Declines in violence and police arrest among female sex workers in Karnataka state, south India, following a comprehensive HIV prevention program

INTRODUCTION:

Female sex workers (FSWs) frequently experience violence, harassment and arrest by the police or their clients, but there is little evidence as to the impact that such factors may have on HIV risk or whether community interventions could mitigate this impact.

METHODS:

As part of the evaluation of the Avahan programme in Karnataka, serial integrated behavioural and biological assessment (IBBA) surveys (four districts) (2005 to 2011) and anonymous polling booth surveys (PBS) (16 districts) (2007 to 2011) were conducted with random samples of FSWs. Logistic regression analysis was used to assess 1) changes in reported violence and arrests over time and 2) associations between violence by non-partners and police arrest and HIV/STI risk and prevalence. Mediation analysis was used to identify mediating factors.

RESULTS:

5,792 FSWs participated in the IBBAs and 15,813 participated in the PBS. Over time, there were 

• significant reductions in the percentages of FSWs reporting being raped in the past year (PBS) (30.0% in 2007, 10.0% in 2011, p<0.001), 
• being arrested in the past year and being beaten in the past six months by a non-partner (clients, police, pimps, strangers, rowdies). 

The proportion drinking alcohol (during the past week) also fell significantly (32.5% in 2005, 24.9% in 2008, 16.8% in 2011; p<0.001). Violence by non-partners (being raped in the past year and/or beaten in the past six months) and being arrested in the past year were both strongly associated with HIV infection. 

They were also associated with drinking alcohol (during the past week), reduced condom self-efficacy with clients, symptomatic STI (during the past year), gonorrhoea infection and syphilis infection, but not with exposure to peer education, community mobilization or HIV testing uptake. 

Mediation analysis suggests that alcohol use and STIs may partially mediate the association between violence or arrests and HIV prevalence.

DISCUSSION:

Violence by non-partners and arrest are both strongly associated with HIV infection among FSWs. Large-scale, comprehensive HIV prevention programming can reduce violence, arrests and HIV/STI infection among FSWs.

Below:  Reductions in reported violence over time in 16 districts in Karnataka (2007 to 2011); polling booth surveys

Full article at:   http://goo.gl/36esUp

By: Beattie TS1, Bhattacharjee P2, Isac S2, Mohan HL2, Simic-Lawson M3, Ramesh BM2,4, Blanchard JF4,5, Moses S4,5, Watts CH3, Heise L3.

• 1Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; Tara.beattie@lshtm.ac.uk.
• 2Karnataka Health Promotion Trust, Bangalore, India.
• 3Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
• 4Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
• 5Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada. 
• J Int AIDS Soc. 2015 Oct 16;18:20079. doi: 10.7448/IAS.18.1.20079. eCollection 2015.

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Estimating the Hypothetical Dual Health Impact and Cost-Effectiveness of the Woman’s Condom in Selected Sub-Saharan African Countries

Below:  Estimated health impact from distributing 100,000 Woman’s Condoms in each country.

Abbreviation: DALY, disability-adjusted life years.

Programming 100,000 Woman’s Condoms in each of 13 countries in sub-Saharan Africa during a 1-year period could potentially prevent 194 pregnancies and an average of 21 HIV infections in each country. When using the World Health Organization CHOosing Interventions that are Cost-Effective (WHO-CHOICE) criteria as a threshold to infer the potential cost-effectiveness of the Woman’s Condom, we found that the Woman’s Condom would be considered cost-effective.

This was a first and successful attempt to estimate the impact of dual protection of female condoms. The health impact is greater for the use of the Woman’s Condom as an HIV prevention method than for contraception. Dual use of the Woman’s Condom increases the overall health impact. The Woman’s Condom was found to be very cost-effective in all 13 countries in our sample.

Read more at:  http://ht.ly/R2VUB HT @PATHtweets

Social Cohesion among Sex Workers Has an Independent Effect on Reduced Client Condom Refusal in a Canadian Setting

Via: http://ht.ly/QR6vU MT @IAS_conference

Sexual and Contraceptive Behavior among Female University Students In Sweden - Repeated Surveys Over a 25-Year Period

RESULTS:
In 1989, age at first intercourse was 17.6 years vs. 16.7 years in 2014, number of lifetime sexual partners was 4.0 vs. 12.1 in 2014, and number of sexual partners during the previous 12 months was 1.0 vs. 2.8 in 2014. Condom use during first intercourse with the latest partner decreased from 49% to 41% (n = 172 in 2009 vs. n = 148 in 2014: p < 0.001), and experience of anal sex increased from 39% to 46% (n = 136 in 2009 vs. n = 165 in 2014: p = 0.038), and 25% (n = 41 in 2014) always used a condom during anal sex. A total of 70% (n = 251) made use of pornography, and 48% (n = 121) considered their sexual behavior affected by pornography. Eighty-nine percent (n = 291) wanted two to three children and 9% (n = 33) had thought about freezing eggs for the future. The female students' knowledge about increasing age being correlated with decreased fertility varied.

