bluuebunny/crossref_metadata_2025 huggingface dataset:
P1-S6.49 Developing and validating a risk scoring tool for chlamydia infection among sexual health clinic attendees in Australia: a simple algorithm to identify those at high risk of Chlamydia infection
Authors: Wand H
Published: July 2011

Objective

To develop and validate a risk scoring tool for chlamydia infection to identify those who are at increased risk of chlamydia infection.

Methods

We used demographic, sexual behaviour information and chlamydia positivity results from more than 45 000 individuals who attended Sydney Sexual Health Centre between 1998 and 2009. Participants were randomly allocated to either the development or internal validation dataset. Using logistic regression, we created a prediction model and weighted scoring system using the development dataset and calculated the OR of chlamydia positivity for participants in successively higher quintiles of score. The internal validation dataset was used to evaluate the performance characteristics of the model for five quintiles of risk scores including population attributable risk (PAR), sensitivity and specificity.

Results

In the prediction model, inconsistent condom use, increased number of sexual partners in last 3 months, genital or anal symptoms and presenting to the clinic for sexually transmitted infections (STIs) screening or contact of an STI case were consistently associated with increased risk of chlamydia positivity in all groups. High scores (upper quintile) were significantly associated with increased risk of chlamydia infection. A cut-point score of 20 or higher distinguished a “increased risk” group with a sensitivity of 95%, 67% and 79% among heterosexual men, women and MSM, respectively.

Conclusion

The scoring tool may be included as part of a health promotion and/or clinic website to prompt those who are at increased risk of chlamydia infection which may potentially lead to increased uptake and frequency of testing.
P1-S6.50 Chlamyidia partner notification for adolescent females, San Francisco, 2010
Authors: Kohn R , McCright J , Ivory B , Snell A
Published: July 2011

Background

In 2009, African American women 15 to 19 years of age had the highest rate of chlamydia of any population in San Francisco (10 762.13 cases per 100 000 residents per year). Screening and education efforts had not succeeded in lowering rates in this population. Previous research suggests that adolescents may have fewer partners and fewer anonymous encounters than other patients with whom we conduct partner notification. We evaluated a pilot program of contact tracing aimed at male partners of adolescents women diagnosed with chlamydia living in selected neighbourhoods.

Methods

Residential addresses for all reported females under 20 years of age reported with a Chlamydia infection were geocoded. Cases residing in neighbourhoods with the highest rates of Chlamydia in 2009 were assigned to a health worker for partner notification. Cases were interviewed at least two weeks after being tested in order to give providers time to disclose the results. Names of male partners during the previous three months were collected along with locating information. The total number of partners for each woman (including unnamed partners) was also recorded. Male partners were contacted by the health worker; if partners had not been tested or prophylactic ally treated, they were tested for Chlamydia and treated if positive.

Results

Between 1 June 2010 and 31 December 2010, 296 Chlamydia cases were reported among women under 20 years of age. Of these, 106 (35.8%) resided in the priority neighbourhoods. Only 64 cases (60.4%) were located and interviewed; all but one of the remaining cases were not locatable. The cases claimed a total of 96 male partners, with 66% claiming just one partner in the previous 3 months, and only two cases claiming more than three partners. However, only 39 partners (40%) were named, including 11 partners residing out of jurisdiction, and 4 who had already been treated by the time they were located. Eleven (11) male partners were tested, and only 2 were positive for Chlamydia. The greatest barrier to contacting the cases and their male partners was cell phones numbers that were disconnected by the time we needed to use them.

Conclusion

While women in this population have fewer anonymous encounters than other populations targeted using partner notification, few cases among male partners were brought to treatment. Partner notification for adolescent females will likely have minimal impact on chlamydia transmission.
P1-S6.51 Antiretroviral therapy, sexual behaviour, and their simulated impact on HIV epidemiologic trends in Uganda
Authors: Shafer L A , Nsubuga R , Chapman R , O'Brien K , Mayanja B , White R
Published: July 2011

Background

Debate exists concerning the potential impact of ART on the HIV epidemic in Africa. We combine empirical evidence for sexual behaviour change in response to ART in a Ugandan cohort, with mathematical modelling, to examine the likely impact of ART on the HIV epidemic, accounting for potential behaviour change.

Methods

Cohort participants are surveyed every 3 months on sexual behaviours. ART rollout began in 2004. Using regression, we examined potential associations between timing of ART initiation and sexual behaviour among HIV-infected, and timing of ART availability and sexual behaviour among HIV-uninfected. We then used a compartmental mathematical model to assess the impact of ART on HIV epidemiologic trends, under varying assumptions about rates of initiating ART and behaviour change. The model has been described previously in peer-reviewed literature.

Results

We found no evidence of increased risk behaviour after ART initiation to levels higher than 2 years before initiation. There is some evidence of rising risk behaviour among HIV-uninfected people in response to ART availability. Among HIV-uninfected, the mean number of casual partners in the past 3 months fell from 0.02 in 2002 to 0.01 by 2004 and then rose to 0.03 by late 2008 (p for change in trend from declining to rising numbers of casual partners over the period 2002–2008=0.030). The mean number of new partners in the past 3 months fell from 0.13 in early 2002 to 0.02 in the late 2004. By 4th quarter of 2008, the number of new partners in the past 3 months had risen to 0.20 (p=0.058). Regardless of changing sexual behaviour, the model suggests that ART will reduce HIV incidence, but increase prevalence. This occurs even when ART initiation begins in HIV stage 2 (∼3 months after infection) and 90% of HIV-infected are on ART and the probability of transmission while on ART declines greatly (right panel of Abstract P1-S6.51 Figure 1 baseline of no ART displayed in left panel). The conditions required for ART to reduce prevalence had to be more extreme than this (left panel).

