Abstract
Quantifying sexual activity of sub-populations with high-risk sexual behaviour is important in understanding HIV epidemiology.
This study examined inconsistency of seven outcomes measuring self-reported clients per month (CPM) of female sex workers
(FSWs) in southern India and implications for individual/population-level analysis. Multivariate negative binomial regression
was used to compare key social/environmental factors associated with each outcome. A transmission dynamics model was used
to assess the impact of differences between outcomes on population-level FSW/client HIV prevalence. Outcomes based on ‘clients
per last working day’ produced lower estimates than those based on ‘clients per typical day’. Although the outcomes were strongly
correlated, their averages differed by approximately two-fold (range 39.0–79.1 CPM). The CPM measure chosen did not greatly
influence standard epidemiological ‘risk factor’ analysis. Differences across outcomes influenced HIV prevalence predictions.
Due to this uncertainty, we recommend basing population-based estimates on the range of outcomes, particularly when assessing
the impact of interventions.
This study examined inconsistency of seven outcomes measuring self-reported clients per month (CPM) of female sex workers
(FSWs) in southern India and implications for individual/population-level analysis. Multivariate negative binomial regression
was used to compare key social/environmental factors associated with each outcome. A transmission dynamics model was used
to assess the impact of differences between outcomes on population-level FSW/client HIV prevalence. Outcomes based on ‘clients
per last working day’ produced lower estimates than those based on ‘clients per typical day’. Although the outcomes were strongly
correlated, their averages differed by approximately two-fold (range 39.0–79.1 CPM). The CPM measure chosen did not greatly
influence standard epidemiological ‘risk factor’ analysis. Differences across outcomes influenced HIV prevalence predictions.
Due to this uncertainty, we recommend basing population-based estimates on the range of outcomes, particularly when assessing
the impact of interventions.
- Content Type Journal Article
- Category Original Paper
- Pages 1-13
- DOI 10.1007/s10461-012-0279-x
- Authors
- Kathleen N. Deering, Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, 608 – 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- P. Vickerman, London School of Hygiene and Tropical Medicine, London, UK
- M. Pickles, Department of Infectious Disease Epidemiology, Imperial College, London, UK
- S. Moses, Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
- J. F. Blanchard, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- B. M. Ramesh, Karnataka Health Promotion Trust, Bangalore, India
- S. Isac, Karnataka Health Promotion Trust, Bangalore, India
- M.-C. Boily, Department of Infectious Disease Epidemiology, Imperial College, London, UK
- Journal AIDS and Behavior
- Online ISSN 1573-3254
- Print ISSN 1090-7165