1
|
Almeida LFD, Guimarães MDC, Dourado I, Veras MADSM, Magno L, Leal AF, Kerr LRS, Kendall C, Pontes AK, Rocha GM. Envolvimento em organizações não governamentais e a participação em ações de prevenção ao HIV/aids por homens que fazem sexo com homens no Brasil. CAD SAUDE PUBLICA 2021. [DOI: 10.1590/0102-311x00150520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A epidemia do HIV no Brasil é concentrada em populações-chave. Organizações não governamentais (ONGs) que atuam em defesa dos direitos da população LGBT e de pessoas vivendo com HIV/aids podem contribuir para o desenvolvimento de políticas de prevenção. O objetivo deste estudo é avaliar o envolvimento em ONGs e analisar sua associação com a participação individual em ações de educação em saúde, testagem e prevenção às infecções sexualmente transmissíveis (IST) e ao HIV, como parte de um estudo nacional de vigilância biológica e comportamental entre homens que fazem sexo com homens (HSH). Trata-se de estudo transversal utilizando respondent driven sampling (RDS) em 12 cidades brasileiras. A magnitude da associação do envolvimento em ONGs com cada ação foi avaliada pela estimativa de odds ratio por meio de regressão logística por amostragem complexa, considerando cada cidade como um estrato e ponderando pelo estimador de Gile. Foi estimada a proporção relativa atribuída ao envolvimento em ONGs para cada evento avaliado. Dentre 4.176 participantes, a maioria tinha menos de 25 anos (56,5%) e baixo nível econômico (56,7%). Um quarto dos HSH referiu se envolver em ONGs, que foi significativamente associado com as ações avaliadas: receber preservativo e gel lubrificante, participar de palestra, receber material educativo e aconselhamento em IST, conhecimento de profilaxia pós-exposição (PEP) e profilaxia pré-exposição (PrEP), testagem para sífilis e HIV, ter aceitação do autoteste e saber onde realizar teste para HIV. ONGs têm um papel histórico na resposta à epidemia de HIV no Brasil e, apesar de terem sofrido significativa redução de recursos nos últimos anos, mantêm relevante atuação nas ações de saúde pública.
Collapse
Affiliation(s)
| | | | | | | | - Laio Magno
- Universidade Federal da Bahia, Brazil; Universidade do Estado da Bahia, Brazil
| | | | | | | | | | | |
Collapse
|
2
|
Kendall C, Kerr L, Mota RS, Guimarães MDC, Leal AF, Merchan-Hamann E, Dourado IC, Veras MA, Brito AMD, Pontes AK, Castro ARCM, Macena RHM, Knauth D, Linda LC, Oliveira LC, Cavalcante S, Camillo AC, Bermudez XPD, Moreira RC, Benzaken AS, Pereira G, Pascom ARP, Pimenta C, Grazina Johnston L. The 12 city HIV Surveillance Survey among MSM in Brazil 2016 using respondent-driven sampling: a description of methods and RDS diagnostics. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22:e190004. [PMID: 30892467 DOI: 10.1590/1980-549720190004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 05/15/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. METHODS Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile's successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. RESULTS Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). CONCLUSION The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines.
