Rural HIV prevention programmes among India’s sex workers can increase condom use, study finds

BMJ 2014; 349 doi: (Published 03 July 2014) Cite this as: BMJ 2014;349:g4437
  1. Sanjeet Bagcchi
  1. 1Kolkata

Community based HIV prevention programmes among female sex workers in rural India can substantially increase the use of condoms, HIV counselling, and testing services, a new study has found.

The study was published in the July 2014 issue of the Asia-Pacific Journal of Public Health and was led by Reynold Washington, an adjunct professor at the St John’s Research Institute in Karnataka. It noted that, in India, the HIV epidemic is concentrated in high risk groups, such as intravenous drug users, men who have sex with men, female sex workers, and people who attend sexually transmitted infection (STI) clinics.

“Almost 70% of India’s population resides in rural areas, and 57% of people living with HIV . . . in India also come from rural areas,” Washington and his colleagues noted, adding, “The state of Karnataka in south India accounts for 11% of the [people living with] HIV in the country.”1

The researchers examined the changes in behavioural outcomes among 14 284 rural female sex workers who participated in a community based HIV prevention programme in eight districts of Karnataka that had high HIV prevalence.

Female sex workers in these villages received condoms and education on how to use them correctly, and their use of STI services and HIV counselling was also assessed. Two rounds of polling booth surveys (to collect sensitive behavioural information anonymously) were conducted in 2008 and 2011, to assess the behavioural changes in these sex workers.

Washington and his colleagues found that, in the community based programme, 95% of the female sex workers were reached at least once, 80.3% received condoms as they needed, and 71% received health services for STIs. Between the two rounds of polling booth surveys the researchers found a significant increase in condom use (from 60.4% to 72.4%; P=0.001) and in the use of HIV counselling and testing services (from 63.9% to 92.4%; P=0.000).

“The coverage of outreach, distribution of condoms and referrals for STI and HIV counseling and testing services increased significantly over the project period,” they wrote. “There was significant decline in reported rates of partner refusal to use condoms and of condom breakage.”

They added, “One in four FSWs [female sex workers], however, reported instances of non-availability of the condoms when needed, and this is an issue of concern. The stigma associated with keeping condoms ready for use in home settings has been reported earlier and is an issue that needs further attention.”

Washington told The BMJ, “The HIV epidemic is becoming increasingly visible in rural areas in a number of developing countries. The study presents an innovative model for rural outreach and care that can be applied to HIV/AIDS prevention and care, and to other health problems.”

James Blanchard, professor and director at the University of Manitoba’s Centre for Global Public Health in Canada, said that the study illustrated the importance of considering female sex workers’ needs in rural areas, in order for programmes and services to reduce their vulnerability to HIV. He told The BMJ, “Traditionally, HIV programmes for female sex workers are focused in urban areas, despite growing evidence from many regions of large populations of female sex workers in rural areas. Based on the results of this study I would recommend that national and regional programmes do more to establish HIV programmes and services in rural areas.”


Cite this as: BMJ 2014;349:g4437


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