Papers by parinita bhattacharjee
Background: Stepping Stones training aims to help individuals explore sexual relationships and re... more Background: Stepping Stones training aims to help individuals explore sexual relationships and recognize gender inequalities, the structural drivers of the HIV epidemic, in order to understand risk behaviours and to seek solutions to factors that increase HIV vulnerability. Despite earlier studies suggesting the success of Stepping Stones, little data exist to show diffusion to trainees ’ social networks or the wider community. Methods: A mixed-methods evaluation of this approach was undertaken using in-depth interviews of trainees and friends, and polling booth surveys in 20 villages where Stepping Stones training took place and in another 20 villages with no Stepping Stones intervention. Results: The interview respondents and their friends reported significant changes in their relationships after training, and benefit from discussion of gender, sexuality, condom use and HIV vulnerability issues. However, though diffusion of this knowledge at the level of personal contacts was stro...
PLOS ONE, 2015
<p>Polling booth survey sample coverage of key populations in each study site across Kenya.... more <p>Polling booth survey sample coverage of key populations in each study site across Kenya.</p
This paper draws on the findings from two programme evaluations implemented by the Karnataka Heal... more This paper draws on the findings from two programme evaluations implemented by the Karnataka Health Promotion Trust (KHPT). These programmes aim to reduce girl school drop-out and child marriage and to decrease female sex workers’ experience of intimate partner violence. The study found that social norms play an important role in driving violence against women and girls, and in sustaining practices such as child marriage. Understanding how social norms operate will help design better interventions.
PLOS ONE, Mar 20, 2012
Objectives: There is a lack of information on sexual violence (SV) among men who have sex with me... more Objectives: There is a lack of information on sexual violence (SV) among men who have sex with men and transgendered individuals (MSM-T) in southern India. As SV has been associated with HIV vulnerability, this study examined health related behaviours and practices associated with SV among MSM-T. Design: Data were from cross-sectional surveys from four districts in Karnataka, India. Methods: Multivariable logistic regression models were constructed to examine factors related to SV. Multivariable negative binomial regression models examined the association between physician visits and SV. Results: A total of 543 MSM-T were included in the study. Prevalence of SV was 18% in the past year. HIV prevalence among those reporting SV was 20%, compared to 12% among those not reporting SV (p = .104). In multivariable models, and among sex workers, those reporting SV were more likely to report anal sex with 5+ casual sex partners in the past week (AOR: 4.1; 95%CI: 1.2-14.3, p = .029). Increased physician visits among those reporting SV was reported only for those involved in sex work (ARR: 1.7; 95%CI: 1.1-2.7, p = .012). Conclusions: These results demonstrate high levels of SV among MSM-T populations, highlighting the importance of integrating interventions to reduce violence as part of HIV prevention programs and health services.
arXiv (Cornell University), Dec 10, 2019
Potential Feasible Table 3A. Univariate and multivariable analyses of factors associated with the... more Potential Feasible Table 3A. Univariate and multivariable analyses of factors associated with the history of HIV testing among adolescent girls and young women aged 14-24 years in Mombasa, Kenya
AIDS, Jan 19, 2023
Objective: To infer the timing of HIV acquisition in relation to self-reported events in the sexu... more Objective: To infer the timing of HIV acquisition in relation to self-reported events in the sexual life course of adolescent girls and young women (AGYW) who self-identify as female sex workers (FSW) in Mombasa, Kenya. Design: Next-generation viral sequencing of samples of AGYW living with HIV in the Transitions study, a cross-sectional bio-behavioural survey of AGYW aged 14–24 years in Mombasa, Kenya. Method: Dried blood spot specimens were collected from study participants (n = 37, all FSW). A portion of the HIV pol gene was sequenced using an in-house next-generation sequencing assay for HIV drug resistance mutation genotyping. Estimated time since infection (ETI) was inferred using the HIV EVO web-based tool (https://hiv.biozentrum.unibas.ch/ETI/), and data on self-reported events were obtained from the survey. Results: The median ETI among FSW was 3.4 (interquartile range = 1.7, 6.3) years, with a median ETI of 1.5 years prior to entry into formal sex work. We estimated that 74.1% (95% confidence interval = 53.7–88.9%) of participants living with HIV and who self-identified as FSW likely acquired HIV prior to self-identification as a sex worker. Conclusions: Findings suggest a large fraction of prevalent HIV infection among AGYW engaged in sex work stems from acquisition prior to entry into formal sex work. Current HIV prevention programs tailored for sex workers may miss key opportunities for HIV prevention as they are designed to reach women after entry into formal sex work, signaling a need for tailored programs to reach high-risk AGYW earlier on in their sexual life course.