Collapse
Affiliation(s)
- Carl Kendall
- Tulane University, Global Community Health and Behavioral Sciences - New Orleans (LA), United States.,Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | - Ligia Kerr
- Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | - Rosa Salani Mota
- Departamento de Estatística e Matemática Aplicada, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | | | - Andrea Fachel Leal
- Departamento de Sociologia, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Edgar Merchan-Hamann
- Faculdade de Ciências da Saúde, Saúde Coletiva, Universidade de Brasília - Brasília (DF), Brazil
| | - Inês Costa Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia - Salvador (BA), Brazil
| | - Maria Amélia Veras
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas da Santa Casa de São Paulo - São Paulo (SP), Brazil
| | - Ana Maria de Brito
- Departamento de Saúde Coletiva, Centro de Pesquisas Aggeu Magalhães - Recife, PE, Brazil
| | - Alexandre Kerr Pontes
- Instituto de Psicologia, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | | | | | - Daniela Knauth
- Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | | | | | | | | | | | - Adele Schwartz Benzaken
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Gerson Pereira
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Ana Roberta Pati Pascom
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Cristina Pimenta
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Lisa Grazina Johnston
- Tulane University, Global Community Health and Behavioral Sciences - New Orleans (LA), United States
| |
Collapse
|
3
|
Tao L, Liu M, Li S, Liu J, Wang N. Condom use in combination with ART can reduce HIV incidence and mortality of PLWHA among MSM: a study from Beijing, China. BMC Infect Dis 2018; 18:124. [PMID: 29534685 PMCID: PMC5851291 DOI: 10.1186/s12879-018-3026-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/28/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Condom use and antiretroviral therapy (ART) are effective means to prevent and control HIV transmission. We aimed to assess the effect of condom use in combination with antiretroviral therapy (ART) on HIV incidence and mortality among men who had sex with men (MSM) in Beijing, China. METHODS We evaluated the effect of condom use, ART, and the combination of both among people living with HIV/AIDS (PLWHA) of MSM in the Chaoyang District of Beijing using the Asian Epidemic Model (AEM). Evaluation indicators included absolute risk reduction (ARR) and the percentage of relative risk reduction (RRR %). RESULTS HIV incidence and prevalence declined substantially when condoms were used by MSM in Chaoyang from 2003 to 2013. The ARR of HIV incidence was from 0 to 0.91% and the RRR% was from 0 to 43.93%. The ARR of HIV prevalence was from 0 to 3.79% and the RRR% was from 0 to 31.53%. The HIV mortality rate decreased substantially (ARR from 0 to 1.75%, and RRR% from 0 to 40.03%) when ART was implemented. When condom use combined with ART was implemented in MSM in 2003-2013, HIV incidence declined substantially (ARR from 0 to 0.99%, and RRR% from 0 to 46.11%). HIV prevalence was also reduced with an ARR from 0 to 3.5%, and an RRR% from 0 to 29.88%. The HIV mortality also declined substantially (ARR from - 0.01% to 1.02%, RRR% from - 1.44% to 39.98%). CONCLUSIONS Among MSM, a combination of condom use and ART reduces both HIV incidence and mortality caused by HIV. Combining these methods results in a more effective prevention and control of HIV.
Collapse
Affiliation(s)
- Lili Tao
- Beijing Chaoyang District Centre for Disease Control and Prevention, No. 25 Panjiayuan Huaweili, Chaoyang District, Beijing, China
| | - Min Liu
- Peking University, School of Public Health, No. 38 Xueyuan Road, Haidian District, Beijing, China
| | - Shuming Li
- Beijing Chaoyang District Centre for Disease Control and Prevention, No. 25 Panjiayuan Huaweili, Chaoyang District, Beijing, China
| | - Jue Liu
- Peking University, School of Public Health, No. 38 Xueyuan Road, Haidian District, Beijing, China
| | - Ning Wang
- National Center for AIDS/STD Control & Prevention, No. 155 Chang Bai Road, Changping District, Beijing, China
| |
Collapse
|
4
|
Chatterjee A, Sarkar A, Ansari S, Siddhanta S, Banerjee S, Sarkar R, Chakraborty N. Spread of human immunodeficiency virus 1 among men who have sex with men is emerging as a genuine social concern and affecting the general populace - case reports from Eastern India. World J Virol 2016; 5:183-188. [PMID: 27878105 PMCID: PMC5105051 DOI: 10.5501/wjv.v5.i4.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/16/2016] [Accepted: 09/08/2016] [Indexed: 02/05/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) has increased to a drastic proportion throughout India in the last couple of years due to a lack of productive identification and management framework. In apprehension of social disgrace these men attempt to live a normal hetero conjugal life and, in the process, act as a bridge in spreading the virus to their women partners. In this case report we have highlighted two cases which clearly distinguished the adequacy of HIV treatment among MSM when they are diagnosed during early or late phases of infection. An intensive and ample counseling to comprehend the psychology and sexual behavior of these men was found to be critically important in both the cases. Our study, which is actually the first of its kind, recorded and documented evidence of HIV infected MSM from Eastern India and renders a ray of hope among this marginally isolated group to comprehend the challenges and health risks faced by the MSM population. It also provides a format for the medical practitioners here in managing and treating related cases.
