‘A lakh HIV cases fewer’ and how they got there

"The effort was to mobilise them, understand their issues and grievances and help find a solution," says Bhattacharjee, and citing the result: HIV prevalence among sex workers has declined from 25 to 14 per cent since 2005-06.

Karnataka, along with other governments, has been working on intervention programmes in collaboration with Avahan, an initiative launched in India with funding from the Bill and Melinda Gates Foundation.

Prof Lalit Dandona, researcher at Public Health Foundation of India, New Delhi, told The Indian Express large-scale interventions by Avahan alone have helped prevent over a lakh infections between 2003 and 2008, an assessment published online in The Lancet on Tuesday.

It is based on a statistical analysis of trends and current data among high-risk individuals inkey areas, researchers say. "We created a counter-factual model — 'What if Avahan had not been there?' — and that's how we arrived at the estimation," Dandona said.

In Karnataka, the project every month sees over 22,000 people treated at clinics and nearly four million condoms distributed.

In Mumbai, a sex worker says she knows she could any day face a stubborn client refusing to use a condom, or even a violent one. Yet in any crisis, she knows, she is assured of help in minutes. Since a violence response programme was set up under Avahan, Mumbai has seen a 38 per cent decline in crisis incidents between 2007 and 2009 , and Andhra Pradesh a 30 per cent drop between 2006 and 2008.

Avahan was launched in 2003, in six states with a high HIV burden. It received $258 million from the Gates Foundation until 2008; an additional $80 million was announced in 2009 to support the transition of this initiative to merge with the government's HIV control effort by 2013.

"We work in Tamil Nadu, Karnataka, Andhra Pradesh, Maharashtra, Nagaland, and Manipur. Within those states, our partners serve 75 districts — each with a population of about 2 million people — and around 630 towns. Avahan also works along 8,000 km of national highways" to reach truckers, says Alkesh Wadhwani, head of Avahan India.

Avahan's partners include local and international NGOs, universities, and research organisations. Nine lead partners at state level support local a number of NGOs that implement the strategy.

In Andhra, S V Shreeram the director of programmes at India-HIV Alliance, an Avahan partner, cited 90 intervention programmes. "Today we have covered 45,000 sex workers and men having sex with men."

In Maharashtra, interventions by Avahan were implemented through Pathfinder International and Family Health International. Darshana Vyas, programme director of Pathfinder in Mumbai, said, "By 2009 on a monthly basis the programme was meeting more than 39,000 sex workers and distributing approximately two million condoms and servicing over 20,000 visits. Over two million condoms were sold monthly to high-risk men."

"There were sex workers from various cities who barely spoke to each other. We had to get them on a common platform," said Sanjeevsingh Gaikwad, director of Family Health International in Mumbai. After the Aastha programme, "groups collectively came to the aid of any sex worker who complained that the client refused to use a condom".

National AIDS Control Organisation programme manager Mani Lal gave a picture of the overall reach of combined efforts — 1,600 NGOs, 8.62 lakh female sex workers, 4.24 men-having-sex-with-men and 1.8 intravenous drug users. "NACO spends Rs 250 crore on targeted interventions," Lal said.

Dr Dileep Deshmukh, joint director of the Maharashtra State AIDS Control Society, said the prevalence rate of HIV has shot down from 1.1 per cent in 2005 to 0.3 per cent in 2010 among antenatal women.

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