CONCLUSIONS:
Sexual behavior among female university students has gradually changed during the last 25 years and behavior appears more risky today. As this may have consequences on future reproductive health, it is vital to inform women about consistent and correct condom use and about the limitations of the fertile window.

Via:  http://ht.ly/I2NFC HT @uppsalauni

Condomless Anal Intercourse among Males and Females at High Risk for Heterosexual HIV Infection

Via:   http://ht.ly/N8gWy  HT @JohnsHopkinsSPH

Is pornography consumption associated with condom use and intoxication during hookups?

Via:   http://ht.ly/NYMIr  HT @BYU

Utilization of contraceptives by persons living with HIV in Eastern Uganda

Below: Contraceptive methods used by persons living with HIV in Eastern Uganda, 2011

Approximately 62% (185/298) of persons living with HIV had used contraceptives within the three months preceding the study. Among the significant predictors, higher proportions of female respondents aged 36–49 years used injectables and male aged 50–54 years used condoms (p = 0.030 and p = 0.034, respectively). Furthermore, higher proportions of respondents with primary, secondary and tertiary education levels were more likely to use condoms (p = 0.004, p = 0.000 and p = 0.005, respectively) compared with those who never went to school. Besides, condoms were being used by Protestants (p = 0.000) compared to Catholics and Muslims. Also, more female respondents (p = 0.000) used condoms with their partners compared with the male counterparts. The main barrier to contraceptive use among non-users was desire for more children.

More efforts are needed to sensitize and provide contraceptives targeting the illiterate clients, youth, men and believers from different religious sects to increase utilization.

Via:  http://ht.ly/MWrmI  MT @WorldVisionUg

Segmentation of condom use by type of sex in Myanmar

Via:   http://ht.ly/NHMOt  .@UCSF

The Impact of Condom Use Negotiation Self-Efficacy and Partnership Patterns on Consistent Condom Use among College-Educated Women

Via: ht.ly/Q56H3 HT @JohnsHopkinsSPH

Is Porn Consumption Associated with Condom Use & Intoxication During Hookups?

Via:  http://ht.ly/NYMT5  HT @BYU

Hispanic Men in the United States: Acculturation and Recent Sexual Behaviors with Female Partners, 2006-2010

Via:  http://ht.ly/OpD83  HT @CDCgov

RESULTS:

Compared with Hispanic Spanish-speaking immigrants, non-Hispanic White men were less likely to report exchange of money or drugs for sex (adjusted odds ratio [AOR] = 0.3; 95% confidence interval [CI] = 0.1, 0.9), but were also less likely to report condom use at last vaginal (AOR = 0.6; 95% CI = 0.4, 0.8) and anal sex (AOR = 0.4; 95% CI = 0.3, 0.7). Hispanic US natives were less likely to report condom use at last vaginal sex than were Spanish-speaking immigrants (AOR = 0.6; 95% CI = 0.4, 0.8). English- and Spanish-speaking immigrants did not differ in risky or protective sexual behaviors

CONCLUSIONS:

Our findings suggest that targeted interventions focusing on unique sexual risks and sociodemographic differences by acculturation level, particularly nativity, may be helpful for preventing sexually transmitted infections.

Increases in Condomless Sex in the Swiss HIV Cohort Study

Via: http://VViaiaht.ly/PR88G  HT @uzh_news

Condomless sex is a key driver of sexually transmitted diseases. In this study, we assess the long-term changes (2000–2013) of the occurrence of condomless sex among human immunodeficiency virus (HIV)-infected individuals enrolled in the Swiss HIV Cohort study. The frequencies with which HIV-infected individuals reported condomless sex were either stable or only weakly increasing for 2000–2008. For 2008–2013, these rates increased significantly for stable relationships among heterosexuals and men who have sex with men (MSM) and for occasional relationships among MSM. Our results highlight the increasing public health challenge posed by condomless sex and show that condomless sex has been increasing even in the most recent years.

Below:  Frequency with which human immunodeficiency virus-infected individuals report unprotected sex over time (yearly average and 95% confidence interval). Dashed lines correspond to the fit of the piece-wise linear model to the frequencies of unprotected sex. Occasional and Stable refer to type of sexual partnership). The vertical dashed line indicates the level of condomless sex in 2008 (year of the Swiss Statement): 10.8% (men who have sex with men [MSM], stable), 6.0% (MSM, occasional), 15.9% (heterosexuals [HET], stable), and 1.0% (HET, occasional). The table displays the number of questionnaires evaluated for a given year and the number of patients responding to questionnaires in that year.

Sexual Activity and Condom Use among Israeli Adolescents

Via: http://ht.ly/PmbZz  HT @telavivuni1