Collapse
|
5
|
Bhatnagar T, Dutta T, Stover J, Godbole S, Sahu D, Boopathi K, Bembalkar S, Singh KJ, Goyal R, Pandey A, Mehendale SM. Fitting HIV Prevalence 1981 Onwards for Three Indian States Using the Goals Model and the Estimation and Projection Package. PLoS One 2016; 11:e0164001. [PMID: 27711212 PMCID: PMC5053468 DOI: 10.1371/journal.pone.0164001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/19/2016] [Indexed: 11/26/2022] Open
Abstract
Models are designed to provide evidence for strategic program planning by examining the impact of different interventions on projected HIV incidence. We employed the Goals Model to fit the HIV epidemic curves in Andhra Pradesh, Maharashtra and Tamil Nadu states of India where HIV epidemic is considered to have matured and in a declining phase. Input data in the Goals Model consisted of demographic, epidemiological, transmission-related and risk group wise behavioral parameters. The HIV prevalence curves generated in the Goals Model for each risk group in the three states were compared with the epidemic curves generated by the Estimation and Projection Package (EPP) that the national program is routinely using. In all the three states, the HIV prevalence trends for high-risk populations simulated by the Goals Model matched well with those derived using state-level HIV surveillance data in the EPP. However, trends for the low- and medium-risk populations differed between the two models. This highlights the need to generate more representative and robust data in these sub-populations and consider some structural changes in the modeling equation and parameters in the Goals Model to effectively use it to assess the impact of future strategies of HIV control in various sub-populations in India at the sub-national level.
Collapse
Affiliation(s)
- Tarun Bhatnagar
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Tapati Dutta
- International AIDS Vaccine Initiative, New Delhi, India
| | - John Stover
- Avenir Health, Glastonbury, Connecticut, United States of America
| | - Sheela Godbole
- Department of Epidemiology, National AIDS Research Institute, Indian Council of Medical Research, Pune, Maharashtra, India
| | - Damodar Sahu
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Kangusamy Boopathi
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Shilpa Bembalkar
- Department of Epidemiology, National AIDS Research Institute, Indian Council of Medical Research, Pune, Maharashtra, India
| | - Kh. Jitenkumar Singh
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Rajat Goyal
- International AIDS Vaccine Initiative, New Delhi, India
| | - Arvind Pandey
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Sanjay M. Mehendale
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India
- * E-mail: ,
| |
Collapse
|
6
|
Phanuphak N, Lo YR, Shao Y, Solomon SS, O'Connell RJ, Tovanabutra S, Chang D, Kim JH, Excler JL. HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials. AIDS Res Hum Retroviruses 2015; 31:1060-76. [PMID: 26107771 DOI: 10.1089/aid.2015.0049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.
Collapse
Affiliation(s)
| | - Ying-Ru Lo
- HIV, Hepatitis, and STI Unit, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Yiming Shao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sunil Suhas Solomon
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Robert J. O'Connell
- Department of Retrovirology, U.S. Army Medical Component, Armed Forces Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Sodsai Tovanabutra
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - David Chang
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jerome H. Kim
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jean Louis Excler
- U.S. Military HIV Research Program, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| |
Collapse
|
7
|
Raj Y, Sahu D, Pandey A, Venkatesh S, Reddy D, Bakkali T, Das C, Singh KJ, Kant S, Bhattacharya M, Stover J, Jha UM, Kumar P, Mishra RM, Chandra N, Gulati BK, Mathur S, Joshi D, Chavan L. Modelling and estimation of HIV prevalence and number of people living with HIV in India, 2010-2011. Int J STD AIDS 2015; 27:1257-1266. [PMID: 26494704 DOI: 10.1177/0956462415612650] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/28/2015] [Indexed: 11/17/2022]
Abstract
This paper provides HIV estimation methodology used in India and key HIV estimates for 2010-2011. We used a modified version of the Spectrum tool that included an Estimation and Projection Package as part of its AIDS Impact Module. Inputs related to population size, age-specific pattern of fertility, gender-ratio at birth, age and gender-specific pattern of mortality, and volume and age-gender distribution of net migration were derived from census records, the Sample Registration System and large-scale demographic health surveys. Epidemiological and programmatic data were derived from HIV sentinel surveillance, large-scale epidemiological surveys and the programme management information system. Estimated adult HIV prevalence retained a declining trend in India, following its peak in 2002 at a level of 0.41% (within bounds 0.35-0.47%). By 2010 and 2011, it levelled at estimates of 0.28% (0.24-0.34%) and 0.27% (0.22-0.33%), respectively. The estimated number of people living with HIV (PLHIV) reduced by 8% between 2007 and 2011. While children accounted for approximately 6.3% of total HIV infections in 2007, this proportion increased to about 7% in 2011. With changing priorities and epidemic patterns, the programme has to customise its strategies to effectively address the emerging vulnerabilities and adapt them to suit the requirements of different geographical regions.
