***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of this study was to evaluate the effects of a brief intervention programme on STD knowledge , condom use and gonorrhoea incidence among sex workers in Singapore . A controlled before- and -after study design with non-r and om assignment of sex workers was used , supplemented by multivariate analysis to adjust for baseline differences .  Control ( n = 221 , denoted C1 ) and experimental ( n = 221 , denoted E1 ) groups were interviewed on 2 occasions 3 months apart . Two supplementary groups were interviewed once each at the end of the 3-month period ( n = 145 who had received the intervention and n = 151 who had not ) . Basic knowledge of STD symptoms and HIV transmission was high in all groups . There were misconceptions about casual transmission of HIV which improved dramatically at the second interview for group El ( from 37–56 % correct responses to 82–90 % ) . Overall condom use was high ( about 75 % ) and did not change after the intervention . Gonorrhoea rates were correspondingly low ( 0.4 episodes/worker/year ) and also did not change . This brief intervention improved the STD knowledge of sex workers . However , behaviour as measured by reported condom use and gonorrhoea incidence did not change . Implication s for future intervention programmes are discussed Background Violence against female sex workers ( FSWs ) can impede HIV prevention efforts and contravenes their human rights . We developed a multi-layered violence intervention targeting policy makers , secondary stakeholders ( police , lawyers , media ) , and primary stakeholders ( FSWs ) , as part of wider HIV prevention programming involving > 60,000 FSWs in Karnataka state . This study examined if violence against FSWs is associated with reduced condom use and increased STI/HIV risk , and if addressing violence against FSWs within a large-scale HIV prevention program can reduce levels of violence against them . Methods FSWs were r and omly selected to participate in polling booth surveys ( PBS 2006 - 2008 ; short behavioural question naires administered anonymously ) and integrated behavioural-biological assessment s ( IBBAs 2005 - 2009 ; administered face-to-face ) . Results 3,852 FSWs participated in the IBBAs and 7,638 FSWs participated in the PBS . Overall , 11.0 % of FSWs in the IBBAs and 26.4 % of FSWs in the PBS reported being beaten or raped in the past year . FSWs who reported violence in the past year were significantly less likely to report condom use with clients ( zero unprotected sex acts in previous month , 55.4 % vs. 75.5 % , adjusted odds ratio ( AOR ) 0.4 , 95 % confidence interval ( CI ) 0.3 to 0.5 , p < 0.001 ) ; to have accessed the HIV intervention program ( ever contacted by peer educator , 84.9 % vs. 89.6 % , AOR 0.7 , 95 % CI 0.4 to 1.0 , p = 0.04 ) ; or to have ever visited the project sexual health clinic ( 59.0 % vs. 68.1 % , AOR 0.7 , 95 % CI 0.6 to 1.0 , p = 0.02 ) ; and were significantly more likely to be infected with gonorrhea ( 5.0 % vs. 2.6 % , AOR 1.9 , 95 % CI 1.1 to 3.3 , p = 0.02 ) . By the follow-up surveys , significant reductions were seen in the proportions of FSWs reporting violence compared with baseline ( IBBA 13.0 % vs. 9.0 % , AOR 0.7 , 95 % CI 0.5 to 0.9 p = 0.01 ; PBS 27.3 % vs. 18.9 % , crude OR 0.5 , 95 % CI 0.4 to 0.5 , p < 0.001 ) . Conclusions This program demonstrates that a structural approach to addressing violence can be effectively delivered at scale . Addressing violence against FSWs is important for the success of HIV prevention programs , and for protecting their basic human rights Background : In preparation for a r and omized controlled trial ( RCT ) , we conducted a pilot RCT of the acceptability and feasibility of diaphragms and c and i date vaginal microbicide for sexually transmitted infection prevention among high-risk women in Madagascar . Methods : Participants were r and omized to four arms : ( 1 ) diaphragm ( worn continuously ) with Acidform ™ applied in the dome ; ( 2 ) diaphragm ( worn continuously ) with placebo gel hydroxyethylcellulose ( HEC ) in the dome ; ( 3 ) HEC applied intravaginally before sex ; ( 4 ) Acidform applied intravaginally before sex . All women were given condoms . Participants were followed weekly for 4 weeks . We fit unadjusted negative binomial regression models with robust variance estimators to generate the proportion of sex acts with casual partners where condoms and experimental study products were used . Results :  Retention  was 98 % among 192 participants .  Experimental product use with casual partners was high , reported in 85 % , 91 % , 74 % , and 81 % of sex acts for women in the Acidform-diaphragm , HEC-diaphragm , HEC-alone , and Acidform-alone arms , respectively . However , the proportion reporting product use during 100 % of acts with casual partners over the full follow-up period was much lower : 28 % to 29 % in the gel-diaphragm arms and 6 % to 10 % in gel-alone arms . Women used condoms in 62 % to 67 % of sex acts with casual partners , depending on the r and omization arm . Participants found diaphragms easy to insert ( 97 % ) and remove ( 96 % ) . Acidform users ( with or without the diaphragm ) reported more genitourinary symptoms than HEC users ( 14 % vs. 5 % of visits ) . Conclusions : A sexually transmitted infection prevention RCT of c and i date microbicide with and without the diaphragm appears acceptable and feasible in this population Objectives : To investigate changes in HIV-related behaviours among female sex workers ( FSW ) and associations with services