Division of Epidemiology, Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
BMJ Open. 2013 Jun 20;3(6):e002724. doi: 10.1136/bmjopen-2013-002724.
We examined if increased spending and coverage of female sex worker (FSW) interventions were associated with declines in HIV or syphilis risk among young pregnant women (as a proxy for new infections in the general population) in the high-burden southern states of India.
Repeated cross-sectional analysis.
We used logistic regression to relate district-level spending, number of sexually transmitted infections (STIs) treated, FSWs reached or condoms distributed to the declines in the annual risk of HIV and syphilis from 2003 to 2008 among prenatal clinic attendees in the four high-HIV burden states of Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu.
386 961 pregnant women aged 15-24 years (as a proxy for incident infections in the adult population).
We examined National AIDS Control Organisation (NACO) data on 868 FSW intervention projects implemented between 1995 and 2008.
HIV or syphilis infection.
HIV and syphilis prevalence declined substantially among young pregnant women. Each additional STI treated (per 1000 people) reduced the annual risk of HIV infection by -1.7% (95% CI -3.3 to -0.1) and reduced the annual risk of syphilis infection by -10.9% (95%CI -15.9 to -5.8). Spending, FSWs reached or condoms distributed did not reduce HIV risk, but each was significantly associated with reduced annual risk of syphilis infection. There were no major differences between the NACO-funded and Avahan-funded districts in the annual risk of either STI.
Targeted FSW interventions are associated with reductions in syphilis risk and STI treatment is associated with reduced HIV risk. Both more and less costly FSW interventions have comparable effectiveness.
我们考察了在印度南部高负担州，增加针对女性性工作者（FSW）的干预措施的投入和覆盖范围是否与年轻孕妇（作为一般人群中新感染的替代指标）的 HIV 或梅毒风险下降有关。
重复横断面分析。
我们使用逻辑回归，将地区支出、治疗性传播感染（STI）的数量、接触到的 FSW 数量或分发的避孕套数量与 2003 年至 2008 年期间，在安得拉邦、卡纳塔克邦、马哈拉施特拉邦和泰米尔纳德邦这四个 HIV 高负担州的产前诊所就诊者中 HIV 和梅毒年风险下降相关联。
386961 名年龄在 15-24 岁的孕妇（作为成年人新感染的替代指标）。
我们检查了国家艾滋病控制组织（NACO）在 1995 年至 2008 年期间实施的 868 个 FSW 干预项目的数据。
HIV 或梅毒感染。
年轻孕妇的 HIV 和梅毒感染率显著下降。每治疗 1000 人额外的 STI（每 1000 人）可使 HIV 感染的年风险降低 -1.7%（95%CI-3.3 至 -0.1），梅毒感染的年风险降低-10.9%（95%CI-15.9 至 -5.8）。支出、接触到的 FSW 或分发的避孕套并未降低 HIV 风险，但都与梅毒感染年风险降低显著相关。在 NACO 资助和 Avahan 资助的地区之间，两种 STI 的年风险没有显著差异。
针对 FSW 的干预措施与梅毒风险的降低有关，而 STI 治疗与 HIV 风险的降低有关。更多和更少成本的 FSW 干预措施具有相当的效果。
