Sustained changes in sexual behavior by female sex workers after completion of a randomized HIV prevention trial.
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.
Ngugi
Elizabeth N
EN
Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
Chakkalackal
Michelle
M
Sharma
Anjali
A
Bukusi
Elizabeth
E
Njoroge
Betty
B
Kimani
Joshua
J
MacDonald
Kelly S
KS
Bwayo
Job J
JJ
Cohen
Craig R
CR
Moses
Stephen
S
Kaul
Rupert
R
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