1. Strengthening the response to HIV: virtual learning from Aastha, India Dr Sanjeev Singh Gaikwad

2. The Context: Aastha Project HIV prevention among male, female and transgender SWs in Mumbai and Thane from 2004 -2012 Large metropolitan area with many single male migrants SWs ever reached: 80,000 SWs Rapid scale up and innovations make it a model within BMGF Avahan Special recognition by BMGF at International AIDS Conference, Toronto, 2006

3. Aastha Project – cont’d Aastha Innovations and lessons have been incorporated in the Indian National Guidelines for Targeted Interventions (2007) Identified as learning site by NACO and FHI 360 Globally Winner of FHI 360 Program Excellence Award in 2009 Aastha has lead to FHI360 being requested by BMGF for transferring learning's to African countries.

4. Large number of SWs: about 50,000 with > 1 new partner per day Extreme heterogeneity among SWs High churn rate of SWs

5. Benchmark results….. Avg. monthly STI screening coverage ranges between 31 - 45 % ( Currently 8-10k SWs) 99% of all New SWs screened for STI 85% of SWs Screened for Syphilis at least once and 69 % screened every 6 months About 85.2% of SWs have undergone C&T at least once and 50.2% access C&T every 6 months on an average

6. HIV Prevention approaches Community Engagement and Ownership Poverty; Lack of support structures Decreased social status; Decreased autonomy Poverty; Lack of support structures Decreased social status; Decreased autonomy Entry into SW Violence Vulnerability to HIV Social ostracism Access to services Sex Work HIV Behavioral Biomechanical Biological

7. Aastha: The focus on Quality…. ACQUA (Aastha Continuous Quality Approach) Principle Innovations of Aastha Branding with niche marketing Microplanning; Peer Educators as Managers for sites; individual tracking Aastha Minimum Package Community based monitoring of key indicators Demand generation mechanisms Aastha condom Rapid response system Counseling and Testing under PPP SW specific CoC package Aastha Enterprises Vivek FP-HIV Integration

8. Impact of ACQUA Monthly STI screening of SWs has been scaled up to 36% SWs (10,000 SWs/month) with quarterly STI screening at 93% Six monthly uptake of VCT is 50% Crisis response coverage is 99% with an average response time of 24 minutes and decreased police arrests Uptake of prevention messaging and condoms is nearly 100% Decrease in STI incidence from 37% to 3%

9. Brothel Based 44.76 50.2 28.1 38 25.2 18.6 17.1 13.7 0 10 20 30 40 50 60 2004200520072010 Brothel Based(Mumbai)Brothel Based (Thane) Brothel Based Trend of HIV prevalence among SWs in Mumbai & Thane

10. Virtual Learning on Aastha…. Tools, manuals and monographs from Aastha are available at the FHI360 website India HIV Portal is being developed as a repository for learning resources. Virtual training sessions through webinars: links will be sent to interested persons Fixed time theme specific group chats and webinars Training of trainers on manuals and tools through virtual classrooms Bridge project (Africa-India-Asia Learning Network) supported by the Gates Foundation to provide virtual learning from Aastha and other Avahan and India projects.

11. Virtual learning…. 45 abstracts presented as poster presentations during international conferences 20 abstracts presented as oral presentations during international conferences Learnings have disseminated to Gujarat SACS, Goa SACS, MPSACS, Uttarakhand SACS, UPSACS, other Avahan Partners like HLFPPT, Pathfinder Disseminated learnings to 17 countries (Pakistan, Vietnam, Bangladesh, Papua New Guinea, Kenya, Nepal, Indonesia, Laos, Cambodia, Australia, Tanzania, Egypt, Ivory coast, Ghana, Ethiopia) 15 publications including training manuals, SOPs, Monographs published and disseminated across the country and the globe.

12. Thank You