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Background

Need for innovative intervention strategies to reduce HIV transmission among men who have sex with men in Andhra Pradesh, India – following a large scale HIV prevention intervention.

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Background

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  1. Need for innovative intervention strategies to reduce HIV transmission among men who have sex with men in Andhra Pradesh, India – following a large scale HIV prevention intervention Sharmistha Khobragade1, Prabuddhagopal Goswami2, Lakshmi Ramakrishnan2, Bitra George2, Rajatashuvra Adhikary3, Shreena Ramanathan2, Shajan Mathew2, Rachakulla Harikumar4, Venkaiah Kodali4 , Ramesh Paranjape5 1 FHI 360, India, Mumbai, India 2 FHI 360, India, New Delhi, India 3 FHI 360, Washington DC, Washington DC, United States 4 National Institute of Nutrition (NIN), Hyderabad, India 5 National AIDS Research Institute

  2. Background • As per HIV estimates (NACO/UNAIDS) in 2008-09 data, India had an estimated 2.4 million (CI:2.1 million- 2.8million) HIV-positive persons • HIV prevalence among HR-MSM in Andhra Pradesh has shown an upward trend (10.25% in 2006, 17.0% in 2007 and 23.6% in 2008) • The Bill & Melinda Gates Foundation funded Avahan in 2004, a program designed to reduce the spread of the AIDS epidemic in six high prevalence states of India focusing on high-risk groups including men who have sex with men (HR-MSM) • Avahan’s strategy for HR-MSM group included HIV awareness, condom education, STI management and condom social marketing • As a part of Avahan program’s evaluation, two rounds of cross-sectional bio-behavioral surveys in 2006 (R1) and 2009 (R2) among HR-MSM were carried out in four districts of Andhra Pradesh, India, supported by BMGF Avahan program

  3. Objectives Map of Andhra Pradesh, India Hyderabad

  4. Methods • HR-MSM aged 18 years or older who acknowledged having had paid or unpaid sex with another men in past one month were recruited • Two-stage cluster sampling approach was adopted to recruit respondents in both rounds of survey • A sample size of 1621 in Round 1 and 1608 in Round 2 were achieved • Demographic profiles and behavioral information were collected through structured questionnaires • Blood and urine specimen were collected and tested for HIV and STIs status. • Multivariate analysis was carried out to measure change in condom use and biological outcomes

  5. Profile of respondents p=0.01 p=0.06 p=0.46

  6. Condom use with different male partners increased among HR-MSM p<0.001 p=0.236 p<0.001 p<0.001

  7. No significant change in HIV and STI prevalence among HR-MSM p=0.10 p=0.65 p=0.63

  8. Exposure to HIV prevention intervention and HIV testing increased over two rounds of survey p<0.001 p<0.001

  9. Multivariate analysis of selected outcomes compared between Round 1 and Round 2 among clients of female sex workers (Ref: Round 1)

  10. Summary of results from analysis • Few changes were seen in the profiles of HR-MSM between R1 and R2 • Condom use with all type of male partners significantly increased in R2 compared to R1 • No significant change in HIV and STI prevalence was observed over time between R1 and R2 • The proportion of HR-MSM exposed to intervention and those reporting ever having undergone an HIV test increased significantly between the two rounds of survey • Multivariate analysis also shows that among HR-MSM, there was significant increase in condom use with no change in HIV/STI prevalence

  11. Conclusion • Despite significant increase in condom use and exposure to HIV prevention services, HIV and STI prevalence show no change among HR-MSM in Andhra Pradesh. • More investigations and operation research are needed to identify new and innovative approaches for reducing HIV transmission among HR-MSM in Andhra Pradesh

  12. Acknowledgment • The analysis presented here is based on the data collected as part of the Avahan evaluation strategy supported by the Bill & Melinda Gates Foundation

  13. Thank you

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