HIV prevention programs for female sex workers in India reduce syphilis, HIV

HIV prevention programs for female sex workers in India reduce rates of syphilis, HIV and other sexually transmitted infections (STIs), a University of Toronto study has found.

About two million Indians are infected with HIV, mostly in the southern states of Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu. The study, led by Professor Prabhat Jha from U of T's Dalla Lana School of Public Health and St. Michael's Hospital's Centre for Global Health Research (CGHR), examined the impact of prevention among female sex workers whose contact with male clients contributes substantially to new HIV infections in the general population. The virus is then spread to the wives and other sex partners of these male clients.

"We not only have to prevent HIV, but also other infections like syphilis. Prevention among sex workers can reduce various infections, and prompt treatment of sexually transmitted infections is particularly important," said CGHR's Paul Arora, the lead author.

The peer-based prevention programs provided condoms and treated STIs among sex workers and their clients in addition to other activities. The authors examined data from 868 prevention projects - serving about 500,000 female sex workers - implemented between 1995 and 2008. They found that reaching sex workers through prevention programs decreased HIV and syphilis infection rates among young pregnant women tested routinely at government prenatal health clinics.

Other findings included:

• Levels of HIV fell by 40 per cent and the levels of syphilis fell by 70 per cent among pregnant women (who represent new infections in the population) between 2003 and 2008.
• Each additional sexually transmitted infection treated (per 1000 people) reduced the annual risk of HIV infection by two per cent and reduced the annual risk of syphilis infection by 11 per cent.
• Increased funding, outreach, treatment of STIs and condom distribution reduced syphilis infections, but only STI treatment significantly reduced HIV infections.
• There was no difference on the impact on HIV or syphilis infection between the Gates Foundation- funded projects or the NACO-funded projects, even though the per person cost of the Gates programme was about five times that of NACO.

"This vital study is a reminder that governments must invest in prevention, and that even modest amounts of funding that reach the most at risk groups can yield big reductions in HIV and other infections" added Professor Peter Piot, Director of the London School of Hygiene and Tropical Medicine, UK, and former Director of UNAIDS, who was not involved in the study.