Abstract P1-S6.51 Figure 1

Sensitivity analyses of dual impact of ART and potential behaviour change on HIV prevalence.

Conclusions

Due to HIV+ people enjoying a longer life expectancy, and an insufficient drop in incidence, HIV prevalence will rise as a result of ART. Modelling suggests that even small increases in risky sexual behaviour will lead to further substantial increases in HIV prevalence. Policy makers are urged to continue promoting sex education, and be prepared for a higher than previously suggested number of HIV+ people in need of treatment.
P1-S6.52 Is PEP a misused therapy? Cross sectional PEP study in sex worker outreach program clinic
Authors: Mungai Jane , Kiguoya Marion , Wachihi Charles , Kimani Joshua , Kiogora Festus , Mwanjewe James , Gelmon Lawrence
Published: July 2011

Background

Post-exposure prophylaxis (PEP) is a short-term anti-retroviral (ARV) treatment that reduces the likelihood of HIV infection after exposure to HIV-infected blood or sexual contact with an HIV-positive person. We are able to offer PEP mediations in our SWOP clinics to clients reporting high risk exposure. Normally ARVs for PEP are given within 72 h of exposure for a period of 4 weeks. Our objective was to assess whether the clients had already established STIs prior administration of PEP. The clients were aged between 19 and 49 years with each having an average of 9 men clients per day.

Methods

A cross sectional study was conducted on 91 female sex workers who came to the clinic for PEP in the period September 2009 to July 2010. The female sex workers were first given counselling, completed a standard questionnaire before having PEP administered. The samples taken included blood for HIV Elisa, high vaginal swab for Gonorrhoea Culture on Thayer martin media and Gram stain smear for Bacteria vaginosis, presence of spermatozoa and white blood cells.

Results

The clients were all HIV seronegative. 76% of the women had come for PEP for the first time, 21% for the second time and 3% for the third time. 80% of the patients reported condom burst, 8.6% were as a result of rape or coerced sex, while 3.2% reported client refused condom use. However 73% smears of the women did not have spermatozoa. Overall 9% of the patients were GC positive but 3.2% had GC and spermatozoa while 6.6% had GC without spermatozoa. Trichomonas prevalence was 4.3% but all these patients did not have spermatozoa. 38% had a WBC count of over 6–30 field on gram stain Conclusion: The presence of high white cell count at the time of seeking PEP may indicate a pre-existing infection, hence presence of underlying high risk behaviour. Moreover presence of GC and TV without spermatozoa may also indicate exposure longer reported. There is need to educate sex workers on proper use of PEP and to maintain low risk behaviour. We also need to understand the decision making process of sex workers in choosing post-exposure prophylaxis and any barriers that may contribute to delays in seeking PEP.
P1-S6.54 Medical male circumcision may be protective of urogenitalMycoplasma genitaliuminfection: results from a randomised trial in Kisumu, Kenya
Authors: Mehta S , Gaydos C , Maclean I , Odoyo-June E , Moses S , Murugu R , Agunda L , Nyagaya E , Quinn N , Bailey R
Published: July 2011

Background

We determined the prevalence ofMycoplasma genitalium(MG) and whether this was associated with circumcision status, among men enrolled in the randomised trial of medical male circumcision (MMC) to prevent HIV acquisition in Kisumu, Kenya.

Methods

MG was detected in first void urine (FVU) by APTIMA transcription mediated amplification (TMA) assay. FVU and urethral swabs were assessed forNeissseria gonorrhoeae(NG) andChlamydia trachomatis(CT) by PCR, and forTrichomonas vaginalis(TV) by culture. HSV-2 detection was by IgG ELISA. Personal interview assessed socio-demographic and behavioural risks. All men underwent standardised medical history and physical examination.

Results

July through September 2010, 52 (9.9%; 95% CI: 7.3 to 12.4%) MG infections were detected among 526 men. The prevalence of NG (1.4%) and TV (2.7%) did not differ by MG status. CT prevalence was 5.8% among MG-infected men, and 0.8% among MG-uninfected men (p=0.02). CT infection at enrolment was more prevalent among MG infected men (27% vs 9% uninfected, p=0.005); NG and TV at enrolment were not associated with MG. Current urethral discharge symptoms and exam findings did not vary by MG status (1.9% positive vs 1.5% negative, p=0.80), but remote history of urethral discharge (past 6 months) was 5.8% among men with MG vs 2.1% uninfected (p=0.10). The prevalence of MG was 13.4% in uncircumcised men vs 8.2% in circumcised men (p=0.06). In multivariable logistic regression, circumcision status nearly halved the odds of MG [adjusted OR=0.54; 95% CI 0.29 to 0.99], adjusted for variables significant at the p<0.05 level: HSV-2 infection [aOR=2.05; 95% CI 1.05 to 4.00], CT infection at enrolment or at follow-up [aOR=2.69; 95% CI 1.44 to 5.02], washing the penis ≤1 h after sex [aOR=0.47; 95% CI 0.24 to 0.95]. The prevalence of MG did not differ by HIV status, age, education, marital status, number of sex partners, condom use, or sex during menses. There were no interactions with circumcision status.

