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A dose-response relationship between exposure to a large-scale HIV preventive intervention and consistent condom use with different sexual partners of female sex workers in southern India.
BMC Public Health. 2011 Dec 29; 11 Suppl 6:S8.BP

Abstract

BACKGROUND

The Avahan Initiative, a large-scale HIV preventive intervention targeted to high-risk populations including female sex workers (FSWs), was initiated in 2003 in six high-prevalence states in India, including Karnataka. This study assessed if intervention exposure was associated with condom use with FSWs' sexual partners, including a dose-response relationship.

METHODS

Data were from a cross-sectional study (2006-07) of 775 FSWs in three districts in Karnataka. Survey methods accounted for the complex cluster sampling design. Bivariate and multivariable logistic regression was used to separately model the relationships between each of five intervention exposure variables and five outcomes for consistent condom use (CCU= always versus frequently/sometimes/never) with different sex partners, including with: all clients; occasional clients; most recent repeat client; most recent non-paying partner; and the husband or cohabiting partner. Linear tests for trends were conducted for three continuous intervention exposure variables.

RESULTS

FSWs reported highest CCU with all clients (81.7%); CCU was lowest with FSWs' husband or cohabiting partner (9.6%). In multivariable analysis, the odds of CCU with all clients and with occasional clients were 6.3-fold [95% confidence intervals, CIs: 2.8-14.5] and 2.3-fold [95% CIs: 1.4-4.1] higher among FSWs contacted by intervention staff and 4.9-fold [95% CIs: 2.6-9.3] and 2.3-fold [95% CIs: 1.3-4.1] higher among those who ever observed a condom demonstration by staff, respectively, compared to those who had not. A significant dose-response relationship existed between each of these CCU outcomes and increased duration since first contacted by staff (P=0.001; P=0.006) and numbers of condom demonstrations witnessed (P=0.004; P=0.026); a dose-response relationship was also observed between condom use with all clients and number of times contacted by staff (P=0.047). Intervention exposure was not associated with higher odds of CCU with the most recent repeat client, most recent non-paying partner or with the husband or cohabiting partner.

CONCLUSION

Study findings suggest that exposure to a large-scale HIV intervention for FSWs was associated with increased CCU with commercial clients. Moreover, there were dose-response relationships between CCU with clients and increased duration since first contacted by staff, times contacted by staff and number of condom demonstrations. Additional program effort is required to increase condom use with non-commercial partners.

Authors+Show Affiliations

Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada. kdeering@cfenet.ubc.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22375863

Citation

Deering, Kathleen N., et al. "A Dose-response Relationship Between Exposure to a Large-scale HIV Preventive Intervention and Consistent Condom Use With Different Sexual Partners of Female Sex Workers in Southern India." BMC Public Health, vol. 11 Suppl 6, 2011, pp. S8.
Deering KN, Boily MC, Lowndes CM, et al. A dose-response relationship between exposure to a large-scale HIV preventive intervention and consistent condom use with different sexual partners of female sex workers in southern India. BMC Public Health. 2011;11 Suppl 6:S8.
Deering, K. N., Boily, M. C., Lowndes, C. M., Shoveller, J., Tyndall, M. W., Vickerman, P., Bradley, J., Gurav, K., Pickles, M., Moses, S., Ramesh, B. M., Washington, R., Rajaram, S., & Alary, M. (2011). A dose-response relationship between exposure to a large-scale HIV preventive intervention and consistent condom use with different sexual partners of female sex workers in southern India. BMC Public Health, 11 Suppl 6, S8. https://doi.org/10.1186/1471-2458-11-S6-S8
Deering KN, et al. A Dose-response Relationship Between Exposure to a Large-scale HIV Preventive Intervention and Consistent Condom Use With Different Sexual Partners of Female Sex Workers in Southern India. BMC Public Health. 2011 Dec 29;11 Suppl 6:S8. PubMed PMID: 22375863.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A dose-response relationship between exposure to a large-scale HIV preventive intervention and consistent condom use with different sexual partners of female sex workers in southern India. AU - Deering,Kathleen N, AU - Boily,Marie-Claude, AU - Lowndes,Catherine M, AU - Shoveller,Jean, AU - Tyndall,Mark W, AU - Vickerman,Peter, AU - Bradley,Jan, AU - Gurav,Kaveri, AU - Pickles,Michael, AU - Moses,Stephen, AU - Ramesh,Banadakoppa M, AU - Washington,Reynold, AU - Rajaram,S, AU - Alary,Michel, Y1 - 2011/12/29/ PY - 2012/3/2/entrez PY - 2012/3/2/pubmed PY - 2012/11/9/medline SP - S8 EP - S8 JF - BMC public health JO - BMC Public Health VL - 11 Suppl 6 N2 - BACKGROUND: The Avahan Initiative, a large-scale HIV preventive intervention targeted to high-risk populations including female sex workers (FSWs), was initiated in 2003 in six high-prevalence states in India, including Karnataka. This study assessed if intervention exposure was associated with condom use with FSWs' sexual partners, including a dose-response relationship. METHODS: Data were from a cross-sectional study (2006-07) of 775 FSWs in three districts in Karnataka. Survey methods accounted for the complex cluster sampling design. Bivariate and multivariable logistic regression was used to separately model the relationships between each of five intervention exposure variables and five outcomes for consistent condom use (CCU= always versus frequently/sometimes/never) with different sex partners, including with: all clients; occasional clients; most recent repeat client; most recent non-paying partner; and the husband or cohabiting partner. Linear tests for trends were conducted for three continuous intervention exposure variables. RESULTS: FSWs reported highest CCU with all clients (81.7%); CCU was lowest with FSWs' husband or cohabiting partner (9.6%). In multivariable analysis, the odds of CCU with all clients and with occasional clients were 6.3-fold [95% confidence intervals, CIs: 2.8-14.5] and 2.3-fold [95% CIs: 1.4-4.1] higher among FSWs contacted by intervention staff and 4.9-fold [95% CIs: 2.6-9.3] and 2.3-fold [95% CIs: 1.3-4.1] higher among those who ever observed a condom demonstration by staff, respectively, compared to those who had not. A significant dose-response relationship existed between each of these CCU outcomes and increased duration since first contacted by staff (P=0.001; P=0.006) and numbers of condom demonstrations witnessed (P=0.004; P=0.026); a dose-response relationship was also observed between condom use with all clients and number of times contacted by staff (P=0.047). Intervention exposure was not associated with higher odds of CCU with the most recent repeat client, most recent non-paying partner or with the husband or cohabiting partner. CONCLUSION: Study findings suggest that exposure to a large-scale HIV intervention for FSWs was associated with increased CCU with commercial clients. Moreover, there were dose-response relationships between CCU with clients and increased duration since first contacted by staff, times contacted by staff and number of condom demonstrations. Additional program effort is required to increase condom use with non-commercial partners. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/22375863/A_dose_response_relationship_between_exposure_to_a_large_scale_HIV_preventive_intervention_and_consistent_condom_use_with_different_sexual_partners_of_female_sex_workers_in_southern_India_ DB - PRIME DP - Unbound Medicine ER -