Journal of the International AIDS Society, Aug 1, 2022
IntroductionIn 2018, the National AIDS and sexually transmitted infection (STI) Control Programme... more IntroductionIn 2018, the National AIDS and sexually transmitted infection (STI) Control Programme developed a national guidelines to facilitate the inclusion of young women who sell sex (YWSS) in the HIV prevention response in Kenya. Following that, a 1‐year pilot intervention, where a package of structural, behavioural and biomedical services was provided to 1376 cisgender YWSS to address their HIV‐related risk and vulnerability, was implemented.MethodsThrough a mixed‐methods, pre/post study design, we assessed the effectiveness of the pilot, and elucidated implementation lessons learnt. The three data sources used included: (1) monthly routine programme monitoring data collected between October 2019 and September 2020 to assess the reach and coverage; (2) two polling booth surveys, conducted before and after implementation, to determine the effectiveness; and (3) focus group discussions and key informant interviews conducted before and after intervention to assess the feasibility of the intervention. Descriptive analysis was performed to produce proportions and comparative statistics.ResultsDuring the intervention, 1376 YWSS were registered in the programme, 28% were below 19 years of age and 88% of the registered YWSS were active in the last month of intervention. In the survey, respondents reported increases in HIV‐related knowledge (61.7% vs. 90%,p&lt;0.001), ever usage of pre‐exposure prophylaxis (8.5% vs. 32.2%,p&lt; 0.001); current usage of pre‐exposure prophylaxis (5.3% vs. 21.1%,p&lt;0.002); ever testing for HIV (87.2% vs. 95.6%,p&lt;0.04) and any clinic visit (35.1 vs. 61.1,p&lt;0.001). However, increase in harassment by family (11.7% vs. 23.3%,p&lt;0.04) and discrimination at educational institutions (5.3% vs. 14.4%,p&lt;0.04) was also reported. In qualitative assessment, respondents reported early signs of success, and identified missed opportunities and made recommendations for scale‐up.ConclusionsOur intervention successfully rolled out HIV prevention services for YWSS in Mombasa, Kenya, and demonstrated that programming for YWSS is feasible and can effectively be done through YWSS peer‐led combination prevention approaches. However, while reported uptake of treatment and prevention services increased, there was also an increase in reported harassment and discrimination requiring further attention. Lessons learnt from the pilot intervention can inform replication and scale‐up of such interventions in Kenya.
Research Square (Research Square), May 18, 2020
Background: Across Sub-Saharan Africa, young women who sell sex (YSW) face institutional barriers... more Background: Across Sub-Saharan Africa, young women who sell sex (YSW) face institutional barriers in accessing sexual health and HIV prevention programs designed for female sex workers. In 2018, Kenya developed a national framework to guide service provision for YSW aged 14-24 years. To help inform the implementation of the framework, we estimated the burden of vulnerabilities related to the Sustainable Development Goals (SDGs related to health and gender equality) and program contact among YSW. Methods: We used data from Transitions, a 2015 bio-behavioural cross-sectional survey of 408 YSW aged 14-24 years in Mombasa, Kenya. We estimated the prevalence of sexual (inconsistent condom use), structural (financial, violence), and reproductive health vulnerabilities; and characterized engagement with local HIV programs tailored to sex workers. We then compared the prevalence of vulnerabilities by age group (14-18 years, N=117; 19-24 years, N=291) and by program contact (ever contacted by local program for sex workers). Results: 47.3% reported inconsistent condom use with any partner in the previous week (no difference by agegroup, p=1.00). Structural vulnerabilities were common and did not vary by age: 83.6% did not have a regular source of income; 29.9% and 29.2% had experienced physical and sexual violence, respectively. 26.5% reported at least one pregnancy before age 18, and 18.5% used a non-reliable form of contraception with little variability by age. 25.7% were aware of at least one program, and only 13.7% of YSW had ever been contacted by a program (8.5% of those aged 14-18 years; and 15.8% of those aged 19-24 years, p=0.06). Sexual, structural, and reproductive health vulnerabilities did not vary by program contact. Conclusions: SDG-related vulnerabilities begin early in the lives of YSW who are not currently reached by programs designed for female sex workers.
