To examine changes in behavioral outcomes among rural female sex workers (FSWs) involved in a community-based comprehensive HIV preventive intervention program in south India. A total of 14, 284 rural FSWs were reached by means of a community-based model for delivering outreach, medical, and referral services. Changes in behavior were assessed using 2 rounds of polling booth surveys conducted in 2008 and 2011. In all, 95% of the mapped FSWs were reached at least once, 80.3% received condoms as per need, and 71% received health services for sexually transmitted infections. There was a significant increase in condom use (from 60.4% to 72.4%, P = .001) and utilization of HIV counseling and testing services (from 63.9% to 92.4%; P = .000) between the 2 time periods. This model for a community-based rural outreach and HIV care was effective and could also be applied to many other health problems.
National AIDS Control Organization, Department of AIDS Control. Annual report 2010-11. New Delhi, India: Ministry of Health and Family Welfare; 2011.
2.
Registrar General and Census Commissioner. Census of India 2011. New Delhi, India: Ministry of Home Affairs; 2012.
3.
National AIDS Control Organization. HIV Sentinel Surveillance and HIV Estimation in India 2007. A Technical Brief. New Delhi, India: Ministry of Health and Family Welfare; 2008.
4.
BeckerMLRameshBMWashingtonRGHalliSBlanchardJFMosesS. Prevalence and determinants of HIV infection in south India: a heterogeneous, rural epidemic. AIDS. 2007;21:739-747.
5.
BlanchardJFBhattacharjeePKumaranS. Concepts and strategies for scaling up focused prevention for sex workers in India. Sex Transm Infect. 2008;84(suppl 2):19-23.
6.
Karnataka Health Promotion Trust and University of Manitoba. A Rapid Assessment of HIV Risk in Rural Areas in Karnataka. Bengaluru, Karnataka, India: Karnataka Health Promotion Trust; 2007.
7.
National AIDS Control Organization. Operational Guidelines for District HIV/AIDS Prevention Control Unit. New Delhi, India: Ministry of Health and Family Welfare; 2008.
8.
BlanchardJFHalliSRameshBM. Variability in the sexual structure in a rural Indian setting: implications for HIV prevention strategies. Sex Transm Infect. 2007;83(suppl 1):i30-i36.
9.
MignoneJHiremathGMSabnisV. Use of rapid ethnographic methodology to develop a village-level rapid assessment tool predictive of HIV infection in rural India. Int J Qual Methods. 2009;8(3):52-67.
10.
Ministry of Health and Family Welfare, Government of India. National Guidelines on Prevention, Management and Control of Reproductive Tract Infections Including Sexually Transmitted Infections. New Delhi, India: Ministry of Health and Family Welfare; 2007.
11.
LowndesCMJayachandranAABanandurP. Polling booth surveys: a novel approach for reducing social desirability bias in HIV-related behavioural surveys in resource-poor settings. AIDS Behav. 2012;16:1054-1062.
12.
WeirSSMorroniCCoetzeeNSpencerJBoermaJT. A pilot study of a rapid assessment method to identify places for AIDS prevention in Cape Town, South Africa. Sex Transm Infect. 2002;78(suppl 1):i106-i113.
13.
RameshBMBeattieTSShajyI. Changes in risk behaviours and prevalence of sexually transmitted infections following HIV preventive interventions among female sex workers in five districts in Karnataka state, south India. Sex Transm Infect. 2010;86(suppl 1):i17-i24.
14.
PallikadavathSGardaLApteHFreedmanJStonesRW. HIV/AIDS in rural India: context and health care needs. J Biosoc Sci. 2005;37:641-655.
15.
DandonaRDandonaLGutierrezJP. High risk of HIV in non-brothel based female sex workers in India. BMC Public Health. 2005;5:87.
16.
O’NeilJOrchardTSwarankarRCBlanchardJFGuravKMosesS. Dhanda, dharma and disease: traditional sex work and HIV/AIDS in rural India. Soc Sci Med. 2004;59:851-860.
17.
BuzduganRCopasAMosesS. Devising a female sex work typology using data from Karnataka, India. Int J Epidemiol. 2010;39:439-448.
18.
Reza-PaulSBeattieTSyedHU. Declines in risk behaviour and sexually transmitted infection prevalence following a community-led HIV preventive intervention among female sex workers in Mysore, India. AIDS. 2008;22(suppl 5):91-100.
19.
HalliSSBuzduganRMosesS. High-risk sex among mobile female sex workers in the context of jatras (religious festivals) in Karnataka, India. Int J STD AIDS. 2010;21:746-751.
20.
RothJKrishnanSPBunchE. Barriers to condom use: results from a study in Mumbai (Bombay), India. AIDS Educ Prev. 2001;13:65-77.
21.
ChakrapaniVNewmanPAShunmugamMDubrowR. Prevalence and contexts of inconsistent condom use among heterosexual men and women living with HIV in India: implications for prevention. AIDS Patient Care STDS. 2010;24:49-58.
22.
GeibelSKing’olaNTemmermanMLuchtersS. The impact of peer outreach on HIV knowledge and prevention behaviours of male sex workers in Mombasa, Kenya. Sex Transm Infect. 2012;88:357-362.
23.
SarafianI. Process assessment of a peer education programme for HIV prevention among sex workers in Dhaka, Bangladesh: a social support framework. Soc Sci Med. 2011;75:668-675.
24.
CampbellCMzaidumeZ. Grassroots participation, peer education, and HIV prevention by sex workers in South Africa. Am J Public Health. 2001;91:1978-1986.
25.
BasuIJanaSRotheram-BorusMJ. HIV prevention among sex workers in India. J Acquir Immune Defic Syndr. 2004;36:845-852.
26.
BéhanzinLDiabatéSMinaniI. Assessment of HIV-related risky behaviour: a comparative study of face-to-face interviews and polling booth surveys in the general population of Cotonou, Benin. Sex Transm Infect. 2013;89:595-601.
27.
ChakrapaniVNewmanPAShunmugamMKurianAKDubrowR. Barriers to free antiretroviral treatment access for female sex workers in Chennai, India. AIDS Patient Care STDS. 2009;23:973-980.
28.
GalavottiCWheelerTKuhlmannAS. Navigating the swampy lowland: a framework for evaluating the effect of community mobilisation in female sex workers in Avahan, the India AIDS Initiative. J Epidemiol Community Health. 2012;66(suppl 2):ii9-ii15.
29.
VermaRShekharAKhobragadeS. Scale-up and coverage of Avahan: a large-scale HIV-prevention programme among female sex workers and men who have sex with men in four Indian states. Sex Transm Infect. 2010;86(suppl 1):i76-i82.
