June 17, 2013
A University of Toronto review of 868 peer-based prevention programs indicated that HIV prevention programs conducted among approximately 500,000 Indian female sex workers were effective in reducing HIV, syphilis, and other sexually transmitted infections (STIs). The prevention programs, conducted between 1995-2008, provided condoms, STI treatment, and other prevention activities to reduce HIV and syphilis incidence among pregnant women tested routinely at government prenatal clinics.
India has approximately 2 million HIV-infected residents, living mainly in the Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu states. Lowering the number of STIs among female sex workers "substantially" decreased the incidence of HIV in the general population, according to Professor Prabhat Jha from the University of Toronto's Dalla Lana School of Public Health and St. Michael's Hospital's Centre for Global Health Research. The study's lead author Paul Arora stated that prompt treatment was especially critical to preventing syphilis and HIV transmission.
From 2003-2008, incidence of STIs declined (HIV by 40 percent and syphilis by 70 percent) among pregnant women. The study authors estimated that each STI treated (per 1,000 people) lowered the "annual risk" of HIV (2 percent) and syphilis (11 percent). While increased funding outreach, condom distribution, and STI treatment were effective in lowering syphilis incidence, only STI treatment was effective in decreasing HIV incidence.
The study found that programs funded by the Gates Foundation and the National AIDS Control Organization (NACO) were equally effective, although the Gates-funded projects cost five times as much as NACO projects.
The full article, "Female Sex Work Interventions and Changes in HIV and Syphilis Infection Risks from 2003 to 2008 in India: A Repeated Cross-Sectional Study," was published online in the journal BMJ Open (2013; doi:10.1136/bmjopen-2013-002724).