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HIV-positive men who have sex with men (HIV+MSM) in India need culturally-relevant interventions to promote safer sex. We tested a multi-level intervention among HIV+MSM that targeted individual, interpersonal, and community factors, based on the Social-Personal and Social Ecological Models. We conducted a 2 × 2 factorial RCT with 119 HIV+MSM randomised to receive either an individual-level intervention (ILI) using motivational interviewing to promote safer sex, a community-level intervention (CLI) to strengthen community norms toward safer sex and reduce stigma among MSM communities, a multi-level intervention combining the individual- and community-level interventions (ILI + CLI), or standard-of-care control. Participants completed pre- and post-intervention assessments of a composite sexual risk score and a process evaluation to assess fidelity and satisfaction. Out of the 119 HIV+MSM, 106 (89.0%) completed pre- and post-intervention assessments. Generalised Estimating Equation models showed that both CLI (Incidence Rate Ratio [IRR] =.67, 95% CI.47 to.96) and ILI + CLI (IRR =.66, 95% CI.48 to.91) groups had a statistically significant decrease in sexual risk compared to the standard-of-care. The interventions had high levels of fidelity and satisfaction. This pilot RCT demonstrated feasibility and potential effectiveness of a multi-level intervention that addresses individual, interpersonal and community-level contributors of sexual risk among HIV+MSM. [ABSTRACT FROM AUTHOR]

This study presents sexual behaviour and prevalence of HIV and STIs among married couples seeking STI care at a STD clinic of a major government hospital. Of the 209 eligible married couples who approached the STD clinic, 126 eligible index cases (who were STI symptomatic or had a risk exposure) and their spouses who consented to participate in the study over a period of 18 months were included in the study. This cross sectional study covered data on demographic details, sexual behavior and details of clinical symptoms, from each of the individuals who consented for participation. The mean age of the respondents was 32.5 years. Most of the females (<93%) reported that their first sexual partner was their spouse; whereas in men it was 50% or less. More males had, a history of STI, non-marital partners (in the last week, last 3 months, and in their life time), pre/extra marital contacts and were positive for HIV than the females. More females were syphilis reactive than the males. Multiple regression analysis showed that only factors like male gender for HIV positivity and being an index case for Syphilis positivity were significantly associated in the presence of other variables. Our findings strongly suggest both, a couple-centered and a gender specific approach for case detection, management and prevention of HIV and STIs among married couples. [ABSTRACT FROM AUTHOR]

This study was done in collaboration with Social Welfare Centre for Weaker Section (SWCWS) which focussed on 5 districts of Ellapuram Panchayat Union, at Periyapalayam. The exploratory study found that there were no cultural beliefs or myths associated with the temple or the Goddess and sex work. Since the number of people who came to the temple as a pilgrimage place were floating population with more anonymity, the opportunity for sex work was more conducive. In the main study having 248 FSWs, nearly half the females (46.8%) were 35 years or more, 59% were literates and 56% were married. Most of the FSWs (92%) were from outside Periyapalayam area. Nearly half of them (48%) reported that their age at first sexual intercourse was less than 18 years and the mean age of entry into the sex work was 27 years. With respect to type of clients, 50% reported of truck/lorry/bus/car/auto drivers and mean number of casual clients and regular clients in the previous week was 6 and 5, respectively. In the last one month, 30% reported that they were asked for anal sex by their clients; in that 25% of the FSWs had accepted. Overall only 16% reported of consistent condom usage. Alcohol consumption was reported by 27% and among them, 91% informed of, drinking before sexual act. Significant proportion of drivers (52%) used consistent condom use whether they were casual clients (p=0.045) or regular clients (0.032). Significantly (p=0.036) more literate FSWs (78%) reported of condom usage than the illiterate FSWs (65%). There were significant associations between duration of profession, usage of condom with casual clients or regular clients and STI symptoms (p=<0.005). The odd of getting STI symptoms by FSWs with inconsistent use of condom by casual or regular clients was 2.67 (O.R.=2.67, 95% CI is 1.512 to 4.714, p=0.001/O.R.=2.29, 95% CI is 1.275 to 4.135, p=0.006) times higher than the consistent use of condom by casual clients/regular clients, respectively. In all, HIV seroprevalence in the FSWs was 3.6%. This article reports, floating population and more anonymity for sex work at Periyapalayam. In addition, type of clients, literacy status, inconsistent condom usage, drinking habit and history of STIs were reported as risk factors for STIs and AIDS among these FSWs, who required specific intervention. [ABSTRACT FROM AUTHOR]