Nossal Institute for Global Health, University of Melbourne, Victoria, Australia.
BMC Public Health. 2013 May 15;13:476. doi: 10.1186/1471-2458-13-476.
There a concentrated HIV epidemic among female sex workers (FSWs) in the state of Nagaland, located in the north-east of India. Local non-government organisations (NGOs) are supported by the National State AIDS Control Society (NSACS) and the Avahan-funded Project ORCHID (Avahan is the India AIDS initiative of Bill & Melinda Gates Foundation in India) to deliver a range of interventions to FSWs including safe sex promotion, condom distribution, and testing and treatment of sexually transmitted infections (STIs). The commercial hub of Nagaland, Dimapur, is an important transportation node, and hosts a concentration of FSWs. This paper reports on comparative analysis of Integrated Behavioural and Biological Assessment (IBBA) data collected from FSWs in Dimapur in 2006 and 2009 to assess changes in condom use, HIV testing, and exposure to interventions.
Two IBBA cross-sectional surveys were undertaken among FSWs in Dimapur in 2006 (Round 1) and 2009 (Round 2) using an interviewer-administered questionnaire and the collection of blood and urine samples. Respondent-driven sampling (RDS), a sampling technique for use among hidden populations, was used to recruit the samples.
When round 1 is compared with round 2, there was a marked and statistically significant improvement in the use of condoms at last sex with both occasional (35.2% to 72.4%) and regular (25.8% to 57.7%) clients, and an increase in the proportion having ever had an HIV test (8.9% to 29.1%). There was no evidence of an improvement in the proportional coverage of the HIV prevention services delivered to FSWs in Dimapur between round 1 and round 2. In round 2, FSWs exposed to the programme were more than twice (OR=2.27) as likely to consistently use condoms with occasional clients, four times (OR: 4.11) more likely to use condoms consistently with regular clients and nine times (OR: 9.08) more likely to have ever had an HIV test.
We found evidence of an increase in condom use and HIV testing, and a strong and consistent association between programme exposure and condom use and HIV testing indicating that NGO HIV prevention programmes have been making a substantial contribution to HIV prevention among FSWs in Dimapur. However, there was no evidence of improved coverage of HIV prevention services, and there is a clear need to expand the reach of services in order for them to have an impact on a larger pool of FSWs.
在印度东北部的那加兰邦，性工作者（FSW）中存在集中的 HIV 疫情。当地非政府组织（NGO）得到国家艾滋病控制协会（NSACS）和奥里希德项目（Avahan）的支持，为 FSW 提供了一系列干预措施，包括安全性行为推广、避孕套分发以及性传播感染（STI）的检测和治疗。那加兰邦的商业中心迪马普尔是一个重要的交通枢纽，集中了大量的性工作者。本文报告了对 2006 年和 2009 年在迪马普尔采集的 FSW 综合行为和生物学评估（IBBA）数据的比较分析，以评估 condom 使用、HIV 检测和接触干预措施的变化。
2006 年（第 1 轮）和 2009 年（第 2 轮），采用访谈者管理的问卷和采集血液和尿液样本，在迪马普尔对 FSW 进行了两次 IBBA 横断面调查。采用 respondent-driven sampling（RDS），一种用于隐藏人群的抽样技术，来招募样本。
与第 1 轮相比，第 2 轮中与偶尔（35.2%到 72.4%）和定期（25.8%到 57.7%）客户发生性行为时 condom 使用的比例明显且具有统计学意义的改善，并且曾经进行过 HIV 检测的比例有所增加（8.9%到 29.1%）。在第 1 轮和第 2 轮之间，向迪马普尔的 FSW 提供的 HIV 预防服务的比例没有改善的迹象。在第 2 轮中，接触到该计划的 FSW 与偶尔客户发生性行为时持续使用 condom 的可能性是对照组的两倍多（OR=2.27），与定期客户发生性行为时持续使用 condom 的可能性是对照组的四倍多（OR：4.11），曾经进行过 HIV 检测的可能性是对照组的九倍多（OR：9.08）。
我们发现 condom 使用和 HIV 检测有所增加，并且接触项目与 condom 使用和 HIV 检测之间存在强烈而一致的关联，这表明非政府组织的 HIV 预防方案为迪马普尔的 FSW 预防 HIV 做出了重大贡献。然而，没有证据表明 HIV 预防服务的覆盖范围有所改善，显然需要扩大服务范围，以便对更多的 FSW 产生影响。
