Community mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis

Anna Vassall, Sudhashree Chandrashekar, Michael Pickles, Tara S. Beattie, Govindraj Shetty, Parinita Bhattacharjee, Marie-Claude Boily, Peter Vickerman, Janet Bradley, Michel Alary, Stephen Moses, CHARME India Group, Charlotte Watts PLOS One, 2014; 10.1371/journal.pone.0110562 Community Mobilisation and Empowerment Interventions as Part of HIV Prevention for Female Sex Workers in Southern India: A Cost-

Most HIV prevention for female sex workers (FSWs) focuses on individual behaviour change involving peer educators, condom promotion and the provision of sexual health services. However, there is a growing recognition of the need to address broader societal, contextual and structural factors contributing to FSW risk behaviour.

The paper, co-written by Anna Vassall and Charlotte Watts, and published by PLOS ONE, assesses the cost-effectiveness of adding community mobilisation (CM) and empowerment interventions to core HIV prevention services delivered as part of the Avahan programme (an initiative sponsored by the Bill & Melinda Gates Foundation to reduce the spread of HIV in India) in two districts of Karnataka state, Southern India. Its findings aim to inform funders, policy makers and programme managers designing HIV prevention for FSWs globally.

Two districts were chosen purposively for the study, based on:

  • Karnataka’s socio-cultural regions
  • the size of the high-risk population 
  • the availability of detailed behavioural, biological and costing data. 

Surveys were carried out amongst FSWs and clients in districts in Karnataka state over several years. Approximately 400 respondents were randomly sampled at each round in most districts, using a probability-based sampling method. In addition to questions on sexual behaviour and risk factors for HIV, blood samples were taken to test for HIV, HSV-2 and syphilis. 

Measures of collective power (power with) were explored using the following questions: “I feel a strong sense of unity with FSWs I do not know”, “In the last 1 year, have you negotiated with or stood up against a powerbroker to help a fellow FSW?", “In the last 6 months, have you attended any public events, such as a rally or a gathering of sex workers, where you could be identified as a sex worker?"

Full paper and key findings








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