Community-based Prevention Leads to an Increase in Condom Use and a Reduction in Sexually Transmitted Infections (STIs) among Men Who Have Sex with Men (MSM) and Female Sex Workers (FSW)

Published in BMC Public Health (10:497), this article explores the International HIV/AIDS Alliance's Frontiers Prevention Project (FPP), which was a community-based HIV prevention initiative designed to reduce risk-taking behaviours and sexually transmitted infection (STI) incidence, thereby resulting in a lower HIV incidence, geared towards female sex workers (FSW), men who have sex with men (MSM), injection drug users (IDU), and people with HIV (PWH) in the state of Andhra Pradesh (AP), India. This paper reports the overall changes in behaviour and STI outcomes between 2003-4 and 2007 and also describes the changes attributed to the FPP.

The evaluation used 2 cross-sectional surveys among MSM and FSW at 24 sites in AP. Surveys were implemented using a similar methodology. Univariate analyses were conducted by comparing means: baseline vs. 4-year follow-up and FPP vs. non-FPP. For both MSM and FSW, random and fixed-effects logit regression models at the site level were estimated for condom use with last partner, syphilis sero-positivity and herpes simples virus type 2 (HSV 2) sero-positivity. In addition, researchers estimated models for condom use with regular partner (FSW) and for condom use with last female partner (MSM).

The intervention was implemented by 14 NGOs at 26 sites in 9 districts across the Rayalseema and Telengana regions of AP. By April 2007, 8,757 FSW, 5,597 MSM and transgender individuals, 4,730 PWH, and 350 IDU were registered and were receiving health-related services regularly. Also, 6,328 FSW, 3,136 MSM, and 2,363 PWH had been given STI treatment; in addition, 3,161 FSW, 2,086 MSM and 481 PWH received treatment for asymptomatic gonococcus and/or chlamydia infections.

Among MSM, fixed-effects analysis revealed that FPP was positively correlated with the probability of condom use with last female sexual partner and negatively correlated with the individual probability of sero-positivity to syphilis and HSV 2. Among FSW, the FPP intervention was significantly correlated with increased condom use with regular partners and with lower probability of STI sero-positivity.

The authors conclude that: "The FPP-specific results here strongly suggest that there are important benefits associated with approaches that engage communities in the design and implementation of prevention interventions for their communities. The overall results (the time trends) documents important changes in sexual behaviours and reductions in STI prevalences that accompany the scale-up of community-wide prevention programs that achieve high levels of coverage. These changes are also accompanied by important reductions in HIV prevalence during the same period..."