Patterns of condom use by men who have sex with men before and after the Avahan intervention in Andhra Pradesh state of India.

BACKGROUND: Two rounds of integrated biological and behavioural assessment (IBBA) surveys were done among men who have sex with men (MSM) in Andhra Pradesh during 2006 and 2009. Avahan, the India AIDS initiative, funded by the Bill and Melinda Gates Foundation implemented HIV prevention interventions among MSM starting around the time of the first round of IBBA. METHODS: Data on socio-demographic, sex behaviour characteristics and HIV status of MSM from the two IBBA rounds were used. Changes in the rates of consistent condom use over the past one month by MSM with various types of partners between the two rounds were assessed. Multivariate analysis was performed to assess associations between various factors and inconsistent condom use for sex with regular partners as well as HIV in MSM. RESULTS: A significant increase in consistent condom use by MSM was noted from 2006 to 2009 for paid male partners (19.5% to 93.8%), occasional male partners (13.2% to 86.2%), and paid female partners (25.9% to 94.2%). Consistent condom use with regular sex partners also increased but remained lower with regular male partner (75.8%) and very low with regular female partners (15.7%). MSM who used condoms inconsistently with their regular male partner were also more likely to use condoms inconsistently with their regular female partner. Multivariate analysis showed MSM who used condoms inconsistently with regular male partner had higher odds of HIV (odds ratio 1.8; 95% CI 1.2-2.7). MSM who received condoms from Avahan had the lowest odds (odds ratio 0.3; 95% CI 0.1-0.5) of inconsistent condom use with regular male partners. CONCLUSIONS: Condom use by MSM increased markedly after implementation of Avahan, though a causal association cannot be assessed with the available data. The relatively lower condom use with regular partners of MSM suggests that additional programme effort is needed to address this aspect specifically.

National Family Health Survey-3 reported low full-immunization coverage rates in Andhra Pradesh, India: who is to be blamed?

BACKGROUND: National Family Health Surveys (NFHS), the Indian counterpart of Demographic and Health Surveys, are the most recognized surveys in India and provide reliable measures of RCH indicators. But NFHS-3 figures on full immunization coverage rate for the state of Andhra Pradesh (AP) is very low compared with seven other major surveys on immunization carried out around the same time period. METHODS: The objective is to analyse factors responsible for low full-immunization coverage rate reported by NFHS-3 in AP. Data from three waves of NFHS and other surveys on immunization were used for analysis. RESULTS: Although full immunization coverage rate did not increase, other related indicators have shown an improvement between the second and third waves of NFHS. The full immunization coverage rate was significantly higher among card seen category as compared with card not seen category. CONCLUSIONS: Low full immunization coverage rate in AP as reported by NFHS-3, in all likelihood cannot be totally attributed to poor performance of the immunization programme. Probable reasons are issues related to methodological and logistic processes in NFHS, which include collection of data from a wider age group, differences in data collection methods, commitment levels and skill sets of investigator, fatigue factor and low percentage of cards seen by investigator.