Table 3

Avahan community mobilisation and structural intervention data published to date

Area of measurementMethod and indicatorsResults
  • Economic cost for community mobilisation activities

  • Chandrashekar et al44

Costing data was gathered based on expenditures from the first 2 years of Avahan, Y2003–Y2005. Cost data collected separately for community mobilisation (drop-in centre activities, special events, self-help group formation and welfare activities) and enabling environment activities (advocacy, sensitisation of stakeholders, crisis management and creation of mass awareness).
  • The percentage of the total intervention cost:

    • community mobilisation: 6.0%

    • enabling environment: 8.9%

  • The cost per person registered was $76, ranging from $18 to $650 across the NGO service delivery partners.

  • Association of community mobilisation with reported condom use

  • Blankenship et al53

Cross-sectional survey from a district in coastal Andhra Pradesh in 2006 assessing relationships between FSWs' perceived agency and exposure to a community mobilisation intervention with consistent condom use with clients.Consistent reported condom use with clients associated with:
  • FSWs reporting control over the type of sex (AOR 1.70, 95% CI 1.23 to 2.340)

  • FSWs reporting control over the amount charged (AOR 1.56, 95% CI 1.12 to 2.16)

  • Programme exposure (AOR 2.09, 95% CI 1.48 to 2.94)

  • The interaction between programme exposure and collective agency was also significant (χ2 6.62, p=0.01). Among respondents who reported both programme exposure and high levels of collective agency, the OR of consistent condom use was 2.5 times that of other FSWs.

  • Relationship between violence and HIV related vulnerability among FSWs who report debt

  • Reed et al54

Cross-sectional survey from a district in coastal Andhra Pradesh in 2006.FSWs who reported debt were more likely to report the following:
  • Recent physical violence (OR=2.4; 95% CI 1.5 to 3.9)

  • Unprotected sex with occasional clients in the past week (OR=2.3; 95% CI 1.2 to 4.3)

  • Anal sex with clients in the past 30 days (OR=2.0; 95% CI 1.1 to 3.9)

  • At least one STI symptom in the past six months (OR=1.6; 95% CI 1.1 to 2.4)

  • Willingness to be identified in public as a sex worker and intervention exposure

  • Blankenship et al55

Two rounds of a cross-sectional survey from a district in coastal Andhra Pradesh in 2006 and 2007.In 1 year:
  • Programme awareness in FSWs increased from 42% to 70%

  • Active utilisation or participation in services and activities of the programme (among those who were aware) increased from 49% to 61%.

  • The most important factor associated with both forms of intervention exposure across rounds was willingness to be identified in public as FSWs (OR 2.2–4.8).

  • Sexual violence experienced by FSWs and association of violence with condom use and STI treatment seeking behaviour.

  • Beattie et al50

Polling booth surveys (PBS) 2006–2008 and cross-sectional integrated behavioural and biological survey (IBBA) 2005–2009 among FSWs in the state of Karnataka.
  • In the first round of the IBBA FSWs reported being raped or beaten in the past year at rates of 11.0% and in another anonymous, polling both survey, 26.4%.

  • FSWs who reported sexual violence in the past year were:

    • less likely to report condom use with clients, 55% vs 76% (AOR 0.4, 95% CI 0.3 to 0.5);

    • less likely to ever have been contacted by peer educator, 85% vs 90% (AOR 0.7, 95% CI 0.4 to 1.0);

    • less likely or to have ever visited the project sexual health clinic, 59% vs 68% (AOR 0.7, 95% CI 0.6 to 1.0);

    • more likely to have gonorrhoea, 5.0% vs 2.6% (AOR 1.9, 95% CI 1.1 to 3.3).

  • In the follow-up surveys, significant reductions were seen in the proportions of FSWs reporting violence compared with baseline

    • From IBBA, 13% vs 9% (AOR 0.7, 95% CI 0.5 to 0.9);

    • From PBS, 27% vs 19% (crude OR 0.5, 95% CI 0.4 to 0.5).

  • Violence and the association with reproductive health and HIV risk among mobile FSWs

  • Swain et al56

Cross-sectional behavioural survey of mobile FSWs conducted in 22 districts in the states of Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu between September 2007 and July 2008.
  • A total of 30.5% of mobile FSWs reported violence at least once in the past year: 11% physical violence and 19.5% sexual violence.

  • FSWs who experienced violence were more likely to:

    • have experienced a higher number of pregnancies (AOR 1.2, 95% CI 1.0 to 1.6);

    • ever have experienced pregnancy loss (AOR 1.4, 95% CI 1.2 to 1.6);

    • ever have experienced forced termination of pregnancy (AOR 2.4, 95% CI 2.0 to 2.7);

    • Currently practice inconsistent condom use (AOR 1.97, 95% CI 1.4 to 2.0).

  • Declines in risk behaviour and sexually transmitted infection prevalence following a community-led HIV preventive intervention

  • Reza-Paul et al57

Two rounds of cross-sectional behavioural and biological data in FSWs from Mysore, Karnataka; surveys took place in 2004 and 2006
  • Biological data showing increased condom use and declines in STI prevalence where community mobilisation had been strengthened.

  • Condom use at baseline and follow-up with occasional clients was 65% vs 90% (p<0.001); with repeat clients 53% vs 66% (p<0.001); and with regular partners 7% vs 30% (p<0.001).

  • STI prevalence declined from baseline to follow-up: syphilis 25% vs 12% (p<0.001); trichomoniasis 33% vs 14% (p<0.001); chlamydial infection 11% vs 5% (p<0.001); gonorrhoea 5% vs 2% (p<0.03). HIV prevalence remained stable.

  • Reasons for entry into sex work among women and a primarily IDU driven epidemic.

  • Devine et al58

Survey and focus group analysis from a district in Northeast India.Diverse reasons for entry into sex work have implications for HIV prevention strategies:
  • The willingness and capacity of sex workers to mobilise as a community.

  • NGO capacity to ensure that the interests of all sex workers are adequately captured and represented.

  • Operational approaches taken by a FSW to confront discriminatory behaviour by the police.

  • Biradavolu et al59

Detailed ethnographic observations of a sex worker intervention in a district in coastal Andhra Pradesh.An FSW community-based organisation with support from an NGO undertook the following:
(1) Articulated new standards for acceptable police behaviour; (2) Set up a network to monitor compliance; (3) Created a rapid reaction team to punish non-compliance through confrontation, publicity and legal action, escalating the response.