This monograph is a compilation of information related to efforts by the Karnataka Health Promoti... more This monograph is a compilation of information related to efforts by the Karnataka Health Promotion Trust (KHPT) to design and scale-up targeted interventions for HIV prevention among urban female sex workers (FSWs). KHPT staff, their affiliated programmes and partner organizations all provided essential support for this document, including data and case studies used for examples, the many practical programme planning guidelines cited throughout, and valuable content and editorial reviews. The original concept of a monograph to reach policymakers, programme managers, and implementing organizations was developed by Stephen Moses, James Blanchard, and Parinita Bhattacharjee. Laura H. Thompson was predominantly responsible for the coordination of the preparation of this monograph and compiling the information, while John Antony and Mrunal Shetye provided meaningful inputs. Dorothy L. Southern provided editorial support to finalize the publication.
Sexually Transmitted Infections, Jul 1, 2011
number of female sex partners ranged from 0 to 2; over 90% (89%e 98%) of MSW reported anal sex an... more number of female sex partners ranged from 0 to 2; over 90% (89%e 98%) of MSW reported anal sex and 26% of them engaged in group sex; but proportions who reported always using condoms for anal sex were less than 60% (ranged from 28% to 60%). HIV screening positive rate was 9% in both 2007 and 2008 see Abstract O2-S6.04 table 1. HIV positive rate is associated with the number of male sex partners and condom use frequency in both 2007 and 2008. Conclusion MSW have been emerging in the sex trade industry in China. Behavioural risk factors and high prevalence of HIV in the MSW survey sample signalled a need for further understanding of this special population. Effective public health intervention strategy and programs are in urgent demand.
Gates Open Research
Introduction: Effective coverage of Human Immunodeficiency Virus prevention services for Key Popu... more Introduction: Effective coverage of Human Immunodeficiency Virus prevention services for Key Populations (KPs) including female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID) and transgender (TG) people necessitates periodic validation of physical venues and size estimates. Kenya conducted a robust size estimation of KPs in 2012 and a repeat mapping and size estimation exercise was conducted in 2018 to update KP Size Estimates and sub-typologies within each County for calculation of realistic program indicators. Methods: A prospective mixed methods programmatic mapping approach adopted comprised two steps. The first step involved consolidating and documenting all known venues where KPs congregate while the second step included visiting and validating these venues confirming their active status. Data were collected in 34 out of 47 Counties in Kenya between January and March 2018. Data collected included estimated number of KPs (range), venue typo...
Gates Open Research
Background: The HIV Prevention Self-Assessment Tools (PSATs) were developed by the Global Prevent... more Background: The HIV Prevention Self-Assessment Tools (PSATs) were developed by the Global Prevention Coalition as an easy-to-use tool for country-led review of national HIV prevention response against a global standardised set of programmatic components. As part of the South to South Learning Network (SSLN), country-level data on HIV prevention programmes for sex workers were collected by 10 African countries, using the PSAT to self-assess their HIV prevention progress. Methods: Data were collected August 2020 to July 2021 from participating countries. In each country, a technical team of 8-10 members completed the tool with support from the SSLN. The PSAT collects data for three programme domains: management, implementation and outcomes and sustainability, each of which comprises essential programme functions and elements. Once all elements are scored, the tool automatically calculates the final scores for each domain, on a scale of 1-5. Also, 15 interviews were conducted with 15 c...
AIDS
Objectives: People who inject drugs (PWID) in Kenya have high HIV (range across settings: 14–26%)... more Objectives: People who inject drugs (PWID) in Kenya have high HIV (range across settings: 14–26%) and hepatitis C virus (HCV; 11–36%) prevalence. We evaluated the impact of existing and scaled-up interventions on HIV and HCV incidence among PWID in Kenya. Design: HIV and HCV transmission model among PWID, calibrated to Nairobi and Kenya's Coastal region. Methods: For each setting, we projected the impact (percent of HIV/HCV infections averted in 2020) of existing coverages of antiretroviral therapy (ART; 63–79%), opioid agonist therapy (OAT; 8–13%) and needle and syringe programmes (NSP; 45–61%). We then projected the impact (reduction in HIV/HCV incidence over 2021–2030), of scaling-up harm reduction [Full harm reduction (‘Full HR’): 50% OAT, 75% NSP] and/or HIV (UNAIDS 90–90–90) and HCV treatment (1000 PWID over 2021–2025) and reducing sexual risk (by 25/50/75%). We estimated HCV treatment levels needed to reduce HCV incidence by 90% by 2030. Results: In 2020, OAT and NSP aver...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2019
way for HIV acquisition. “Young age at first sexual contact” should replace the disquietingly pos... more way for HIV acquisition. “Young age at first sexual contact” should replace the disquietingly positive “early sexual debut.” “AGYW”: Had the terminology more accurately represented the people, as well as the phenomena, the discussion might have been different. For example, the authors describe common adverse first sexual experiences among their sample: “3 of every 10 AGYW reported a first sex that was early (,15 years of age) and before or within a year of menarche, an exchange of gifts or money at first sex, and a coerced first sex.”1 “AGYW” is an abbreviation for “adolescent girls and young women.” All participants are described as AGYW at their first sexual experience when the median age of first sex was 16 (IQR 14–18). Actual age and the adjective “young” would be accurate. “Adolescent” is more contentious given that 39% of the girls interviewed had their first sexual encounter before, or within 1 year of, menarche. Biological notions of adolescence denote transition from child ...
BackgroundPeople who inject drugs (PWID) in Kenya have a high prevalence of HIV (14-26%) and HCV ... more BackgroundPeople who inject drugs (PWID) in Kenya have a high prevalence of HIV (14-26%) and HCV (11-36%). Needle and syringe programmes (NSP) and antiretroviral therapy (ART) have high coverage among PWID, while HCV treatment and opioid substitution therapy (OST) access is low.MethodsA dynamic model of HIV (sexual and injecting-related) and HCV (injecting-related) transmission among PWID was calibrated using Bayesian methods to data from Nairobi and the Coastal region. We projected the impact of existing coverage levels of interventions (ART: 64-66%; OST: 4-7%; NSP: 54-56%) in each setting, and the impact over 2020-2030 of increasing the coverage of OST (50%) and NSP (75%; ‘full HR’), ART (UNAIDS 90-90-90 target), HCV treatment (1000 over 5 years), and reducing HIV sexual risk by 75%. We estimated HCV treatment levels needed to reduce HCV incidence by 90% with or without full HR.FindingsSince 2013, HR has averted 15.1-20.6% (range in medians across settings) of HIV infections and 2...
Sexual and Reproductive Health Matters, 2020
This secondary data analysis of a cross-sectional survey conducted in Mombasa, Kenya characterise... more This secondary data analysis of a cross-sectional survey conducted in Mombasa, Kenya characterises sexual and reproductive health (SRH) indicators among adolescent girls and young women (AGYW) engaged in casual and transactional sexual relationships as well as sex work. It describes the association between awareness of local HIV programmes and SRH services uptake for AGYW engaged in sex work. Thirty-eight percent of the participants reported a history of pregnancy. Among participants not trying to get pregnant, 27% stated that they were not currently using any form of contraception. Of the participants who had an abortion, 59% were completed under unsafe conditions. For AGYW engaged in sex work, awareness of local HIV prevention programmes was associated with increased STI testing within the last year (29%) as well as at least one HIV test (99%) compared to those who were not aware of local programming (18% and 92%, respectively); however, only 26% of participants engaged in sex work had heard of local HIV prevention programmes. There were no associations between awareness of local HIV programming and rates of dual contraception use, safe abortion, most recent birth attended by a skilled health professional or testing for HIV during pregnancy. Our study found high need for SRH services, particularly, access to contraception and safe abortion. Continued efforts are required to improve access to the full spectrum of SRH interventions, including family planning services and access to safe abortion in addition to HIV prevention to promote health equity.
Poster Presentations, 2019
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Papers by parinita bhattacharjee