Division of Community Studies, National Institute of Nutrition, Hyderabad, India.
BMC Public Health. 2011 Dec 29;11 Suppl 6(Suppl 6):S1. doi: 10.1186/1471-2458-11-S6-S1.
Avahan, the India AIDS initiative began HIV prevention interventions in 2003 in Andhra Pradesh (AP) among high-risk groups including female sex workers (FSWs), to help contain the HIV epidemic. This manuscript describes an assessment of this intervention using the published Avahan evaluation framework and assesses the coverage, outcomes and changes in STI and HIV prevalence among FSWs.
Multiple data sources were utilized including Avahan routine program monitoring data, two rounds of cross-sectional survey data (in 2006 and 2009) and STI clinical quality monitoring assessments. Bi-variate and multivariate analyses, Wald Chi-square tests and multivariate logistic regressions were used to measure changes in behavioural and biological outcomes over time and their association.
Avahan scaled up in conjunction with the Government program to operate in all districts in AP by March 2009. By March 2009, 80% of the FSWs were being contacted monthly and 21% were coming to STI services monthly. Survey data confirmed an increase in peer educator contacts with the mean number increasing from 2.9 in 2006 to 5.3 in 2009. By 2008 free and Avahan-supported socially marketed condoms were adequate to cover the estimated number of commercial sex acts, at 45 condoms/FSW/month. Consistent condom use was reported to increase with regular (63.6% to 83.4%; AOR=2.98; p<0.001) and occasional clients (70.8% to 83.7%; AOR=2.20; p<0.001). The prevalence of lifetime syphilis decreased (10.8% to 6.1%; AOR=0.39; p<0.001) and HIV prevalence decreased in all districts combined (17.7% to 13.2%; AOR 0.68; p<0.01). Prevalence of HIV among younger FSWs (aged 18 to 20 years) decreased (17.7% to 8.2%, p=0.008). A significant increase in condom use at last sex with occasional and regular clients and consistent condom use with occasional clients was observed among FSWs exposed to the Avahan program. There was no association between exposure and HIV or STIs, although numbers were small.
The absence of control groups is a limitation of this study and does not allow attribution of changes in outcomes and declines in HIV and STI to the Avahan program. However, the large scale implementation, high coverage, intermediate outcomes and association of these outcomes to the Avahan program provide plausible evidence that the declines were likely associated with Avahan. Declining HIV prevalence among the general population in Andhra Pradesh points towards a combined impact of Avahan and government interventions.
印度艾滋病倡议“阿伐哈”于 2003 年在安得拉邦（AP）开始对包括性工作者（FSWs）在内的高危人群实施艾滋病毒预防干预措施，以帮助遏制艾滋病毒的流行。本文利用已发表的阿伐哈评估框架评估了这一干预措施，并评估了 FSWs 中性传播感染（STI）和艾滋病毒流行率的覆盖范围、结果和变化。
利用了多种数据来源，包括阿伐哈常规项目监测数据、两轮横断面调查数据（2006 年和 2009 年）和性传播感染临床质量监测评估。采用双变量和多变量分析、沃尔德卡方检验和多变量逻辑回归来衡量随着时间的推移行为和生物学结果的变化及其相关性。
阿伐哈与政府项目一起扩大规模，到 2009 年 3 月在 AP 的所有地区开展业务。到 2009 年 3 月，80%的性工作者每月接受一次接触，21%的人每月接受性传播感染服务。调查数据证实，同伴教育者的接触人数有所增加，平均人数从 2006 年的 2.9 人增加到 2009 年的 5.3 人。到 2008 年，免费和阿伐哈支持的社会营销安全套足以覆盖估计的商业性行为次数，即每月每 FSW 45 个安全套。报告称，与经常（63.6%至 83.4%；AOR=2.98；p<0.001）和偶尔（70.8%至 83.7%；AOR=2.20；p<0.001）客户发生性行为时的避孕套使用频率均有所增加。终身梅毒的患病率下降（从 10.8%降至 6.1%；AOR=0.39；p<0.001），所有地区的艾滋病毒患病率均下降（从 17.7%降至 13.2%；AOR 0.68；p<0.01）。18 至 20 岁的年轻性工作者中 HIV 患病率下降（从 17.7%降至 8.2%，p=0.008）。在接触阿伐哈项目的性工作者中，与偶尔和经常客户发生性行为时使用避孕套的比例以及与偶尔客户发生性行为时使用避孕套的比例均显著增加。虽然数量较少，但接触与艾滋病毒或性传播感染之间没有关联。
本研究的局限性在于缺乏对照组，因此无法将结果的变化和艾滋病毒及性传播感染的下降归因于阿伐哈项目。然而，大规模实施、高覆盖率、中间结果以及这些结果与阿伐哈项目的关联为下降可能与阿伐哈项目有关提供了合理的证据。安得拉邦普通人群中艾滋病毒流行率的下降表明，阿伐哈和政府干预措施共同产生了影响。
