1. University of Manitoba
Community led HIV prevention model: Experience from Ashodaya Samithi India
Sushena Reza Paul
Assistant Professor
University of Manitoba
Advisor
Ashodaya Samithi

2. Context
Map
Mysore and Mandya sites were initiated for HIV prevention intervention with high degree of community involvement
Highly dynamic nature of sex work; from a street based SW metamorphosed to a mixed pattern
Ashodaya Samithi was borne out of aspiration of the sex workers of Mysore & Mandya in 2005: governed by a democratically elected governing board, spans over 4 districts in Karnataka, India
A collective membership of over 8000 Female, Male and Trans Sex Workers
Pioneer in community to community capacity building and community led research- Ashodaya Academy

3. Moving Beyond Community Friendly to Community LedS T A G E
Inclusion/ Participation
FOR
Poor to Low Coverage
Minimal Prevention Impact
Congregation
Aggregation
Self Identity
Safe Space
Communitization
Involvement
WITH
Increasing Coverage
No Sustained Impact
Community
Mobilization
Community Organizing
Representation / Ownership BY
Community Organizing
Community
Organization
Saturated Coverage
Sustained Impact
Sustaining Action

4. Sex Work as a service industry:
Underpinnings of the Program
Rights- based:
Community is able to exert agency
Sex Work is work:
Sex work is a livelihood option, HIV an occupational hazard
Sex Work as a service industry:
Address sex work as whole and not sex workers in isolation
Understanding the presentation & operation of sex work

5. Program Elements Capacity Building
Community members engage in rallying fellow community members around a common agenda
Program Elements
Community Mobilization
Community-owned Health Services
Creating an Enabling environment
Community-led Monitoring
Capacity Building
On going- community to community handholding
Including STI, SRH, condom testing, community clinic with positive health image, accompanied referral, SW run clinic management committee and forum for grievance redressal
Using simple tools (minimum) and methods (important)
Enhance community’s capacity on local data collection and their understanding on interpreting results and its implications
Ensure accountability to the community
Putting community’s interest in the center; they spearhead
Crisis response system for violence and other S&D cases
Social Champions, Health care navigator

6. Community Mobilization
Engaging without involvement
Involvement without purpose
Middle Ground
Deconstruct science for community insight
Suggest strategy
Make community think, decide, accept and own
Community-led Crisis response and mitigation
Safe Space
Carving Community Identity
Building on existing relationships
Services owned
A different attraction
Community Mobilization
Approaches
What Contributed

7. Clinic visits and STI treated
Monthly Outreach Contacts
Clinic visits and STI treated

8. HIV testing and new HIV positives 2008-2018
Crisis Response

9. Oct17-Mar 18 KP population size (denominator) = 2181
Identify systematically
Active coverage /Condom distribution= 2216/238430
Frequent outreach
Monthly outreach contacts = 2005(91.93%)
Quarterly checkups
Quarterly medical checkups (RMC) = 2091(95.9%)
(multiple STI/SRH services provided)
HTC 6- monthly (88% of eligible) 1844
Cum HIV+ = 117
HIV+
HIV-
1842(99.9%)
2(0.1%)
Link Pre-ART= 117
On ART=63
100% of those eligible
Retain=63
100.0% of those on ART) (No lost to FU)
Low VL
VL testing not routinely available

10. Challenges & The Way Forward
Project Level
Reinventing the program & adjusting with changing sex work pattern
Maintaining speed, efficiency and quality
Environmental Level
Social and legal status
Violence, raid, stigma, discrimination & criminalization
Funding & Policy Level
Lack of faith in the potentials of the community
Commitment for supporting community led processes
Funding from Donors & National Program
Challenges & The Way Forward
Enhancing community involvement in HIV/TB convergent program, Developing a community led model
Capturing key lessons for scaling up

11. Keeping the Prevention agenda high
Blood Tenofovir level
Combination prevention by including ‘Community-led PrEP delivery’ for FSW
647 enrolled, 640 completed 15 month follow-up
Self-reported adherence during the last 7 days and last month consistently high
Condom use with different clients remain high, STI low
466 continue to take the medicine post study

12. Lessons Learnt & Conclusion
HIV impact can be achieved and sustained among sex workers by approaches that ensure community involvement and ownership
Linking communities across geographies can hasten the process of capacity development and developing ownership
HIV epidemic is far from being over, hence newer prevention tools (PrEP) are critical in reducing HIV incidence
Community institution building (CBO), Learning location development (Ashodaya Academy) continue to harness community intelligence that will provide sustainable impact

13. Acknowledgements All the Sex Workers at Ashodaya- My Gurus
Community & Non-Community staff of Ashodaya
DMSC
NACO
WHO
UNAIDS
Bill & Melinda Gates Foundation
Everyone who contributed to the birth, growth & development of Ashodaya