Decline in unprotected sex & sexually transmitted infections (STIs) among female sex workers from repeated behavioural & biological surveys in three southern States of India

Background & objectives: Since 2003, Avahan the India AIDS Initiative, has been working with female sex workers (FSW) in Andhra Pradesh (AP), Maharashtra (MH) and Tamil Nadu (TN) using a package of preventive services. Two rounds (R1 and R2) of Integrated Behavioural and Biological Assessment (IBBA) surveys were done to measure changes in condom use and prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in the three Southern States. Methods: Two rounds of bio-behavioural surveys were conducted among FSWs in selected districts of AP, MH and TN during 2005-2007 and 2009, respectively. Survey districts and methodology were consistent across rounds. Participants were selected through two stage conventional cluster sampling from fixed sites and time-location cluster sampling from floating groups. Information on sexual behaviour was collected by face-to-face interview. Participants provided urine and blood samples for testing of STIs. Results: At aggregate level, condom use at every sex act with occasional and regular clients, taken as a whole, increased from 66.8 per cent in R1 to 85.2 per cent in R2 (AOR 3.5, P<0.001). Levels of HIV and syphilis declined from 14.1 to 11.9 per cent (AOR 0.9, P<0.5) and 10.8 to 5.0 per cent (AOR 0.4, P<0.001), respectively. Odds of using condom among FSWs who availed Avahan services was significantly more than those who did not (P<0.01). Interpretation & conclusions: An increase in consistent condom use along with decrease in STIs was observed among FSWs. The increase in safer sexual practices was more among those exposed to Avahan interventions.