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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:

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


Mounting focus on structural i nterventions and community mobilization
Mounting Focus on Structural Interventions and Community Mobilization

…major efficiency gains through community mobilization…


On ground scope of avahan program
On Ground Scope of Avahan Program

10 Years(2003 – 2013)


Coverage and condoms new peer approaches made a difference
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


Condom users have collective power
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


Violence means less condom use access and higher stis
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


Changes after community mobilization strengthened in mysore karnataka
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


Testing community mobilization theory of change in avahan
Testing Community Mobilization Theory Karnatakaof 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


Emerging results high exposure to community mobilization drives results
Emerging Results: KarnatakaHigh 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


Conclusion
Conclusion Karnataka

  • 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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