Background Community mobilisation interventions for HIV prevention among female sex workers (FSWs) aim to organise FSWs for collective action and challenge the structures of power that underlie HIV risk. Assessing intervention impact is challenging because the importance of direct individual exposure to intervention components may decrease over time as change occurs at social-normative, policy and other structural levels. In this paper, the authors examine changes over time in consistent condom use among FSWs in Rajahmundry, Andhra Pradesh, the location of a long-standing community mobilisation intervention.
Methods The authors analyse cross-sectional data collected among FSWs at three time points (n=2276) using respondent-driven sampling. Multiple logistic regression was used to assess the association of programme exposure with consistent condom use and whether this association varied over time.
Results The proportion of FSWs having no exposure or only receptive exposure to the intervention decreased over time, while active utilisation increased from 19.4% in 2006 to 48.5% in 2009–2010. Consistent condom use with clients also increased from 56.3% in 2006 to 75.3% in 2009–2010. Multivariate analysis showed that age, age at start of sex work, venue, living conditions and programme exposure were significantly associated with condom use. The positive association between programme exposure and consistent condom use did not vary significantly over time.
Conclusions Findings indicate improvements in HIV risk reduction behaviour among FSWs and suggest that the intervention has substantial reach in the FSW population. The intervention's strategies may be contributing to population-level HIV risk reduction among FSWs.
- Female sex workers
- condom use
- community mobilisation
- structural intervention
- social inequalities
- social epidemiology
- sexually transmitted disease
- research methods
- multilevel modelling
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Funding This study was supported by Bill and Melinda Gates Foundation through the Avahan India AIDS Initiative. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Bill & Melinda Gates Foundation and Avahan.
Competing interests None.
Ethics approval Ethics approval was provided by ethical review boards at American University, Duke University, Yale University and YRG-Care (Chennai, India).
Provenance and peer review Commissioned; externally peer reviewed.
Data sharing statement Data from this study are available for research purposes upon written request to the study PI (KMB).