Goswami, P., Rachakulla, H.K., Ramakrishnan, L., et al. British Medical Journal Open (2013), Vol. 3.
The authors assessed a large-scale HIV prevention program, the Avahan India AIDS Initiative, which targeted high-risk men who have sex with men (MSM) and transgender (TG) populations in Andhra Pradesh, evaluating program coverage, intermediate outcomes, and HIV and sexually transmitted infection (STI) rates using program monitoring data and data from two cross-sectional surveys. From initial coverage of 8 percent (2005), the Avahan program scaled up with strong outreach; peer educators contacted 83 percent of the target population monthly by 2008. MSM and TG populations were significantly more likely to report high and consistent condom use with male partners in the second survey round; however, low consistent condom use was reported with regular female partners. Those exposed to the initiative were more likely to use condoms with their male partners compared with those unexposed. The proportion who reported having ever visited an STI clinic increased from 1 to 80 percent from 2005 to 2008. There was no significant change in HIV incidence. The study’s authors argue that there is an urgent need to continue or develop new HIV prevention activities targeting this population, particularly emphasizing regular STI clinic visits and consistent condom use with all partners, to reduce HIV transmission among MSM and TG populations in India.