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Community Mobilization can reduce HIV/STI risk among female sex workers:

Community Mobilization can reduce HIV/STI risk among female sex workers: E merging evidence from Avahan. Where the Tide will Turn: How is Community Level Participation Most Effective in Turning the Tide? AIDS 2012 (SUSA72 )

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Community Mobilization can reduce HIV/STI risk among female sex workers:

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  1. Community Mobilization can reduce HIV/STI risk among female sex workers: Emerging evidence from Avahan Where the Tide will Turn: How is Community Level Participation Most Effective in Turning the Tide? AIDS 2012 (SUSA72) Tisha Wheeler, Anne SebertKuhlmann, Tara Beattie, Narender Kande, Christine Galavotti, Gina Dallabetta, ParinitaBhattacharjee, SudhaChandrashekar, H L Mohan, M Suresh, DhanunjayaRao, ShajyIsac, Lori Heise, BM Ramesh, Stephen Moses, and Charlotte Watts

  2. Mounting Focus on Structural Interventions and Community Mobilization …major efficiency gains through community mobilization…

  3. On Ground Scope of Avahan Program 10 Years(2003 – 2013)

  4. Coverage and Condoms: New Peer Approaches Made a Difference • The Difference • Peer Empowerment • Real time data use • Evolving program design • Leadership beyond services Source: Wheeler T, et. Al, J Epi Comm Health 2012

  5. Condom Users Have Collective Power AOR=1.61, p<0.05 AOR=1.72, p<0.001 AOR=1.64, p<0.05 Collective identity – sense of unity with FSWs they don’t know Collective efficacy – agreed that all or most FSWs would help to solve a community problem Collective agency – participate in a public event where could be ID’ed as an FSW or spoke to police in last six months Source: Blankenship K et al, AIDS 2008 Behavioral Survey, 2007, East Godavari district, Andhra Pradesh, N=813

  6. Violence means Less Condom Use, Access and Higher STIs AOR 0.4, 95% CI p<0.001 AOR 1.9 95% CI p<0.02 Addressing violence is central for HIV prevention among FSW Integrated Biological and Behavioral Survey, Karnataka, India, N=3852 FSW Source: Beattie T, et al. BMC Public Health 2010

  7. Changes after Community Mobilization Strengthened in Mysore, Karnataka Increases in Consistent Condom Use AOR=4.3, 95%CI, p<0.001 Significant Reductions in STI’s p<0.001 p<0.001 p<0.001 p<0.001 p<0.03 Integrated Biological and Behavioral Survey, Mysore-Karnataka, India Survey 2004 N=525, Survey 2006 N=529 FSW Reza-Paul S, et al, AIDS2008

  8. Testing Community Mobilization Theory of Change in Avahan Sustained community structures Reduced risk & vulnerability Sustained HIV Response through communities Community-level changes Improved outcomes Impact Enhanced program outputs Participation Social norm & behavior change Stage 1- Identification w/others Enabling Environment Strong community groups and organizations Participation • SI • Access to entitlements • Crisis response • Advocacy capacity & practice (media, legal etc) • OD • Readiness & capacity of community groups, networks • Mature processes • HRG • Reliable denominators • Increased coverage & service uptake • Quality Reinforces Stage 2- Collectivization Participation Stage 3- Ownership Structural Intervention (SI) activities Organizational Development (OD) activities HRG Intervention activities Source: Galavotti et. al, J Epi Comm Health 2012

  9. Emerging Results: High Exposure to Community Mobilization Drives Results ** ** ** Increased Collective and Individual Power Increased Knowledge and Uptake of Services ** ** ** ** * ** * ** * Low Medium High *AOR p<0.05 **AOR p<0.001 Reduced Gonorrhea and Chlamydia Prevalence ** * ** Increased CCU * * * Data Source: Biological and behavioral survey, 2011 with random samples of FSWs in 4 districts in Karnataka, India (Bellary, Bangalore, Shimoga, Belgaum) N=1934 FSW Beattie et al, THPE275

  10. Conclusion • Start with peer led outreach • Address violence (and other SI) • Mobilize communities • Measure to capture progress • Authors: • Tisha Wheeler1, Anne Sebert Kuhlmann2, Tara Beattie3, Narender Kande4, Christine Galavotti5, Gina Dallabetta4, Parinita Bhattacharjee6, Sudha Chandrashekar3, H L Mohan6, M Suresh6, Dhanunjaya Rao6, Shajy Isac6, Lori Heise3, BM Ramesh6, Stephen Moses6, Charlotte Watts3 • 1 Futures Group, Washington D.C. USA • 2 Manila Consulting Group, Inc., McLean, VA, USA • 3 London School of Hygiene and Tropical Medicine • 4 Bill & Melinda Gates Foundation, India/Washington DC, USA • 5 CARE, Atlanta, GA, USA • 6 Karnataka Health Promotion Trust; University of Manitoba, India www.gatesfoundation.org/avahan

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