Relationship between reported prior condom use and current self-perceived risk of acquiring HIV among mobile female sex workers in southern India

<p>Abstract</p> <p>Background</p> <p>With the evolution of Health Belief Model, risk perception has been identified as one of several core components of public health interventions. While female sex workers (FSWs) in India continue to be at most risk of acquiring and transmitting HIV, little is known about their perception towards risk of acquiring HIV and how this perception depends upon their history of consistent condom use behavior with different type of partners. The objective of this study is to fill this gap in the literature by examining this relationship among mobile FSWs in southern India.</p> <p>Methods</p> <p>We analyzed data for 5,413 mobile FSWs from a cross-sectional behavioral survey conducted in 22 districts from four states in southern India. This survey assessed participants’ demographics, condom use in sex with different types of partners, continuation of sex while experiencing STI symptoms, alcohol use before having sex, and self-perceived risk of acquiring HIV. Descriptive analyses and multilevel logistic regression models were used to examine the associations between risky sexual behaviors and self-perceived risk of acquiring HIV; and to understand the geographical differences in HIV risk perception.</p> <p>Results</p> <p>Of the total mobile FSWs, only two-fifths (40%) perceived themselves to be at high risk of acquiring HIV; more so in the state of Andhra Pradesh (56%) and less in Maharashtra (17%). FSWs seem to assess their current risk of acquiring HIV primarily on the basis of their past condom use behavior with occasional clients and less on the basis of their past condom use behaviors with regular clients and non-paying partners. Prior inconsistent condom use with occasional clients was independently associated with current perception of high HIV risk (adjusted odds ratio [aOR)] = 2.1, 95% confidence interval [CI]: 1.7-2.6). In contrast, prior inconsistent condom use with non-paying partners was associated with current perception of low HIV risk (aOR= 0.7, 95% CI: 0.5-0.9). The congruence between HIV risk perception and condom use with occasional clients was high: only 12% of FSWs reported inconsistent condom use with occasional clients but perceived themselves to be at low risk of acquiring HIV.</p> <p>Conclusion</p> <p>The association between high risk perception of acquiring HIV and inconsistent condom use, especially with regular clients and non-paying partners, has not been completely internalized by this high risk group of mobile FSWs in India. Motivational efforts to prevent HIV should emphasize the importance of accurately assessing an individual’s risk of acquiring HIV based on condom use behavior with all types of partners: occasional and regular clients as well as non-paying partners; and encourage behavior change based on an accurate self-assessment of HIV risk.</p

Migration/mobility and vulnerability to HIV among male migrant workers: Karnataka 2007-08

The present study was undertaken by the Population Council and the Karnataka Health Promotion Trust to study the patterns and factors driving migration among men and the extent to which they engage in high-risk activities associated with HIV. The specific objectives of the study were: to understand the patterns and factors driving the migration of men seeking work in the state of Karnataka; to describe the characteristics of vulnerable subpopulations among migrant men; and to examine the determinants of high-risk sexual behavior among the subpopulations of migrant men, with an emphasis on their mobility as one possible factor. Results suggest no relationship between degree of mobility and risky sexual behaviors among the migrants surveyed, and no systematic pattern of a relationship between condom use with the various types of sex partners and degree of mobility, indicating the need for HIV-prevention initiatives in their home areas as well as in their work destinations. Future research is needed to improve understanding of the behavior of men working in specific occupational groups in terms of their sexual networks and HIV-prevention needs

Patterns of migration/mobility and HIV risk among female sex workers: Karnataka 2007-08

In Karnataka, South India, HIV infection is spreading, with female sex workers (FSWs) a high-risk group. In an effort to gain control over the epidemic, the HIV/AIDS program has made substantial efforts in the last few years toward offering FSWs access to information about sexually transmitted infections/HIV/AIDS and to condoms, clinics, and other medical services. The present study was undertaken by the Karnataka Health Promotion Trust and the Population Council to determine the patterns and factors that drive mobility among FSWs and the association of mobility with HIV risk. The report’s findings—including mobility routes, sociodemographic profiles of FSWs, membership in self-help groups and collectives, and locations for soliciting—will be used to help increase the impact of program intervention

Advanced techniques of population analysis/ Halli

xvi, 226 hal.:ill.; tab.: 23 cm

Low Birth Weight, the Differentiating Risk Factor for Stunting among Preschool Children in India

