HIV This Week

Moses S, Ramesh BM, Nagelkerke NJ, Khera A, Isac S, Bhattacharjee P, Gurnani V, Washington R, Prakash KH, Pradeep BS, Blanchard JF. Impact of an intensive HIV prevention programme for female sex workers on HIV prevalence among antenatal clinic attenders in Karnataka state, south India: an ecological analysis. AIDS. 2008;22 Suppl 5:S101-8.

Moses and colleagues examined the impact of an intensive HIV preventive intervention among female sex workers on community HIV transmission, as represented by HIV prevalence among young antenatal clinic attenders in Karnataka state, south India. The preventive intervention was initiated in 18 of the 27 districts in Karnataka in 2003, and was generally at scale by mid-2005, covering over 80% of the urban female sex worker population. The authors examined trends over time in HIV prevalence from annual HIV surveillance conducted among antenatal clinic attenders in Karnataka under the age of 25 years from 2003 to 2007, comparing the preventive intervention with the other districts. Overall, HIV prevalence among antenatal clinic attenders under 25 years of age declined from 1.40% to 0.77%. In a multivariate model, the decline in HIV prevalence in the preventive intervention districts compared to the other districts was statistically significant (P = 0.01), with an adjusted annual odds ratio of 0.88 (95% CI 0.79-0.97). The decline in standardized HIV prevalence in the preventive intervention districts over the period was 56%, compared to 5% in the non- preventive intervention districts. Although this analysis is limited by lack of precise comparative data on intervention coverage and intensity, it supports the notion that scaled-up, intensive, targeted HIV preventive interventions among high-risk groups can have a measurable and relatively rapid impact on HIV transmission in the general population, particularly young sexually active populations as represented by antenatal clinic attenders. Such focused intervention programmes should be rapidly taken to scale in all HIV epidemics, and especially in concentrated epidemics such as in India.

Editors’ note: This Avahan-supported programme of intensive prevention with female sex workers in 2500 sex work sites underscores the importance of programme scale reaching high coverage. Attributing HIV prevalence trend differentials in the general population on an ecological basis to specific activities or events in a sub-population is tenuous but, in the absence of other explanations, it does seem likely that one of the major reasons for the observed decline was the intensive prevention programmes led by both the governmental and non-governmental sectors in these districts.