Correlation between behavior change among most-at-risk populations with declining HIV prevalence in general population of Western India
N. Rao1, A. Joy2, L. Jeyaseelan3, S. Kumar4
1Avert Society, Research, Mumbai, India, 2Avert Society, Mumbai, India, 3Christian Medical College, Biostatistics, Vellore, India, 4United States Agency for International Development, New Delhi, India
Background: In a concentrated epidemic the interventions are focused on Most at Risk Population (MARP). The desired change in behavior among the target groups would contain the spread of infection to general population. This paper attempts to study the correlation between behavioral change among MARP and HIV prevalence among general population (GP) in Maharashtra State, India.
Methods: HIV prevalence among GP was obtained from Sentinel Surveillance Survey (2003 to 2007). The knowledge and behavior indicators for Female Sex Workers (FSW) & Men having sex with men (MSM) from the Behavioral Surveillance Survey conducted by Avert Society (2004-05, 2005-06 and 2007-08) in eight districts. Regression analysis was used to estimate the direction and magnitude of correlation between prevalence and knowledge and behavior indicators.
Results: The knowledge of correct and consistent condom use (CCCU) as a method of prevention among Brothel Based (BB) FSW & Non Brothel Based (NBB) FSW increased by 47.5% and 54%, respectively. The practice of CCCU among the two groups also increased by 18.2% and 7.27%, respectively. This increase corresponds to decline in prevalence among GP by 42.3%. Knowledge and behavior indicators show a negative correlation with prevalence suggesting 10% increase in knowledge would have reduced the prevalence by 0.2%; 10% increase in CCCU would have caused 0.1% decline. In MSM the consistent condom use increased by 10.2% from 2004 to 2007. The increase in knowledge of CCCU and practice of CCCU by 10% shows decline in the prevalence by 0.1%, respectively.
Conclusions: Epidemiologically there is a negative correlation between knowledge and practice of CCCU among MARP with HIV prevalence. The findings suggest further strengthening of interventions and saturate the coverage of MARP to halt the epidemic.