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.
The study was supported by The Bill and Melinda Gates Foundation and the Canadian Institutes of Health Research. The study will be published on June 16 at 8pm EST in BMJ Open. Additional information can be found at http://www.cghr.org.
Professor Prabhat Jha will be in India and available for media inquiries on June 17 and 18.
Mr. Paul Arora is also overseas, but available for interviews by phone or Skype.
About St. Michael’s Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
About The Dalla Lana School, University of Toronto
The Dalla Lana School of Public Health (DLSPH) is a regional and global leader in public health education, research and service, with one of the largest concentrations of academic population and public health researchers in Canada and more than $30 million in research funding each year.