Background
Districts | District population1 (thousands) | Estimated size of FSW in districts2 | Avahan intended coverage3 | History / type of intervention coverage* | IBBA sample | |
---|---|---|---|---|---|---|
R-I | R-II | |||||
Chennai | 2,219 | 17,392 | 17% | Minority- Transferred to NACO / Chennai AIDS Prevention Control Society in April 2008 | 410 | 397 |
Coimbatore | 2,176 | 2000 | 100% | Not first but solo | 410 | 400 |
Dharmapuri | 1,473 | 3000 | 100% | First and solo | 408 | 406 |
Dindigul | 968 | 1500 | 100% | Not first but solo | ||
Erode | 1,309 | 1500 | 100% | First and solo | ||
Krishnagiri* | - | 3500 | 100% | First and solo | ||
Madurai | 1,303 | 7000 | 100% | Not first but solo | 402 | 396 |
Namakkal | 759 | 1600 | 100% | Not first but solo | ||
Salem | 1,563 | 5100 | 100% | First and solo | 402 | 407 |
Thanjavur | 1,096 | 1500 | 100% | Not first but solo | ||
Theni | 553 | 1750 | 100% | Not first but solo | ||
Thiruvallur | 1,397 | 4000 | 100% | First and solo | ||
Vellore | 1,741 | 2500 | 100% | Not first but solo |
Methods
Analytical framework for assessment
Data sources
a. Avahan routine program monitoring data
b. Integrated Behavioural and Biological Assessments
c. STI clinical quality monitoring assessments
Operational definitions and assumptions
Data management and statistical methods
Results
Characteristics | Groups | RI (%) N=2032 | RII (%) N=2006 | P Value (Wald Chi-square) |
---|---|---|---|---|
Current age (years)
|
<25
| 13.6 | 9.9 | 0.033 |
25-29
| 22.0 | 19.1 | ||
30-34
| 22.3 | 20.8 | ||
35-39
| 25.8 | 27.6 | ||
40+
| 16.3 | 22.6 | ||
Mean
| 32.3 | 33.8 | ||
Literacy
|
Illiterate
| 57.7 | 41.8 | <0.001 |
Literate
| 42.3 | 58.2 | ||
Marital status
|
Unmarried
| 3.2 | 13.1 | <0.001 |
Married
| 72.5 | 57.5 | ||
Divorced/ separated / widowed
| 24.3 | 29.4 | ||
Additional income
|
None
| 41.8 | 22.5 | <0.001 |
Yes
| 58.2 | 77.5 | ||
Locality status
|
Yes
| 90.2 | 91.6 | 0.488 |
No
| 9.8 | 8.5 | ||
Sex work in city <2 years
|
Yes
| 19.8 | 10.9 | <0.001 |
No
| 80.1 | 89.1 | ||
Age at first sex
|
< 15
| 12.7 | 10.2 | 0.064 |
15+
| 87.1 | 89.8 | ||
Mean
| 17.8 | 17.8 | ||
Age when started sex work
|
<20
| 9.5 | 6.8 | 0.242 |
20-24
| 25.1 | 24.2 | ||
25-29
| 29.2 | 28.6 | ||
30+
| 36.3 | 40.4 | ||
Duration in sex work
|
0-1
| 17.3 | 11.5 | 0.005 |
2 to 4
| 42.3 | 38.5 | ||
4 to 9
| 22.3 | 26.7 | ||
10+
| 18.0 | 23.2 | ||
Usual place of solicitation/ Typology of sex work*
|
Non-street based
| 8.7 | 4.5 | 0.049 |
Street
| 91.3 | 95.5 | ||
Usual place of entertainment
|
Home
| 66.2 | 71.6 | 0.235 |
Brothel/ lodge
| 20.8 | 17.9 | ||
Street
| 13.0 | 10.5 | ||
Clients per week
|
0 to 4
| 36.0 | 34.9 | 0.112 |
5 to 9
| 44.5 | 49.7 | ||
10+
| 19.5 | 15.6 | ||
Mean volume of clients
| 6.5 | 5.8 | ||
Regular partner
|
Yes
| 76.8 | 75.9 | 0.769 |
No
| 23.3 | 24.1 |
Adequacy of Avahan program coverage
Scale of coverage
Intensity of coverage
Condom distribution, need and availability
Quality of coverage
Increase in condom use among FSWs