Collapse
Affiliation(s)
- Yujwal Raj
- National AIDS Control Organization, New Delhi, India
| | - Damodar Sahu
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Arvind Pandey
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - S Venkatesh
- National AIDS Control Organization, New Delhi, India
| | - Dcs Reddy
- Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India (Ex-Professor)
| | | | - Chinmoyee Das
- National AIDS Control Organization, New Delhi, India
| | - Kh Jitenkumar Singh
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Shashi Kant
- Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - M Bhattacharya
- Department of Community Health Administration, National Institute of Health & Family Welfare, New Delhi, India
| | | | | | - Pradeep Kumar
- National AIDS Control Organization, New Delhi, India
| | | | | | - B K Gulati
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Sharad Mathur
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | | | | |
Collapse
|
8
|
Abstract
OBJECTIVE To characterize prevalence, incidence, and associated correlates of HIV infection among MSM in 12 cities across India. DESIGN Cross-sectional sample using respondent-driven sampling from September 2012 to June 2013. METHODS A total 12022 MSM (~1000/city) were recruited. Participants had to be at least 18 years, self-identify as male, and report oral/anal intercourse with a man in the prior year. HIV infection was diagnosed using three rapid tests. Cross-sectional HIV incidence was estimated using a multiassay algorithm. All estimates incorporate respondent-driven sampling-II weights. RESULTS Median age was 25 years, 45% self-identified as 'panthi' (predominantly penetrative anal intercourse) and 30.6% reported being married to a woman. Weighted HIV prevalence was 7.0% (range: 1.7-13.1%). In multivariate analysis, significantly higher odds of HIV infection was observed among those who were older, had lower educational attainment, were practicing purely receptive anal sex or both receptive and penetrative sex, and those who were herpes simplex virus-2 positive. Of 1147 MSM who tested HIV positive, 53 were identified as recent HIV infections (annualized incidence = 0.87%; range = 0-2.2%). In multivariate analysis, injecting drugs in the prior 6 months, syphilis, and higher number of male partners and fewer female partners were significantly associated with recent HIV infection. CONCLUSION We observed a high burden of HIV among MSM in India with tremendous diversity in prevalence, incidence, and risk behaviors. In particular, we observed high incidence in areas with relatively low prevalence suggesting emerging epidemics in areas not previously recognized to have high HIV burden.
