Having an STI increases the risk of HIV transmission by 2 to 9 times. Most STIs are curable with
prompt and proper care. However, prior to this intervention only 2-6% of doctors in India correctly
treated STIs. [FHI/DFID 2001 Summary Report: Health Care Provider Survey in Healthy Highways
Project, India]. Therefore to increase access to high quality STI services, PSI created the Key Clinic
Network, a franchised group of over 800 privately practicing doctors. Member doctors receive initial
trainings and refresher updates every six months as well as monthly support visits on the syndromic
management of male STIs, designed according to international best practices in partnership with
IntraHealth International. As part of this protocol doctors provide risk reduction counseling including
condom advice and counselling for partner treatment. ‘Simulated patients’ are sent to the clinics to
assess quality of care.

One of the barriers to proper STI treatment is confusion arising from the complexity of the Indian
drug market. There are over 1500 variations of drugs used to treat STIs on the market today. This
makes the doctor’s and chemist’s jobs very difficult. To aid in prescription, PSI provides a pre-
packaged urethral discharge treatment kit, ACT-1, containing a single dose of 1g of Azithromycin and
400mg of Cefixime as well as condoms, information on STIs and partner treatment cards.

To ensure that the target group is aware of the benefits of prompt and correct treatment, PSI
conducts behaviour change communication activities promoting the importance of timely, proper
treatment and the availability of Key Clinics. Communication activities include mass media campaigns
and on-the-ground activities such as street theatre performances and interpersonal communications
with the at-risk population. As of June 2006, PSI has achieved approximately 8 million on the ground
contacts with male clients of sex workers with STI prevention and treatment messages. During the
first round of the mass media campaign, the number of men with STIs seeking treatment at the Key
Clinic Network increased by 450%.

  
 

Condom use is essential in preventing HIV transmission in a context of frequent commercial sex such as in
the focus states of this project. Evidence from the beginning of the project indicated that condom
availability was still a barrier to consistent condom use. [PSI’s 2003 Knowledge, Attitude and Practice
(KAP) Survey]. PSI has expanded targeted condom distribution to ensure that condoms are easily and
affordably available where and when they are needed.

Outlets include traditional (chemist shops) and non-traditional (paan shops, bars, lodges, etc.) venues
with an emphasis on outlets open at night. As of June 2006, PSI ensures condom availability in 29,538
outlets in high-risk areas and has sold approximately 86 million condoms as part of this program.

Data from May 2006 shows that while 95% of male clients of sex workers used a condom at least once in
the last year with a commercial sex worker, only 62% of men consistently use them. [PSI’s 2006 BCIS].
PSI is therefore conducting an integrated behaviour change communication campaign to increase the
consistent use of condoms with commercial sex workers. Activities include interpersonal communication,
mid-media events such as street theatre, and outdoor advertising. Messages are developed through
quantitative and qualitative research identifying specific triggers and barriers to consistent condom use
with commercial sex workers.