IBBA R1 N=2032 | IBBA R2 N=2006 | Crude OR (95% CI) | Adjusted OR (95% CI) | P value (Wald test) | |
---|---|---|---|---|---|
No reported unprotected sex with commercial clients
| 66.7 | 87.4 | 3.4 (2.6 – 4.6) | 3.8 (2.8 – 5.2) | < 0.001 |
Condom use last sex act occasional clients
| 92.8 | 98.1 | 4.0 (2.3 - 7.0) | 5.2 (2.9 - 9.5) | < 0.001 |
"Every time" condom use with occasional clients
| 72.5 | 93.1 | 5.1 (3.6 - 7.3) | 5.5 (3.9 - 7.9) | < 0.001 |
Condom use last sex act regular client
| 90.5 | 96.1 | 2.5 (1.7 - 3.9) | 3.0 (1.9 - 5.0) | < 0.001 |
"Every time" condom use with regular clients
| 68.3 | 89.1 | 3.8 (2.8 - 5.1) | 4.3 (3.1 - 5.9) | < 0.001 |
Last time condom use with regular partner
| 25.9 | 21.7 | 0.8 (0.5 – 1.2) | 0.5 (0.4 - 0.8) | 0.004 |
"Every time" condom use with regular partners
| 11.5 | 16.6 | 1.5 (0.9 – 2.5) | 0.9 (0.6 - 1.5) | 0.795 |
HIV prevalence
| 6.1 | 6.1 | 1.0 (0.6 - 1.7) | 0.6 (0.4 – 1.0) | 0.07 |
Syphilis infection
| 9.7 | 2.2 | 0.2 (0.1 - 0.3) | 0.2 (0.1 - 0.3) | < 0.001 |
High-titre syphilis
| 1.1 | 0.6 | 0.6 (0.2 - 1.9) | 0.6 (0.2 - 1.9) | 0.39 |
Chlamydia infection
| 2 | 1.4 | 0.7 (0.3 - 1.4) | 0.7 (0.4 - 1.5) | 0.37 |
Gonorrhoea infection
| 0.5 | 0.2 | 0.3 (0.1 - 1.5) | 0.5 (0.1 - 1.9) | 0.28 |
Reduction in STIs and new HIV infections
IBBA R1 N=2032 | IBBA R2 N=2006 | Crude OR (95% CI) | Adjusted OR (95% CI) | P value (wald chi-square test) | |
---|---|---|---|---|---|
HIV prevalence | |||||
Chennai
| 2.2 | 2.4 | 1.1 (.33 - 3.5) | 1.9 (.52-7.5) | 0.31 |
Coimbatore
| 6.3 | 6.3 | 1.0 (.43 - 2.3) | 1.2 (.54-2.8) | 0.62 |
Dharmapuri-Krishnagiri
| 12.4 | 8.8 | 0.68 (0.33 –1.4) | 0.42 (0.18 -0.95) | <0.05 |
Madurai
| 4.3 | 8.3 | 2.0 (0.75 - 5.5) | 1.8 (0.68-4.8) | 0.23 |
Salem
| 12.5 | 6.7 | 0.50 (0.25 - 1.0) | 0.78 (0.38-1.6) | 0.52 |
Syphilis prevalence
| |||||
Chennai
| 11.3 | 0.82 | 0.06 (.02 - 0.19) | 0.05 (.01-.19) | <0.001 |
Coimbatore
| 11.9 | 0.37 | 0.03 (.01 -. 09) | 0.03 (.01-.13) | <0.001 |
Dharmapuri-Krishnagiri
| 10.7 | 4.2 | 0.37 (0.17 -0.81) | 0.31 (0.11 –0.85) | <0.05 |
Madurai
| 11.1 | 2.4 | 0.19 (0.06 - 0.66) | 0.11 (0.02-0.47) | <0.01 |
Salem
| 7.5 | 3.1 | 0.39 (0.15 - 1.0) | 0.38 (0.11-1.2) | 0.12 |
Association of Avahan exposure with change in condom use and STI prevalence
Condom use | Received any one service | Crude OR | Adjusted OR | P value |
---|---|---|---|---|
(95% CI) | (95% CI) | |||
(Wald test Adjusted OR) | ||||
Consistent condom use with occasional clients
|
78.30%
|
2.085**
|
1.822
|
p<0.001
|
(1.601-2.715) | (1.350-2.625) | |||
Consistent condom use with regular clients
|
80.30%
|
2.258**
|
2.282
|
p<0.001
|
(1.770-2.880) | (1.781-2.923) | |||
Consistent condom use with regular partner
|
13.10%
|
3.144**
|
2.005
|
0.002
|
(1.913-5.165) | (1.313-3.217) | |||
Zero-unprotected sex
|
81.40%
|
1.929**
|
1.997
|
p<0.001
|
(1.472-2.529) | 1.503-2.652 | |||
STI prevalence
| ||||
Any STI (NG, CT or High-titre syphilis)
|
2.20%
|
0.548
|
0.644
|
0.165
|
(0.312-0.965) | (0.345-1.199) |