Risk factors of sexually transmitted infection (STI) and their relationship with HIV among female sex workers (FSW) in Nagaland: A high HIV prevalence state in India G K Medhi 1, J Mahanta 2, S Phukan 3, P Goswami 4, R Paranjape Regional Medical Research Centre, NE Region, ICMR, Dibrugarh, India 4 FHI 360, New Delhi, India, 5 National AIDS Research Institute, Pune, India

Methodology A respondent driven sample (RDS) of Study 417 FSWs recruited in Dimapur, Nagaland, a high HIV prevalence state of India bordering Myanmar STI is defined as positive tests for one or more of Syphilis, Neisseria gonorrhoeae, and Chlamydia trachomatis Syphilis (Rapid Plasma Reagin RPR and the confirmatory test TPHA). Urine samples were tested for Neisseria gonorrhoeae, and Chlamydia trachomatis infections by Nucleic Acid Amplification Tests (NAAT) (Gen Probe APTIMA Combo-2 nucleic acid amplification, Gen Probe)

Results FSWs are mostly illiterate (59.2%) and ever married About 19% used alcohol regularly, 12.7% used illicit drugs Low consistent condom use (only 9.6% with regular female sex partners and 33.1% with their clients.

Risk Factors of STIs Being illiterate, Being currently married Being older in age Higher client volumes Duration of commercial sex Positive test result of HIV Use of alcohol daily Use of illicit drugs Alcohol is the strongest independent risk factor of STI.

Prevalence of HIV and STIs (one or more STIs)

Prevalence of HIV according to STI status

Conclusions STIs is a potent risk factor of HIV among FSWs in Nagaland suggesting the need to strengthen STI treatment & prevention programme as a strategy to combat HIV transmission among FSWs in this high HIV prevalence region of India Consistent condom use is still a cause of concern among them despite existence of targeted intervention programme for FSWs. Therefore, there is urgent need to develop innovative strategy to ensure availability, access to and correct and consistent use of condom among FSWs in this population The drug and alcohol using FSWs have been identified as the greater vulnerable groups for STIs in our analysis. Therefore, special attention should be given to these more vulnerable sub- group Sociodemographically, illiterates and married group who constitutes a major a section of FSWs were more vulnerable to STIs. The STI programme should give special attention to this sub- group.