Conclusions

Prospective study is needed to verify the potential protective association between MMC and MG. The mechanism by which MMC may protect against MG is unclear. Randomised trials have not found MMC to protect against other urethral infections (NG, CT, TV), though circumcised and uncircumcised men may have different peri-urethral bacteria and penile microbiome. The role of MG in STI morbidity, syndromic management algorithms and antibiotic regimens for men and women in this region should be evaluated.
P2-S1.01 Beyond the ABC in HIV/AIDS prevention: a systematic literature review of sexual education programs for young people
Authors: Estrada-Montoya J H
Published: July 2011

Background

Latin-American young people are the fastest growing group living with, or at high risk of acquiring HIV. Young people are vulnerable due to sexual behaviour; use of illicit drugs; lack of access to education and health services; cultural and social-economical factors; structural violence; marginalisation and poverty. Acceptable success for sexual education programs are decrease in adolescent pregnancy, STD and HIV infection rates. This study tried to identify those characteristics of programs that achieved one or more of mentioned success criteria and could be adapted and implemented in Latin America, taking into account its particular historical and contextual conditions.

Methods

A systematic literature review of evaluations of HIV educational programs for young people published in international databases within the last 4 years was performed. Specialised educational evaluation books, primary and secondary documents and unpublished literature were also consulted.

Results

The review identified 182 documents related to the evaluation of HIV educational programs. Successful programs had at least one of the following characteristics: exceeded the ABC (Abstinence, Be faithful, Condom use) methodology; were supported by national authorities; used participative instruction methods; presented comprehensive information, including general HIV education, risk reduction practices, methods of contraception and condom use, respect for sexual/gender diversity; and guaranteed that young people joined and remained into the educational programs.

Conclusions

Successful HIV/AIDS educational programs should promote the acquisition of protective though processes and behaviours by focusing on the historical, contextual, psycho-social, and sexual factors that affect behaviour and health. An education committed to HIV/AIDS prevention should be accessible to young people through the schools and must support life conditions that allow them to take advantage of the different learning opportunities. Literature review suggests that youngs may acquire the knowledge, abilities, competences, values, and attitudes that make possible to overcome the conditions of vulnerability to HIV they face.
P1-S1.28 The prevalence and incidence of bacterial vaginosis in a cohort of young Australian women
Authors: Walker J , Hocking J , Fairley C , Tabrizi S , Chen M , Bowden F , Gunn J , Donovan B , Kaldor J , Bradshaw C
Published: July 2011

Background

Bacterial vaginosis (BV) is a common condition of unknown aetiology that can be associated with late miscarriage, pre-term delivery, PID and increased susceptibility to HIV & other STIs. In Australia, treatment is restricted to women who are symptomatic or pregnant or undergoing gynaecological treatment, however, recurrent infection is common following treatment. Currently, there are no community based BV prevalence or incidence data for Australia.

Methods

Women aged 16 to 25 years were recruited from sexual health clinics (SHC) and general practice clinics (GP) in South-Eastern Australia and provided with kits containing vaginal swabs and microscope slides to self-collect vaginal smears at 0, 6 and 12 months; 6- and 12-month samples were returned via post. Vaginal smears were scored using the Nugent method. BV prevalence was measured at time of recruitment and adjusted ORs (AOR) calculated to explore associations; BV incidence was measured over the study period and adjusted HRs (AHR) calculated to explore predictors of infection. Incident BV was diagnosed if a participant at baseline had a Nugent score <7 followed by a subsequent Nugent score of 7–10 at 6 or 12 months. Women diagnosed with BV at recruitment were excluded from the incidence analysis.

Results

Overall, 1116 women were recruited from 29 clinics; slides were available for 1112 (99%) women at the baseline and 875 women (79%) at study completion. The prevalence of BV at recruitment was 11.8% (95% CI 9.9 to 13.7). Prevalent BV was associated with increased numbers of recent male sexual partners (AOR=2.2; 95% CI 1.0 to 4.6), a recent female sexual partner (AOR=3.2; 95% CI 1.6 to 6.5), being recruited from SHC (AOR=1.7; 95% CI 1.1 to 2.5) and having a lower level of education (AOR=0.5; 95% CI 0.3 to 0.7). There were 88 cases of incident BV yielding an incidence of 8.8 per 100 women years (95% CI 7.1 to 10.8). Incident BV was associated having increased numbers of new sexual partners (AHR=1.7; 95% CI 1.1 to 2.5). Both prevalent and incident infections were associated with increased numbers of self-reported symptoms, in particular “abnormal vaginal discharge” and “abnormal vaginal odour”.