coverage rates . Methods : Behavioural surveillance data from Sichuan , China , were analysed . A mapping exercise was conducted ; FSW were recruited from r and omly selected sex-work establishments in 19 sites in Sichuan , China , from 2003 ( n = 7068 ) , 2004 ( n = 6875 ) and 2005 ( n = 6833 ) . Results : Site variations were substantial . The r and om effect pooled AOR comparing the prevalence of condom use with regular sex partners , possession of condoms , HIV-related knowledge , HIV antibody testing and services coverage rates in 2005 versus 2003 ranged from 1.42 to 20.35 . The 95 % CI of these pooled AOR all excluded 1.0 ; hence rejecting the null hypothesis that such OR were not different from 1.0 . Most of the AOR of these evaluative parameters ( indicator of improvement ) for the 19 individual sites in 2004 and 2005 ( vs 2003 ) were significantly associated with coverage rates ( Spearmen correlation coefficients = 0.35 to 0.67 , p<0.05 ) . Conclusions : Improvements were observed in relevant behaviours and coverage rates and the two were associated with each other 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 r and om sample s 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 28–37 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 Objective : To evaluate the effectiveness of a clinician-delivered intervention , implemented during routine clinical care , in reducing unprotected sexual behavior  of HIV-infected patients . Design : A prospect i ve clinical trial comparing the impact of a clinician-delivered intervention arm vs. a st and ard-of-care control arm on unprotected sexual behavior  of HIV-infected patients . Setting : The 2 largest HIV clinics in Connecticut . Participants : A total of 497 HIV-infected patients , aged ≥18 years , receiving HIV clinical care . Intervention : HIV clinical care providers conducted brief client-centered interventions at each clinical encounter that were design ed to help HIV-infected patients reduce unprotected sexual behavior . Main Outcome Measures : Unprotected insertive and receptive vaginal and anal intercourse and unprotected insertive oral sex ; unprotected insertive and receptive vaginal and anal intercourse only . Results : HIV-infected patients who received the clinician-delivered intervention showed significantly reduced unprotected insertive and receptive vaginal and anal intercourse and insertive oral sex over a follow-up interval of 18 months ( P < 0.05 ) . These behaviors increased across the study interval for patients in the st and ard-of-care control arm ( P < 0.01 ) . For the measure of unprotected insertive and receptive vaginal and anal sex only , there was a trend toward a reduction in unprotected sex among intervention arm participants over time ( P < 0.09 ) , and a significant increase in unprotected sex in the st and ard-of-care control arm ( P < 0.01 ) . Conclusions : A clinician-delivered HIV prevention intervention targeting HIV-infected patients result ed in reductions in unprotected sex . Interventions of this kind should be integrated into routine HIV clinical care Background and Objective : The Sonagachi Project in Calcutta , India , organized sex workers to improve working conditions . Goal : To compare rates of sexually transmitted diseases between the  Sonagachi Project  and other areas in which only the National AIDS Control Organization ( NACO ) interventions were implemented . Study : A cross-sectional survey of r and omly selected female sex workers . Results : There was no difference in the prevalence of all STDs between the 2 areas ; both were lower than reported in other surveys in 1992 . Analysis using propensity scores also failed to demonstrate any difference . The number of preventive activities was similar in the Sonagachi and NACO-only areas but was more prevalent than in 1992 . Sex workers in the Sonagachi area had better treatment-seeking behavior and attitudes . Both the Sonagachi and NACO strategies have result ed in lower STD rates , but the Sonagachi Project also increased the proportion who had an optimistic attitude and increased prevention and treatment-seeking behavior Background India has an estimated 2.0 million to 3.1 million people living with HIV ; it has the highest number of HIV-positive people in Asia and ranks third in the world . The Frontiers Prevention Project ( FPP ) was implemented in 2002 to conduct targeted prevention intervention geared towards female sex workers ( FSW ) and men who have sex with men ( MSM ) in the state of And hra Pradesh ( AP ) . This paper reports the overall changes in behaviour and STI outcomes between 2003/4 and 2007 and also describes the changes attributed to the FPP . Methods The evaluation used two cross-sectional surveys among MSM and FSW at 24 sites in AP . Surveys were implemented using a similar methodology . Univariate analyses were conducted by comparing means : baseline vs. four-year follow-up and FPP vs. non-FPP . For both MSM and FSW , r and om and fixed-effects logit regression models at the site level were estimated for condom 
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AUTHORS ' CONCLUSIONS Available evidence nevertheless suggests that compared with st and ard care or no intervention , behavioral interventions are effective in reducing HIV and the incidence of STIs amongst female sex workers ( FSWs ) .
Given the benefits of social cognitive theory and the promotion of condom use in reducing HIV/STI and the public health need to control transmission amongst FSWs , there is a clear finding in favour of behavioral interventions .