title: Sustained changes in sexual behavior by female sex workers after completion of a randomized HIV prevention trial.
abstract: BACKGROUND
  Behavioral interventions in female sex workers (FSWs) are associated with changes in sexual behavior and reduced rates of sexually transmitted infections (STIs) and HIV We examined the sustainability of such interventions.
  
  
  METHODS
  HIV-uninfected Kenyan FSWs were enrolled in a clinical trial that provided free male condoms, community and clinic-based counseling, and STI management. After trial completion, scaled-back community-based resources remained in place. More than a year later, women were invited to complete a follow-up behavioral questionnaire and to undergo STI/HIV counseling and testing. Individual changes in sexual behavior were assessed by paired analysis.
  
  
  RESULTS
  One hundred seventy-two women participated in the resurvey 1.2 years after trial termination. Client numbers had risen (paired t test, P < 0.001), but condom use had also increased (P < 0.001); both remained substantially lower than at enrollment. Regular partners accounted for a greater proportion of unprotected FSW sexual encounters (35% vs. 10%; P < 0.001). Only 9 (5.2%) of 172 women had a conventional STI, and the follow-up HIV incidence of 1.6 per 100 person-years (PYs) was similar to that during the trial period (3.7 per 100 PYs). Incident STIs and HIV were associated with the frequency of unprotected sex and younger age.
  
  
  CONCLUSIONS
  Less intensive community-based risk reduction services after clinical trial termination may support ongoing reductions in STIs and HIV among high-risk FSWs.
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
authors.forename: Elizabeth N
authors.initials: EN
authors.lastname: Ngugi
authors.forename: Michelle
authors.initials: M
authors.lastname: Chakkalackal
authors.forename: Anjali
authors.initials: A
authors.lastname: Sharma
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bukusi
authors.forename: Betty
authors.initials: B
authors.lastname: Njoroge
authors.forename: Joshua
authors.initials: J
authors.lastname: Kimani
authors.forename: Kelly S
authors.initials: KS
authors.lastname: MacDonald
authors.forename: Job J
authors.initials: JJ
authors.lastname: Bwayo
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.forename: Rupert
authors.initials: R
authors.lastname: Kaul
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D017280:Condoms; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D040242:Risk Reduction Behavior; D021841:Safe Sex; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D014505:Urban Population