HIV This Week

Ngugi EN, Chakkalackal M, Sharma A, Bukusi E, Njoroge B, Kimani J, Macdonald KS, Bwayo JJ, Cohen CR, Moses S, Kaul R; The Kibera HIV Study Group . Sustained Changes in Sexual Behavior by Female Sex Workers After Completion of a Randomized HIV Prevention Trial. J Acquir Immune Defic Syndr. 2007 Aug 15;45(5):588-94.

Behavioural interventions in female sex workers (FSWs) are associated with changes in sexual behaviour and reduced rates of sexually transmitted infections (STIs) and HIV. Ngugi and colleagues examined the sustainability of such interventions. HIV-uninfected Kenyan FSWs were enrolled in a clinical trial that provided free male condoms, community and clinic-based counselling, and STI management. After trial completion, scaled-back community-based resources remained in place. More than a year later, women were invited to complete a follow-up behavioural questionnaire and to undergo STI and HIV counselling and testing. Individual changes in sexual behaviour were assessed by paired analysis. One hundred seventy-two women participated in the resurvey 1.2 years after trial termination. Client numbers had risen (paired t test, P < 0.001), but condom use had also increased (P < 0.001); Regular partners accounted for a greater proportion of unprotected FSW sexual encounters (35% vs. 10%; P < 0.001). Only 9 (5.2%) of 172 women had a conventional STI, and the follow-up HIV incidence of 1.6 per 100 person years was similar to that during the trial period (3.7 per 100 person years). Incident STIs and HIV were associated with the frequency of unprotected sex and younger age. Less intensive community-based risk reduction services after clinical trial termination may support ongoing reductions in STIs and HIV among high-risk female sex workers.

Editors’ note: Following the end of this prevention trial which included monthly antibiotic prophylaxis, client numbers which had fallen in the trial from 16.2 to 2.8 per week rose to 6.1. Condom use which had increased during the trial continued to increase but more slowly with the result that unprotected casual encounters increased from 23.3 to 35.6 per year, in part related to an increase in the proportion of clients who were regular clients. Community-based risk reduction services after clinical trial termination need to provide a robust framework for sustained changes in sexual behaviour, addressing needs and building skills among younger women while sustaining safer sex community norms.