Conclusion

These are Australia's first community-based BV prevalence and incidence estimates and show that BV is very common among young women and frequently associated with increased sexual activity.
P2-S1.10 Identifying key elements describing sexual behaviour in the Danish Population: a Qualitative Study
Authors: Jørgensen M J , Maindal H T , Olesen F , Andersen B
Published: July 2011

Background

Surveying the sexual behaviour of the general population serves to identify key points of intervention, monitor the effect of such an intervention and interpret changes in the spread of sexually transmitted infections over time. Validated questionnaires describing sexual behaviour could be adapted from other countries, but due to cultural differences this could result in the need to add additional or other questions in order to describe the important Danish issues sufficiently. With a view to designing and initiating a sexual behaviour surveillance program in Denmark, the aim of this qualitative study was to identify points of particular importance to adolescents' sexual behaviour.

Method

We conducted four semi-structured focus group interviews with a total of 19 sexually experienced adolescents aged 18 to 23. Boys and girls were interviewed separately. Each group contained pupils from the same Danish Folk High School, but with different social and educational backgrounds. The interview guide was developed on the basis of literature reviews and hypotheses based on many years of experience with sexually transmitted infections from an epidemiological perspective as well as treatment of patients with sexually transmitted infections. Data were transcribed verbatim and analysed using qualitative description.

Results

We identified four major categories of risk behaviour: 1) Alcohol consumption is associated with “no condom use”. 2) Nights on the town and meetings in foreign counties or at festivals are associated with one night stands and often lead to unsafe sex. 3) Low self-esteem increases the risk of pushing one's personal boundaries, thus resulting in promiscuous sexual behaviour. 4) Increased sexual experience is associated with lack of condom use. Surprisingly, the informants did not consider drug abuse and internet dating to be triggers of unsafe sex see Abstract P2-S1.10 Figure 1.

Abstract P2-S1.10 Figure 1

Important risk factors for unsafe sex among adolescents.

Conclusion

Danish adolescents identified four key elements that could lead to unsafe sex. These results differed slightly from our expectations and will be included in a sexual behaviour questionnaire to describe important elements influencing the sexual behaviour of Adolescents.
P2-S1.11 Factors surrounding lack of condom use at first intercourse and later onset of condom use: a study of college-age men
Authors: Warner L ,   K M, Gavin L , Macaluso M
Published: July 2011

Background

Condom use at first coitus is associated with greater lifetime condom use. Little is known, however, about factors which influence non-use of condoms at first coitus.

Methods

Data were analysed from a cross-sectional study on condom use behaviours conducted among 98 heterosexual male students attending two Georgia universities. Men were asked to recall condom use during first and subsequent coitus. Multivariable logistic regression was conducted to evaluate factors associated with non-use of condoms at first coitus and how non-use influenced their future condom beliefs and use.

Results

Participant averaged 22.4 years at interview, 16.8 years at first intercourse (range:13–23), and 5.6 years (range:0–12) between first condom use and time of interview. Overall, 47 men (48%) reported not using condoms at first coitus, and not initiating use until an average of 13 acts after sexual debut (med=5; range:1–100). Reasons for eventual condom initiation included: concern about infection/pregnancy (53%), partner insistence (32%), and condoms being available (15%). Compared with men who used condoms at first intercourse, men initiating use afterwards were significantly more likely to report their first condom experience was negative (62% vs 35%, aOR=2.8, 95% CI 1.1 to 7.2), and were less inclined to use condoms subsequently based on this first experience (34% vs 14%, aOR=3.4, 95% CI 1.2 to 8.8). However, measurement of condom use during most recent coitus did not differ significantly between men who initiated condom use after vs at their first intercourse both at last sex (43% vs 55%) and for both consistent use during the last month (43% vs 39%) and year (26% vs 20%).

Conclusions

Public health efforts should emphasise the importance of condom use at first intercourse. Counselling should be provided to help prepare men for a positive first experience with condoms, given that this experience may affect immediate subsequent condom use following sexual debut.
P1-S1.29 Use of molecular sequencing to compare the vaginal microbiota of healthy women and women with bacterial vaginosis in India
Authors: Kotian S , Arun A , Krupp K , Srinivas V , Madhivanan P , Riley L , Raphael E , Reingold A , Klausner J
Published: July 2011

Background

Lactobacillus species is an integral part of vaginal microbiota that maintains a healthy environment and plays an important role in preventing STI and HIV. We examined 20 women to investigate the difference in the diversity of Lactobacillus species present when the women are healthy or have Bacterial Vaginosis (BV).

Method

Between February and November 2010, samples from a total of 20 women attending Prerana Women's Health Clinic were collected. Out of 20, 10 women were considered healthy and 10 women were diagnosed with BV based on Amsel's Criteria. In addition, Gram stained smears of vaginal fluid were Nugent scored as negative, intermediate, or positive for BV. Based on the Nugent score criteria, nine were Positive, nine were negative and two showed “Intermediate” Nugent Score. Vaginal swabs were taken from the women with informed consent after ethical approval and grown in MRS broth. Gram positive Lactobacilli generating about 600–800 bp amplicon by16SrDNA PCR were further characterised by sequencing.

