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Prakash R.,Karnataka Health Promotion Trust | Singh A.,International Institute for Population Sciences | Pathak P.K.,Shivaji University | Parasuraman S.,International Institute for Population Sciences
Journal of Family Planning and Reproductive Health Care

Background and methodology: Early marriage, women's poor reproductive health and child well-being are important areas of concern, especially in developing countries like India. Data from the third wave of National Family Health Survey (NFHS, 2005-2006) was used to examine the effects of early marriage on the reproductive health status of women and on the well-being of their children. Bivariate analyses, multiple linear regression and logistic regression were used for analyses. Results: The results show that early age at marriage had detrimental effects on the reproductive health status of women. Women married at an early age were exposed to frequent childbearing, unplanned motherhood and abortions, which negatively affected their nutritional status. Children born to mothers with poor reproductive health had lower chances of survival and a higher likelihood of anthropometric failure (i.e. stunting, wasting and underweight). Discussion and conclusions: Programmes should focus on delaying entry of adolescents into wedlock and motherhood through information, education and communication. More emphasis needs to be put on meeting the reproductive needs of poor adolescent mothers, and improving the nutritional status of their children, to break the vicious circle of poor reproductive health and poverty. Source

Sitruk-Ware R.,Center for Biomedical Research | Nath A.,Karnataka Health Promotion Trust
Expert Review of Endocrinology and Metabolism

Emerging science will make an important contribution towards the development of improved contraceptives. While long-acting reversible contraceptives remain the most effective method, new user-controlled, mid-acting methods will avoid the need for procedures requiring trained providers. Contraceptives combined with other agents may bring additional health benefits, such as dual protection against both pregnancy and sexually transmitted infections. Emerging research areas in proteomics allowed the discovery of new reproductive targets that may lead to non-hormonal contraceptives for both men and women. Current research objectives include the improvement of existing contraceptive methods, as well as discovery of new materials able to deliver new molecules more specifically to their target without systemic actions. © Informa UK, Ltd. Source

Gurav K.,Karnataka Health Promotion Trust | Bradley J.,University of Quebec | Chandrashekhar Gowda G.,Swasti Health Resource Center | Alary M.,University of Quebec
Culture, Health and Sexuality

A qualitative study was conducted to obtain a detailed understanding of two key determinants of condom breakage - 'rough sex' and poor condom fit - identified in a recent telephone survey of female sex workers, in Bangalore, India. Transcripts from six focus-group discussions involving 35 female sex workers who reported condom breakage during the telephone survey were analysed. Rough sex in different forms, from over-exuberance to violence, was often described by sex workers as a result of clients' inebriation and use of sexual stimulants, which, they report, cause tumescence, excessive thrusting and sex that lasts longer than usual, thereby increasing the risk of condom breakage. Condom breakage in this setting is the result of a complex set of social situations involving client behaviours and power dynamics that has the potential to put the health and personal lives of sex workers at risk. These findings and their implications for programme development are discussed. © 2014 © 2014 Taylor & Francis. Source

Ramesh B.M.,University of Manitoba | Beattie T.S.H.,London School of Hygiene and Tropical Medicine | Shajy I.,Karnataka Health Promotion Trust | Washington R.,University of Manitoba | And 5 more authors.
Sexually Transmitted Infections

Objectives: To examine the impact of a large-scale HIV prevention programme for female sex workers (FSW) in Karnataka state, south India, on the prevalence of HIV/ sexually transmitted infections (STI), condom use and programme coverage. Methods: Baseline and follow-up integrated biological and behavioural surveys were conducted on random samples of FSW in five districts in Karnataka between 2004 and 2009. Results: 4712 FSW participated in the study (baseline 2312; follow-up 2400), with follow-up surveys conducted 28e37 months after baseline. By follow-up, over 85% of FSW reported contact by a peer educator and having visited a project STI clinic. Compared with baseline, there were reductions in the prevalence of HIV (19.6% vs 16.4%, adjusted odds ratio (AOR) 0.81, 95% CI 0.67 to 0.99, p=0.04); high-titre syphilis (5.9% vs 3.4%, AOR 0.53, 95% CI 0.37 to 0.77, p=0.001); and chlamydia and/ or gonorrhoea (8.9% vs 7.0%, AOR 0.72, 95% CI 0.54 to 0.94, p=0.02). Reported condom use at last sex increased significantly for repeat clients (66.1% vs 84.1%, AOR 1.98, 95% CI 1.58 to 2.48, p<0.001) and marginally for occasional clients (82.9% vs 88.0%, AOR 1.22, 95% CI 0.89 to 1.66, p=0.2), but remained stable for regular partners (32%). Compared with street and home-based FSW, brothel-based FSW were at highest risk of HIV and STI, despite high levels of reported condom use. Conclusions: This large-scale HIV prevention programme for FSW achieved reductions in HIV and STI prevalence, high rates of condom use with clients and high rates of programme coverage. Improved strategies to increase condom use with regular partners and reduce the vulnerability of brothel-based FSW to HIV are required. Source

Pickles M.,Imperial College London | Pickles M.,London School of Hygiene and Tropical Medicine | Boily M.-C.,Imperial College London | Vickerman P.,London School of Hygiene and Tropical Medicine | And 16 more authors.
The Lancet Global Health

Background: Avahan, the India AIDS initiative of the Bill & Melinda Gates Foundation, was a large-scale, targeted HIV prevention intervention. We aimed to assess its overall effectiveness by estimating the number and proportion of HIV infections averted across Avahan districts, following the causal pathway of the intervention. Methods: We created a mathematical model of HIV transmission in high-risk groups and the general population using data from serial cross-sectional surveys (integrated behavioural and biological assessments, IBBAs) within a Bayesian framework, which we used to reproduce HIV prevalence trends in female sex workers and their clients, men who have sex with men, and the general population in 24 South Indian districts over the first 4 years (2004-07 or 2005-08 dependent on the district) and the full 10 years (2004-13) of the Avahan programme. We tested whether these prevalence trends were more consistent with self-reported increases in consistent condom use after the implementation of Avahan or with a counterfactual (assuming consistent condom use increased at slower, pre-Avahan rates) using a Bayes factor, which gave a measure of the strength of evidence for the effectiveness estimates. Using regression analysis, we extrapolated the prevention effect in the districts covered by IBBAs to all 69 Avahan districts. Findings: In 13 of 24 IBBA districts, modelling suggested medium to strong evidence for the large self-reported increase in consistent condom use since Avahan implementation. In the remaining 11 IBBA districts, the evidence was weaker, with consistent condom use generally already high before Avahan began. Roughly 32 700 HIV infections (95% credibility interval 17 900-61 600) were averted over the first 4 years of the programme in the IBBA districts with moderate to strong evidence. Addition of the districts with weaker evidence increased this total to 62 800 (32 000-118 000) averted infections, and extrapolation suggested that 202 000 (98 300-407 000) infections were averted across all 69 Avahan districts in South India, increasing to 606 000 (290 000-1 193 000) over 10 years. Over the first 4 years of the programme 42% of HIV infections were averted, and over 10 years 57% were averted. Interpretation: This is the first assessment of Avahan to account for the causal pathway of the intervention, that of changing risk behaviours in female sex workers and high-risk men who have sex with men to avert HIV infections in these groups and the general population. The findings suggest that substantial preventive effects can be achieved by targeted behavioural HIV prevention initiatives. Source

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