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India: Community Empowerment Key to Turning Tide on HIV

November 28, 2012 – Sex worker Akram Pasha remembers when his hometown of Mysore, India—an idyllic south­­ern tourist hub known for a Maharajah’s palace and its many universities—stood on the brink of an explosive epidemic.

In 2004, a new community-based organization in the city, called Ashodaya Samithi, conducted a first-ever survey of local sex workers and found an HIV prevalence of 25%.

“We were shocked,” said Pasha, who now serves as director of Ashodaya Academy, which trains sex workers in HIV prevention, leadership and community mobilization. “It could have been any one of us. We knew we had to do something to protect that 25% and prevent it from spreading to the other 75%.”

At the time, Mysore had no HIV prevention programs in place, and there was only one HIV testing and counseling center at the district hospital. Services simply weren’t reaching those who needed them most.

“There wasn’t a condom to be seen,” said Dr. Sushena Reza-Paul, an assistant professor of public health with the University of Manitoba, who helped start Ashodaya Samithi. “I remember walking several kilometers before finding one medical shop with a handful of condoms, and they were all expired.”

‘By the Community’

Today, India has averted at least 3 million HIV infections in large part through empowering key populations at highest risk — including sex workers, men who have sex with men, people who inject drugs and migrants — to take control of the epidemic through providing counseling, care, support and treatment to their peers, and advocating for their own needs. Some programs targeted to sex workers also provide training for alternative income-generating activities, such as tailoring, with the aim of reducing exposure to HIV.

Ashodaya Samithi is one example of this community ownership approach, which was significantly scaled up—with the help of community-based and nongovernmental organizations —during phase III of India’s National AIDS Control Program (NACP III), from 2007 to 2012. The World Bank has worked closely with the Indian government to develop a national response to HIV and AIDS that emphasizes targeted interventions for those most at risk.

Led by its 8000-plus female, male and transgender sex worker members, Ashodaya Samithi has played a critical role in reversing the epidemic in southern Karnataka state, one of four high-prevalence states that account for 55% of all HIV infections in India. Its members promote condom use, provide HIV testing and counseling, link HIV-positive sex workers to antiretroviral therapy centers so they can receive treatment, and volunteer in hospitals to ensure fellow sex workers receive adequate services and aren’t discriminated against.

To expand its services, the group has taken a social enterprise approach; it runs a local restaurant, originally funded by a World Bank Development Marketplace grant, as well as serviced apartments. Profits go to support a community care home for HIV-positive sex workers.

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