Result

Lactobacillus crispatus(40%) andLactobacillus jensenii(40%) were the most common Lactobacillus species found in the vaginas of healthy women, the same Lactobacillus species found in healthy women in other countries.L crispatuswas cultured from 40% of healthy women and none of women with BV.L jensenii,L gasseri, andL acidophiluswere cultured from 40%, 10% and 10% of healthy women respectively; and none of the women with BV.Lactobacillus inerswas not detected among healthy women or women with BV in our sample. Other organisms found among women wereStaphylococcus epidermidis(60% among women with BV and 30% among healthy women),Streptococcus anginosus(40% among women with BV and 20% among healthy women). SomeCorynebacteriumspp were common among both women with BV and healthy women. Among the two women with “Intermediate” nugent score, one did not show growth of any Lactobacillus and in the other case there was growth ofLactobacillus salivarius.

Conclusion

Our findings showed Lactobacilli species present in healthy vagina of women in India do not differ from those reported from other countries. This information is useful for the development of microbicides for HIV prevention as well as better understanding of the reproductive health of women in India.
P2-S1.16 Social influences on relationship fidelity and concurrency patterns among Latino adolescents in San Francisco
Authors: Minnis A , van Dommelen-Gonzalez E
Published: July 2011

Background

Our previous research in San Francisco's Mission District, a predominantly Latino neighbourhood characterised by high immigration, poverty, and gang-related violence, highlighted diverse partnership patterns among youth and the role of gang affiliation in high-risk sexual activity and pregnancy. 38% of Latino youth reported concurrent partnerships.

Methods

We conducted 33 semi-structured in-depth interviews with immigrant and US-born male and female Latino youth aged 16–21 to explore how the social environment affected partnership formation and STI risk. Participants were recruited from community venues; interviews were conducted in Spanish or English. Interview transcripts were coded in Atlast.ti. We analysed the following themes: relationship fidelity; STI prevention; and concurrency norms (agreement with the statement, Many Mission youth in a relationship are also seeing someone on the side).

Results

Participants were 48% female; had a mean age of 17.5 years; and 55% were immigrants from Mexico or Central America. 27 of 30 believed that concurrency is widespread, described as “cheating” (having a “main girl with ‘friends with benefits’ on the side”) or resulting from initiating new relationships before ending existing ones or between serial break-ups with a main partner. Infidelity was motivated by machismo, a cultural notion of masculinity that was heightened for men respected for having multiple partners; boredom with a single partner; an ideal that fidelity was only relevant within marriage with cheating expected prior to that; and revenge for known, suspected or pre-emptive cheating. Street gangs introduced distinct reasons for young males preferring multiple, casual partnerships: limited time for relationships because of obligations to the gang first and foremost; disinterest in committed relations to avoid emotional vulnerability given emotional demands of street life; and multiple partners bringing status: “you got more game; you got more reputation.” Young women recognised that having partners in a gang brought social prestige and articulated strategies for increasing intimacy (eg, pregnancy) to draw partners away from the street and strengthen commitment to the relationship. Despite a perception of pervasive concurrency, STI risk perception was low.

Conclusions

Many relationship norms and expectations held by youth supported concurrency, highlighting the importance of addressing social influences like gangs in STI prevention.
P2-S2.01 Support groups as a strategy for reducing HIV vulnerability among female sex workers in Bellary, Northern Karnataka, India
Authors: Chintada D R , Pillai P , Mahadevapappa S , Mohammed P , Isac S , Ramesh B M , Ramappa V , Bhattacharjee P , Moses S
Published: July 2011

Background

The Karnataka Health Promotion Trust implements HIV preventive interventions for female sex workers (FSWs) in Karnataka, South India, in partnership with non-governmental and community-based organizations (NGOs and CBOs). These interventions are supported by the Bill & Melinda Gates Foundation. Community mobilisation and collectivisation are key vulnerability reduction strategies. In Bellary district, FSWs are encouraged to form site-level groups of 10–12 members which meet regularly. They discuss STIs, HIV, condom negotiation skills, and other important issues. They also support members during crises, and engage in savings and credit activities. We attempted to understand the impact in Bellary of collective membership and the availability of economic support on two measures of safer sex behaviour: clinic attendance and condom use with last client.

Methods

Multivariate logistic regression was used to measure the association between the outcome variables and collective membership, using data from a round of integrated behavioural and biological assessments conducted in Bellary in 2008. We also conducted focus group discussions (FGDs) with members and non- members of collectives, to understand the reasons for observed associations.

Results

34% of FSWs were members of collectives. Members were 7 times more likely to have used condoms with their last client (adjusted OR [AOR]: 7.5, 95% CI 1.9 to 30.1, p<0.05). Additionally, collective members were 4 times more likely to visit an STI clinic than non-members (AOR: 4.6, 95% CI 2.0 to 10.6, p<0.05). FGDs revealed that alternate sources of economic activity, such as savings enhancement and low interest loans to collective members, reduced sex workers' dependence on exploitative sources of credit, enabling them to better negotiate condom use with clients who resisted unprotected sex. Further, the sex worker collectives helped FSWs to overcome their fears of stigmatisation, creating a more enabling environment that positively influenced access to clinics for STI care.

