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Funders' priorities and targets hindered community mobilisation and meaningful participation of sex workers in India
Roger Pebody, 2015-05-25 09:50:00
Two qualitative studies, investigating the implementation of a massive programme of HIV prevention through community mobilisation in India, have identified challenges to the rapid scale-up and roll-out of a programme in which grassroots action was meant to be central. While the programme was intended to empower sex workers to tackle the social conditions which made them more vulnerable to HIV, a more narrow focus on condoms and clinical services took over. This discouraged sex workers from getting involved in the programme.
Implemented in six Indian states with a high HIV burden, Avahan was one of the largest HIV prevention programmes ever delivered. It aimed to slow the transmission of HIV in the general population by raising the coverage of prevention interventions in high-risk groups such as female sex workers and men who have sex with men. Funded by the Bill & Melinda Gates Foundation, there was a strong emphasis on efficient delivery and scale-up of a defined package of interventions, in order to achieve saturation coverage. Monitoring and evaluation showed that this was achieved.
The core package of HIV prevention services included peer-led outreach and education; distribution of free condoms; community mobilisation initiatives to address structural and environmental barriers; and testing and treatment of sexually transmitted infections (STIs), tuberculosis and HIV.
An inspiration for the programme was the Sonagachi Project in Kolkata. It employed sex workers as peer educators and involved sex workers in all aspects of the project. As a result, the project moved from being focused only on health to empowering sex workers so that they could demand better working conditions and human rights protections. Sonagachi is credited with improving rates of condom use, STIs and experience of violence among sex workers.
The Avahan programme aimed to replicate this success. But what happened in practice? Separate qualitative studies of the delivery of Avahan’s sex worker programmes in Andhra Pradesh and Mumbai have recently been published in Global Public Health and PLOS One respectively.
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