title: Trends in condom use among female sex workers in Andhra Pradesh, India: the impact of a community mobilisation intervention.
abstract: BACKGROUND
  Community mobilisation interventions for HIV prevention among female sex workers (FSWs) aim to organise FSWs for collective action and challenge the structures of power that underlie HIV risk. Assessing intervention impact is challenging because the importance of direct individual exposure to intervention components may decrease over time as change occurs at social-normative, policy and other structural levels. In this paper, the authors examine changes over time in consistent condom use among FSWs in Rajahmundry, Andhra Pradesh, the location of a long-standing community mobilisation intervention.
  
  
  METHODS
  The authors analyse cross-sectional data collected among FSWs at three time points (n=2276) using respondent-driven sampling. Multiple logistic regression was used to assess the association of programme exposure with consistent condom use and whether this association varied over time.
  
  
  RESULTS
  The proportion of FSWs having no exposure or only receptive exposure to the intervention decreased over time, while active utilisation increased from 19.4% in 2006 to 48.5% in 2009-2010. Consistent condom use with clients also increased from 56.3% in 2006 to 75.3% in 2009-2010. Multivariate analysis showed that age, age at start of sex work, venue, living conditions and programme exposure were significantly associated with condom use. The positive association between programme exposure and consistent condom use did not vary significantly over time.
  
  
  CONCLUSIONS
  Findings indicate improvements in HIV risk reduction behaviour among FSWs and suggest that the intervention has substantial reach in the FSW population. The intervention's strategies may be contributing to population-level HIV risk reduction among FSWs.
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, USA. jt.erausquin@gmail.com
authors.forename: Jennifer Toller
authors.initials: JT
authors.lastname: Erausquin
authors.forename: Monica
authors.initials: M
authors.lastname: Biradavolu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Reed
authors.forename: Rebekah
authors.initials: R
authors.lastname: Burroway
authors.forename: Kim M
authors.initials: KM
authors.lastname: Blankenship
mesh_terms: D000293:Adolescent; D000328:Adult; D019058:Community Networks / Q000458:organization & administration*; D017280:Condoms / Q000706:statistics & numerical data* / Q000639:trends; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007194:India; D016015:Logistic Models; D015397:Program Evaluation; D040242:Risk Reduction Behavior; D021841:Safe Sex / Q000523:psychology / Q000706:statistics & numerical data; D011477:Sex Work / Q000523:psychology* / Q000706:statistics & numerical data; D060386:Sex Workers / Q000523:psychology* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult