Index based mapping of high risk behaviours for HIV among female sex workers in India

Background & objectives: Integrated Behavioral and Biological Assessment (IBBA) study is the first cross-sectional survey to study large number of covariates of HIV/STI (sexually transmitted infection) in India. Generally, districts are identified as of HIV high or low based on its prevalence. Instead, it would be optimal to label the districts based on several high-risk related covariates in the concurrent set up. The objectives of the present study were to obtain an index for each district, to discover ′natural′ clusters and a map with Kriged estimates. Methods: The study population consisted of 10461 female sex workers (FSWs) from 29 sites spread over 24 districts from five HIV high prevalent States. Covariates based on demographic characteristics, sexual practices, knowledge of HIV/STI and biological variables were studied. The analyses were done on weighted estimates based on principal component analysis, cluster analysis and Kriging technique. Five factors were extracted and improved using varimax rotation and standardized factor scores obtained. Natural clusters in a multivariate setting were identified. Each district was expressed as geographic co-ordinates and using the standardized scores the Kriged estimates were obtained. Results: The proxy determinants were ′never used a condom′, ′wanted to use a condom but did not use′, ′experience of condom breakage′ and ′current STI that needs a doctor′. Dimapur district stood first rank demanding the greatest attention. The cluster analysis branded Dimapur, Warangal, Prakasam, and Chittoor districts as a cluster, which required greatest attention and kriged estimates showed the high-risk concentrated regions as Andhra Pradesh, Maharashtra and northeast region. Interpretation & conclusions: The results of this study may help the programme officials and policy managers to concentrate on the key factors, and districts/regions, which need greater attention in the order of priority.