Collapse
|
9
|
Jha UM, Raj Y, Venkatesh S, Dhingra N, Paranjpe RS, Saggurti N. HIV epidemic among men who have sex with men in India: national scenario of an unfinished agenda. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2014; 6:159-70. [PMID: 25429240 PMCID: PMC4242134 DOI: 10.2147/hiv.s69708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Although India has demonstrated success in the overall reduction of human immunodeficiency virus (HIV) incidence by 57% in the past 10 years, its control among men who have sex with men (MSM) remains a critical challenge. This paper describes the current status, geographic variability, and factors associated with HIV among MSM from the national perspective. Methods Data on the levels and trends of HIV seropositivity and associated risk behaviors among MSM were analyzed and presented from the following data sources: 1) annual HIV Sentinel Surveillance (HSS) conducted during 2003–10, 2) two rounds of the high-risk group size estimation conducted in 2005 and 2009, 3) two rounds of the Behavioral Surveillance Survey conducted in 2006 and 2009, and 4) the Integrated Bio-behavioral Assessment Round 2. Data were analyzed according to selected sociodemographic characteristics and sexual identities of MSM to understand the factors associated with high HIV prevalence. Results HSS data indicate that at the national level, HIV prevalence among MSM overall is declining (from 12.3% in 2003 to 4.43% in 2010). However, marginal increasing trends were observed in Chandigarh (from 1.4% in 2004 to 2.8% in 2008) and Haryana (from 0% in 2006 to 3.2% in 2008). HSS data indicate high (>5%) levels and increasing trends in HIV prevalence among MSM in eight states of India during 2003–10. Analysis of 2010 HSS data indicates that HIV prevalence was >10% in seven states. The factors associated with high HIV prevalence among MSM were being a kothi (the receptive partner in oral and anal sex, and typically with effeminate mannerisms) or a double-decker (both penetrative and receptive partner) rather than being a panthi (the penetrative partner in oral or anal sex) (8% vs 4.3%; P<0.05), being older than 25 years in age than their younger counterparts (9% vs 4.5%; P<0.05), illiterate rather than literate MSM (9.5% vs 6.9%; P<0.05), and employed versus unemployed MSM (9.1% vs 7.8%; P<0.05). Conclusion While HIV prevalence among MSM at the national level is declining, it continues to remain high in some states and cities. Programs need to build on the successes in reducing HIV among female sex workers in order to control the high HIV prevalence among MSM in India.
Collapse
Affiliation(s)
- Ugra Mohan Jha
- Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Yujwal Raj
- Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Srinivas Venkatesh
- Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Neeraj Dhingra
- Department of AIDS Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | | | | |
Collapse
|
10
|
Ranebennur V, Gaikwad S, Ramesh S, Bhende A. Addressing vulnerabilities of female sex workers in an HIV prevention intervention in Mumbai and Thane: experiences from the Aastha project. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2014; 6:9-18. [PMID: 24600249 PMCID: PMC3933664 DOI: 10.2147/hiv.s54062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background It is important for targeted interventions to consider vulnerabilities of female sex workers (FSWs) such as poverty, work-related mobility, and literacy, for effective human immunodeficiency virus (HIV) prevention. This paper describes and examines the association of the Aastha HIV/sexually transmitted infection (STI) prevention project in Mumbai and Thane, India, on the relationship between vulnerability and behavioral outcomes. Materials and methods Data were drawn from the Behavioural Tracking Survey, a cross-sectional behavioral study conducted in 2010 with 2,431 FSWs recruited in Mumbai and Thane. The key independent measures used were program exposure and “vulnerability index”, a composite index of literacy, factors of dependence (alternative livelihood options, current debt, and children), and aspects of sex work (mobility and duration in sex work). Dependent measures included service uptake, self-confidence, self-identity, and individual agency. Logistic regression analysis was used to examine the study objectives. Results Of the analytical sample of 2,431 FSWs, 1,295 (53.3%) were categorized as highly vulnerable. Highly vulnerable FSWs who were associated with the Aastha program for more than a year were more likely to have accessed crisis-response services in the past 6 months (adjusted odds ratio [AOR] 2.2, 95% confidence interval [CI] 1.4–3.6; P<0.001), to have visited a clinic to get a checkup for STI symptoms (AOR 2.4, 95% CI 1.2–4.8; P<0.015), not to be ashamed to disclose identity as an FSW to health workers (AOR 2.1, 95% CI 1.2–3.5; P<0.008), and to be confident in supporting a fellow FSW in crisis (AOR 1.7, 95% CI 1.0–2.8, P<0.033) compared to those less vulnerable with similar exposure to the Aastha program. Conclusion It is critical for HIV/STI interventions to consider vulnerabilities of FSWs at project inception and address them with focused strategies, including a segmented service-delivery model and community involvement, in order to strengthen the structural response to HIV prevention.
Collapse
Affiliation(s)
| | | | - Sowmya Ramesh
- HIV/AIDS Programs, Population Council, New Delhi, India
| | | |
Collapse
|
11
|
Safety and tolerability of tenofovir for preexposure prophylaxis among men who have sex with men. J Acquir Immune Defic Syndr 2013; 64:3-6. [PMID: 23881239 DOI: 10.1097/qai.0b013e3182a3979c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|