by whether they addressed issues of gender and power.

Results: Of the 22 interventions that met the inclusion criteria, 10 addressed gender or power, and 12 did not. The programs that addressed gender or power were five times as likely to be effective as those that did not; fully 80% of them were associated with a significantly lower rate of STIs or unintended pregnancy. In contrast, among the programs that did not address gender or power, only 17% had such an association.

Conclusions: Addressing gender and power should be considered a key characteristic of effective sexuality and HIV education programs.

Abstract  Full-text [free] access

Editor’s notes: Curriculum-based sexuality and HIV education plays a central role in the prevention of sexually transmitted infections (STI), HIV and unintended pregnancy among young people. This paper synthesizes current evidence from 22 rigorous evaluation studies that assessed the impacts of different curricula based programmes on HIV, STI or pregnancy risk. The nearly opposite outcomes of programmes that address gender and power compared to those that do not, was striking, with programmes that addressed gender or power being five times as likely to be effective as those that did not.

Several common characteristics of effective programmes were identified. In addition to having interactive and learner-centered pedagogical approaches, effective programmes tended to give explicit attention to gender or power in relationships. Effective programmes fostered critical thinking about how gender norms or inequalities in power manifest and operate and influence life, sexual relationships or health. The programmes also support participants to value themselves and recognize their ability to effect change in their life, relationship or community.

The review findings are consistent with broader theory and evidence that links gender, power and intimate partner violence with sexual and reproductive health outcomes, including HIV. The findings illustrate the value of addressing gender in sexual health programming, illustrating that this is not a luxury for programmes, but rather a critical component of successful programming. 

Africa, Northern America
  • share
0 comments.

Prevention services need to focus on newly-started sex workers in South India

Changes in HIV and syphilis prevalence among female sex workers from three serial crosssectional surveys in Karnataka state, South India. 

Isac S, Ramesh BM, Rajaram S, Washington R, Bradley JE, Reza-Paul S, Beattie TS, Alary M. BMJ Open. 2015 Mar 27;5(3):e007106. doi: 10.1136/bmjopen-2014-007106.

Objectives: This paper examined trends over time in condom use, and the prevalences of HIV and syphilis, among female sex workers (FSWs) in South India. 

Design: Data from three rounds of cross-sectional surveys were analysed, with HIV and high-titre syphilis prevalence as outcome variables. Multivariable analysis was applied to examine changes in prevalence over time. 

Setting: Five districts in Karnataka state, India. 

Participants: 7015 FSWs were interviewed over three rounds of surveys (round 1=2277; round 2=2387 and round 3=2351). Women who reported selling sex in exchange for money or gifts in the past month, and aged between 18 and 49 years, were included. 

Interventions: The surveys were conducted to monitor a targeted HIV prevention programme during 2004-2012. The main interventions included peer-led community outreach, services for the treatment and prevention of sexually transmitted infections, and empowering FSWs through community mobilisation.  

Results: HIV prevalence declined significantly from rounds 1 to 3, from 19.6% to 10.8%

(adjusted OR (AOR)=0.48, p<0.001); high-titre syphilis prevalence declined from 5.9% to 2.4% (AOR=0.50, p<0.001). Reductions were observed in most substrata of FSWs, although reductions among new sex workers, and those soliciting clients using mobile phones or from home, were not statistically significant. Condom use 'always' with occasional clients increased from 73% to 91% (AOR=1.9, p<0.001), with repeat clients from 52% to 86% (AOR=5.0, p<0.001) and with regular partners from 12% to 30% (AOR=4.2, p<0.001). Increased condom use was associated with exposure to the programme. However, condom use with regular partners remained low. 

Conclusions: The prevalences of HIV infection and high-titre syphilis among FSWs have steadily declined with increased condom use. Further reductions in prevalence will require intensification of prevention efforts for new FSWs and those soliciting clients using mobile phones or from home, as well as increasing condom use in the context of regular partnerships.

Abstract   Full-text [free] access

Editor’s notes: The HIV epidemic in India has remained largely concentrated in key populations, particularly among female sex workers. One of the most high profile HIV prevention efforts in India has been the Avahan AIDS initiative, which in Karnataka State has reached over 60 000 female sex workers since 2004. The initiative involves peer-mediated safer sex communications, intensive management of sexually transmitted infections, and facilitation of safer sex environments. In the final round of a repeat cross-sectional survey conducted between 2004 and 2011, investigators found that nearly all female sex workers were contacted by a peer educator, had seen a condom demonstration, or had visited a programme clinic. In that time, the prevalence of HIV fell from 19.6% to 10.8% (P<0.01) and the prevalence of new syphilis infections fell from 5.9% to 2.4% (P<0.01). However, HIV prevalence among new female sex workers remained high, reflecting the challenges in reaching women starting sex work before they become HIV positive. The programme is notable for its responsiveness to the HIV prevention needs of female sex workers and the current paper confirms continued increases in condom use and preventive services. However, with the changing nature of sex work, current challenges include preventive services for women soliciting sex through mobile phones, and reaching sex workers soon after they start sex work. 

Asia
India
  • share
0 comments.