Conclusions

Membership in site-level groups considerably increased access of FSWs to program services. Activities to address the economic vulnerability of female sex workers were key factors in enabling greater condom use. Savings and access to credit helped FSWs to reduce their dependency on sex work, and enabled them to more readily negotiate condom use with clients.
P2-S2.03 Reaching the new and young migrant sex workers: strategies for intervention
Authors: Ramanaik S , Doddamane M , Srikantamurthy S , Ravindra I , Meti R , Hiremath T , Mirji A , Holidasar G , Pudur M , Ragavendra T , Bhattacharjee P
Published: July 2011

Background

Large numbers of young girls enter sex work are migrating from source villages in North Karnataka to the brothels in destination cities in Maharashtra facilitated by families, brothel madams and network operators in a very confidential way. Though there is strong evidence that girls from the North Karnataka region start sex work at the age of 15 and are not reached adequately by traditional targeted intervention programmes in either source or destinations. New and young sex worker (FSW) are particularly vulnerable to HIV as they have higher clients, work under power structures where condom negotiation or access to services is poor and do not possess skills to negotiate condoms with clients. Evidence from Integrated Behaviour and Biological Survey in Karnataka show the HIV infection among young FSWs is 28.3% and 16.7% in 2009 and 09 respectively and even it is very high (38.5% & 35.6%) with the women enter through traditional devadasi system.

Methods

The project is providing workable strategies to work with new and young migrant FSWs who are one of the crucial links in HIV prevention. A team of migration counsellors (MCs) tracking and connecting them to the organizations working at source and destination to ensure, they have access to condoms and services. Providing pre-departure and post-arrival counselling, connecting family at source and the free helpline services is also made available. Intervention with brothel madams and family member is an advantage to reach early. The project also working with adolescent girls in traditional devadasi community by developing their life skills to ensure that they are aware of HIV prevention methods and have skills to negotiate their use if and before they enter sex work.

Results

In 1-year period, 1200 young and new migrant FSWs are registered and availing services at both the places. MCs are regularly visiting destinations and able to track 90% of migrant FSWs on every month. 7500 pre departure and post arrival counselling sessions were conducted and all the families at source are contacting regularly. 223 brothel madams are identified and all are actively involved in the program. 1464 adolescent girls are enrolled for life skill education program at source villages.

Conclusions

Young and adolescents' preference for brothel-based sex work suggests the need for programmatic focus on brothel madams, family members and adolescents program at source as an effective way to reach these young FSWs

Abstract P2-S2.03 Figure 1

Logic Model to Reach New & Young FWS.
P2-S2.08 Changing patterns and drivers of migration among female sex workers of Northern Karnataka to large cities of Maharashtra, India in the context of HIV/AIDS
Authors: Halli S , Blanchard J , Bhattacharjee P , Raghavendra T , Moses S
Published: July 2011

Background and Objectives

The large number of FSWs from the rural areas of Northern Karnataka's three districts namely Bagalkot, Belgaum and Bijapur (3B districts) who migrate and work in Maharashtra cities particularly in Solapur, Poona, Bhiwandi and Mumbai in brothels and lodges. In this corridor” of migration and interconnected HIV epidemics, an attempt is made in this paper to specifically address the following objectives: 1. To assess the volume of sex worker migration from different sites and its annual turnover. 2. To describe the patterns of sex worker migration to and from the three districts of northern Karnataka and the large urban centres of Maharashtra.

Methods

Mapping was conducted following enumeration of the units; visited each unit (brothels and in some areas also lodges and/or dhabas) where we had prior information that sex work was conducted and interviewed the unit manager (ie, brothel madam, lodge/ dhaba manager). The manager provided information regarding: the number of FSWs working in the unit at the time—total number, FSWs from Karnataka, FSWs from the 3B districts; number of FSWs from the 3B districts that worked in the unit in the previous year and how many of them had moved to another unit in the same area. Moreover, managers provided the place of origin, age and duration of stay in the area of the FSWs from the 3B districts working in the unit at the time of data collection.

Results

In case of Bhivandi, Mumbai's Kamathipur and Poona, 571, 390 and 604 FSWs were from 3B districts respectively. There were 338 women working in Solapur. Of the 338 women, 127 were from Karnataka and all most all of them (114) from the 3B districts.

Conclusions

Migration of FSWs from 3B districts is decreasing considerably to Maharashtra brothels. There is high turnover of FSWs from 3B districts in Solapur (100% per month), especially in lodges. This suggests that the proximity of Solapur to Bijapur (the main place of origin for FSWs in this place of destination) may be an important driver of the movement of FSWs. In other words, the difference in turnover between Solapur and the other places of destination may be indicative of two changes in the migration pattern: a) FSWs from the 3B districts may prefer closer destinations, rather than the “classic brothel based” destinations (eg, Mumbai, Pune, Bhiwandi due to declining clients); and b) FSWs from the 3B district who migrate to nearby destinations may prefer working in lodges rather than brothels, the “classic” place of sex work in Maharashtra where high prevalence of HIV/AIDS is observed. This is supported by mean ages of the FSWs (31.5, 28.3, 34.5 and 27.6) and mean durations of stay (10.5, 6.8, 11.9 and 4.0) in Bhiwandi, Pune, Mumbai and Solapur respectively.
P2-S2.12 Condom use within intimate partnerships of female sex workers in Southern India
Authors: Deering K , Bhattacharjee P , Washington R , Bradley J , Boily M C , Shaw S , Shannon K , Ramesh B M , Rajaram S , Moses S , Alary M
Published: July 2011

Background

Although female sex workers (FSWs) report high levels of condom use with commercial sex clients, particularly after targeted HIV preventive interventions have been implemented, condom use is often low with intimate partners. There is limited understanding regarding the factors that influence condom use with FSWs' non-commercial intimate partners, and how programs can be designed to increase condom use. The main objectives of this study were therefore to describe FSWs' self-reported intimate partners, along with interpersonal factors characterising their intimate partnerships, and to examine factors associated with inconsistent condom use within intimate partnerships.

Methods

This study used data collected from cross-sectional questionnaires administered to 988 FSWs in four districts in Karnataka state in 2006. We used bivariate and multivariable logistic regression analysis to examine the relationship between inconsistent condom use (ie, “never”, “sometimes” or “frequently”, compared to “always”) with intimate partners of FSWs (including husbands/cohabiting partners and other non-paying partners) and interpersonal factors describing these partnerships. Weighting and survey methods were used to account for the cluster sampling design.

Results

Overall, 511 (51.8%) FSWs reported having husbands/cohabiting partners and 273 (26.0%) reported having other non-paying partners. Inconsistent condom use with these partners was high (77.4% and 60.4% respectively). In multivariable analysis, adjusting for social and environmental factors, the odds of inconsistent condom use with husbands/cohabiting partners and other non-paying partners were 12% (adjusted OR [AOR]: 1.12, 95% CIs 1.06 to 1.17) and 35% (AOR: 1.35, 95% CI 1.13 to 1.62) higher for a one-year increase in the duration of the relationship, respectively. The odds of inconsistent condom use with husbands/cohabiting partners was 50% lower if these partners knew that the respondent was a sex worker (AOR: 0.50, 95% CI 0.29 to 0.86). The odds of inconsistent condom use with other non-paying partners was 68% lower if the respondent reported ever having stayed or lived with these partners (AOR: 0.32, 95% CI 0.13 to 0.79).

Conclusions

Improved designs for HIV preventive programs, including partner- or couples-focused programs, should be developed to address issues related to FSWs' intimate partnerships and increase condom use.
P1-S1.31 Chlamydia trachomatisin Norway, 1988–2009
Authors: Skjeldestad F E , Kløvstad H
Published: July 2011

Background

Chlamydia trachomatisis the most commonly reported STI in Europe. We present the epidemiology ofC trachomatisin Norway from 1988 to 2009.

Methods

Until 2004 the Norwegian Surveillance system of infectious diseases (MSIS) captured the total number of diagnosed cases and tests performed from all diagnosing laboratories. From 2005 date of diagnosis, birth year, sex and municipality of living has been included for each diagnosed case. We calculated testing rates, incidence rates (IR) and incidence rate ratios (IRR) with 95% CIs.

Results

The IR of diagnosed cases was at its lowest in 1995 (287/100 000) and increased yearly until 2008 (467/100 000). The testing rate reached a peak in 1991 (8000/100 000), decreased towards year 2000 (5300/100 000) and has been stable until 2009 (5500/100 000). The proportion positive tests has increased yearly from 4.1 % in 1993 to 8.6 % in 2009. The highest mean annual IR was found in the age group 20–24 years for both men (2983/100 000) and women (4818/100 000). Women were 1.6 times more likely (IRR of 1.6, 95% CI 1.6 to 1.62) to be diagnosed withC trachomatiscompared to men, and inhabitants in the two most northern regions were more likely to be diagnosed than the rest of the country (IRR 1.6, 95% CI 1.5 to 1.7).

Conclusion

The IR ofC trachomatisin Norway is increasing while the testing rate is stable. More detailed data of the case mix among the tested subjects is needed to interpret the observed trends.
P2-S2.14 Alcohol abuse and sexual victimisation among female sex workers in China
Authors: Hong Y , Zhang C , Li X
Published: July 2011

Background

Global literature suggests women often have higher sexual risks under the influence of alcohol abuse. However, data are limited from vulnerable population such as the female sex workers (FSW) in developing countries. The current study aims to fill out the literature gap by examining the association between alcohol abuse and sexual victimisation among FSWs in China.

Methods

A cross-sectional survey was conducted among 1022 FSWs who were recruited through community outreach from nine different types of entertainment establishments in Guangxi, China. The FSWs completed a self-administered survey on their demographic, information, alcohol use/abuse behaviours (AUDIT), and sexual victimisation experience. Multivariate regression was employed to assess the relationship between alcohol abuse and sexual victimisation.

Results

FSWs who were younger, less educated, never married, and working in an alcohol-serving establishment were more likely to have higher risks of alcohol abuse (p<0.05). FSWs who were at higher risks of alcohol abuse reported significantly higher sexual victimisation experience (p<0.001). Multivariate models indicated significant relationships between alcohol abuse and sexual victimisation experience while controlling for potential demographic confounders, such as having been made drunk by client (aOR=1.10, 95% CI 1.07 to 1.16), “having been stripped off (aOR=1.07, 95% CI 1.02, 1.13)”, “having been taking advantages (aOR=1.08,95% CI=1.05 to 1.12)”, “having been asked for extra demands (aOR=1.08, 95% CI 1.05 to 1.11)”, and “having been sexually assaulted (aOR=1.08, 95% CI 1.04 to 1.13)”.

