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Background  India has an estimated 2.0 million to 3.1 million people living with HIV; it has the highest number of HIV-positive people in Asia and ranks third in the world. The Frontiers Prevention Project (FPP) was implemented in 2002 to conduct targeted prevention intervention geared towards female sex workers (FSW) and men who have sex with men (MSM) in the state of Andhra Pradesh (AP). This paper reports the overall changes in behaviour and STI outcomes between 2003/4 and 2007 and also describes the changes attributed to the FPP.    Methods  The evaluation used two cross-sectional surveys among MSM and FSW at 24 sites in AP. Surveys were implemented using a similar methodology. Univariate analyses were conducted by comparing means: baseline vs. four-year follow-up and FPP vs. non-FPP. For both MSM and FSW, random and fixed-effects logit regression models at the site level were estimated for  condom use with last partner ,  syphilis sero-positivity  and  HSV 2 sero-positivity . In addition, for FSW we estimated models for  condom use with regular partner , and for MSM we estimated models for  condom use with last female partner .    Results  Among MSM, fixed-effects analysis revealed that FPP was positively correlated with the probability of  condom use with last female sexual partner  and negatively correlated with the individual probability of  sero-positivity to syphilis and HSV 2 . Among FSW, the FPP intervention was significantly correlated with increased  condom use with regular partners  and with lower probability of  STI sero-positivity .    Discussion  Important changes in behaviours related to an increase in prevention activities translated to reductions in STI sero-prevalence in AP, India. In contrast with non-FPP sites, the FPP sites experienced an intense community approach as part of the FPP intervention, and the general increase in condom use and its effect on STI sero-prevalence reflected the efficacy of these intense prevention activities focused on key populations in AP.

bmc public health

Community-based prevention leads to an increase in condom use and a reduction in sexually transmitted infections (STIs) among men who have sex with men (MSM) and female sex workers (FSW): the Frontiers Prevention Project (FPP) evaluation results