Subramanian, T., Ramakrishnan, L., Aridoss, S., et al. BMC Public Health (September 2013), Vol. 13 No. 1, pp. 857.
This evaluation of Avahan, an Indian AIDS initiative that engaged high-risk men who have sex with men (MSM) and transgender persons (TG) in Tamil Nadu (January 2005-March 2009), assessed Avahan's coverage and impact on condom use and HIV and sexually transmitted infections (STIs) prevalence. Avahan attained high coverage and service uptake by both populations, increased in program scale, and was associated with increased condom use by MSM with commercial and regular partners (81 to 94 percent and 33 to 46 percent, respectively). Condom use with casual male partners among TGs improved slightly, but declined significantly with commercial male partners (from 93 to 80 percent). The proportion of MSM and TGs ever contacted by peer educators increased from 82 percent to 100 percent of estimated populations between 2006 and 2009; the proportion of these who had ever visited STI clinics saw similar increases. Changes in HIV prevalence were not significant (9.7 to 10.9 percent, MSM; 12 to 9.8 percent, TG); however, the prevalence of urethral syphilis declined significantly among MSM and TG (14.3 to 6.8 percent and 16.6 to 4.2 percent, respectively). The authors concluded that public health programs should target MSM and TG separately. Although further research is needed to better understand factors that affect MSM and TG individuals’ condom use with different partners, these findings could be used to improve behavior change communication programs.