Conclusion

Alcohol abuse was prevalent and associated with sexual victimisation experience among FSWs in China. Culturally appropriate interventions are urgently needed to reduce alcohol use related sexual risks among this vulnerable population.
P2-S2.16 Impact of duration of exposure to sex work on HIV prevalence in 23 districts of Southern India
Authors: Pickles M , Boily M C , Deering K , Vickerman P , Ramesh B M , Washington R , Isac S , Adhikary R , Paranjape R S , Alary M
Published: July 2011

Background

HIV prevalence among female sex workers (FSW) in various districts of Andhra Pradesh (AP), Karnataka (KA), Maharashtra (MH), Tamil Nadu (TN) ranged between 8 and 26%, 10 and 34%, 6 and 38%, 2 and 13%, respectively, in 2005–2006. The duration of selling or buying sex has been suggested as a key determinant that may explain ecological difference in HIV prevalence. Thus, we estimated FSW duration across geographically distinct districts and assessed its impact on HIV transmission.

Methods

Cross-sectional FSW survey data from 23 districts of MH, TN, KA, AP (2005–2006) (IBBA), collected as part of the evaluation of Avahan, the India AIDS initiative, were used to estimate FSW duration (crude duration=difference between age at survey and age of entry into sex work). “Corrected” durations that adjust for the censored nature of the data (as FSW are still in sex work) were estimated for FSW using a birth-and-death dynamical model (with 9 duration compartments) fitted by maximum likelihood to each district-specific FSW IBBA duration distribution. A deterministic model of HIV transmission among FSW/clients was parameterized/fitted to Belgaum IBBA data with crude FSW duration of 9.6 years for FSW. FSW duration was thereafter varied between 1and 33 years to assess its influence on model HIV prevalence, for different assumed client duration (4–17 years). Each individual leaving was replaced by a new susceptible person.

Results

Mean crude FSW durations ranged between 3.7 and 9.6 (median 3–7) years across districts compared to 4.3 (Bangalore, Thane street-based) and 12.5 (Belgaum) after correction. District average corrected durations tended to be shorter for TN (6 years) and longer for MH (9 years). Within-district differences (ratios) between corrected and crude durations ranged between 0.5 and 3 years (1.1–1.3-fold). Observed differences in FSW duration across districts had a modest impact on FSW/client HIV prevalence if duration exceeded 9 years (Abstract P2-S2.16 figure 1), independently of client duration. The impact of FSW duration below 3 years on FSW/client HIV was critical. FSW/client HIV prevalence was more sensitive to variation in client duration exceeding 9 years (Abstract P2-S2.16 figure 1).

Abstract P2-S2.16 Figure 1

Conclusions

Crude duration may underestimate FSW duration by up to 32%. This level of error is unlikely to influence FSW HIV prevalence projections. Large variation in HIV across districts is unlikely to be explained by FSW duration alone if exceeding 9 years but could be potentially be explained by variation in client duration.
P2-S2.17 Community-Led Structural Invention's promise for HIV prevention: a case study from the Ashodaya Samithi Sex Worker Collective of Mysore, India.
Authors: O'Brien N , Reza-Paul S , Akram P , Jai S , Venukumarc K T , Venugopalc M S , Fatima M P , Lorway R
Published: July 2011

Background

As evidence has revealed the role of broader political, economic and local environmental factors in shaping HIV epidemic transmission patterns, new approaches have emerged that move beyond addressing individual risk behaviour to addressing the structural forces that condition risk. Within this context, Community-Led Structural Interventions (CLSI) aimed at reducing sex workers' vulnerability have demonstrated successes in reducing STI and HIV transmission in India.

Methods

A comprehensive CLSI, know as Ashodaya Samithi, was initiated in the South Indian district of Mysore. Established in 2004 by the India AIDS Initiative (Avahan), Ashodaya is funded through the Bill and Melinda Gates Foundation and implemented by Karnataka Health Promotion Trust. Four-years into its inception, the project lays claim to significant successes. The collective has reported a reduction in STIs, an increase in condom use, and the mobilisation of 1500 sex workers. Our research describes and analyzes sex workers' participation as it unfurled across various phases of collectivisation. Qualitative, community-based research methodologies were utilised including; 40 open-ended interviews, participant observations and focus groups. Drawing upon these findings we explored how a community of sex workers came to develop the ability to recognise, challenge and significantly alter an array of unequal power relations that shape HIV vulnerability in their everyday lives.

Results

Our research demonstrates the promise CLSI projects hold for preventing the spread of HIV. Ashodaya's success depends on its ability to set new community norms, create a safer working environment, improve stakeholder relationships, and provide a supportive network. The interrelated processes of mobilisation, collectivisation, sex-worker identity, and political action, which transformed day-to-day vulnerability to HIV for Mysore sex workers demonstrates how complex HIV prevention remains.

Conclusions

Findings from the Ashodaya collective offer valuable lessons for public health practice. The Ashodaya collective demonstrates how CLSI strategies can be employed to help transform the very vulnerabilities that endanger health and sustain STI and HIV transmission. The collective provides an example of the positive impact of CLSIs and provides evidence for strategies that steer away from individual or education based public health programs, to those that engage with structural inequities.