Background: The prevalence of low birth weight (LBW) is a major public health issue in India; however, the optimal growth pattern for such infants is not clear. The purpose of this study is to understand the causal association between LBW and stunting of preschool children in India. Methods: The National Family Health Survey-4 is a large cross-sectional survey based on a nationally representative sample of 699,686 women in the age group of 15&ndash;49 years and was conducted during 2015&ndash;2016 in India. The study used the children&rsquo;s file with a sample of 259,002 of 0&ndash;59 months for investigation. Results: The data revealed that 38.7% of the children in India were stunted. The bivariate analysis revealed that, of the women who did not attend any antenatal care (ANC) meetings, 46.8% had stunted children compared to the women who attended more than three ANC meetings, which 30.7% had stunted children. The low birth weight children experienced a much higher chance of stunting compared to children with a normal birth weight (44.3% vs. 33.8%). The multivariable odds ratios of logistic regression, after adjusting for the confounding characteristics, showed that pregnant women attending more than three ANC meetings compared to not attending any ANC meetings experienced a 19% lower adjusted odds ratio (AOR) of having stunted children (AOR = 0.81; CI 0.78, 0.85; p &lt; 0.001). Another important variable, such as women with underweight body mass index (BMI) compared with normal BMI, had 6% higher odds of having stunted children (AOR = 1.06; CI 1.03, 1.10; p &lt; 0.001). Similarly, women who belong to the Scheduled Caste compared to the General Caste had 36% higher odds of having stunted children (AOR = 1.36; CI 1.30, 1.42; p &lt; 0.001); and children aged 13&ndash;23 months compared to children up to one-year-old or younger had 141% higher odds of being stunted (AOR = 2.41; CI 2.32, 2.51; p &lt; 0.001). The conspicuous finding is that LBW babies, after adjusting for other important confounding factors, such as BMI and ANC, experienced 19% higher odds of stunted children (AOR = 1.19; CI 1.14, 1.24; p &lt; 0.001) compared to normal birth weight babies. Conclusions: The results revealed LBW is associated with stunting of preschool children in India

HIV risk behaviors among female sex workers using cell phone for client solicitation in India

Background: With the emerging technological revolution in India, the use of cell phone among female sex workers (FSWs) for client solicitation has increased rapidly in the recent past. This study examines the association between FSWs\u27 cell phone use and their HIV risk behaviors. Methods: Data were drawn from a cross-sectional behavioral survey conducted across 22 districts of southern and western India during 2007-08. The analytical sample consisted of 3028 FSWs. Bivariate and multivariate methods were used to examine the association between use of cell phone and HIV risk behaviors. Results: One-fourth (25%) FSWs used cell phones to solicit clients. Results from the multivariate analyses suggest that FSWs who use cell phones than those who do not use cell phones, were more likely to report inconsistent condom use with occasional clients (Adjusted Odds Ratio (AOR):1.9, 95% confidence interval (CI):1.5- 2.3), inconsistent condom use with regular clients (AOR:1.6, 95% CI:1.3-2.0), experience of STI-related symptoms (AOR:2.4, 95% CI:1.9-3.1), consumption of alcohol prior to sex (AOR:1.7, 95% CI:1.4-2.0) and difficulty in negotiating condom use with clients (AOR:2.1, 95% CI:1.7-2.6). Except for home-based, the use of cell phone had a multifold effect on FSWs\u27 HIV risk behaviors in other typologies of sex work. Conclusion: Use of cell phone is associated with increased HIV risk behaviors among FSWs, independent of their place of solicitation. These findings document the need for developing new strategies to reach FSWs, particularly those who use cell phones or newer technologies for client solicitation

An Estimation of Mortality Risks among People Living with HIV in Karnataka State, India: Learnings from an Intensive HIV/AIDS Care and Support Programme.

In Indian context, limited attempts have been made to estimate the mortality risks among people living with HIV (PLHIV). We estimated the rates of mortality among PLHIV covered under an integrated HIV-prevention cum care and support programme implemented in Karnataka state, India, and attempted to identify the key programme components associated with the higher likelihood of their survival.Retrospective programme data of 55,801 PLHIV registered with the Samastha programme implemented in Karnataka state during 2006-11 was used. Kaplan-Meier survival methods were used to estimate the ten years expected survival probabilities and Cox-proportional hazard model was used to examine the factors associated with risk of mortality among PLHIV. We also calculated mortality rates (per 1000 person-year) across selected demographic and clinical parameters.Of the total PLHIV registered with the programme, about nine percent died within the 5-years of programme period with an overall death rate of 38 per 1000 person-years. The mortality rate was higher among males, aged 18 and above, among illiterates, and those residing in rural areas. While the presence of co-infections such as Tuberculosis leads to higher mortality rate, adherence to ART was significantly associated with reduction in overall death rate. Cox proportional hazard model revealed that increase in CD4 cell counts and exposure to intensive care and support programme for at least two years can bring significant reduction in risk of death among PLHIV [(hazard ratio: 0.234; CI: 0.211-0.260) & (hazard ratio: 0.062; CI: 0.054-0.071), respectively] even after adjusting the effect of other socio-demographic, economic and health related confounders.Study confirms that while residing in rural areas and presence of co-infection significantly increases the mortality risk among PLHIV, adherence to ART and improvement in CD4 counts led to significant reduction in their mortality risk. Longer exposure to the intervention contributed significantly to reduce mortality among PLHIV