Community action for people with HIV and sex workers during the COVID-19 pandemic in India

Sex workers have been one of the marginalized groups that have been particularly affected by India’sstringent lockdown in response to the coronavirus disease 2019 (COVID-19) pandemic. The suddenloss of livelihood and lack of access to health care and social protection intensified the vulnerabilities ofsex workers, especially those living with HIV. In response, Ashodaya Samithi, an organization of morethan 6000 sex workers, launched an innovative programme of assistance in four districts in Karnataka.Since access to antiretroviral therapy (ART) was immediately disrupted, Ashodaya adapted its HIVoutreach programme to form an alternative, community-led system of distributing ART at discreet,private sites. WhatsApp messaging was used to distribute information on accessing government socialbenefits made available in response to the COVID-19 pandemic. Other assistance included advisorymessages posted in WhatsApp groups to raise awareness, dispel myths and mitigate violence, andregular, discreet phone check-ins to follow up on the well-being of members. The lessons learnt fromthese activities represent an important opportunity to consider more sustainable approaches to thehealth of marginalized populations that can enable community organizations to be better prepared torespond to other public health crises as they emerge.

Prioritizing Risk in Preparation for a Demonstration Project: A Mixed Methods Feasibility Study of Oral Pre-Exposure Prophylaxis (PREP) among Female Sex Workers in South India.

BACKGROUND: HIV prevalence among female sex workers (FSWs) in India remains well above the national average. Pre-exposure prophylaxis (PrEP), a new HIV prevention technology, may help to reduce HIV incidence, but there is a dearth of research that can inform the potential scale-up of PrEP in India. In partnership with Ashodaya Samithi, a local sex worker collective, we conducted a feasibility study to assess acceptance of a planned PrEP demonstration project, willingness to use PrEP, and recommendations for project roll-out among FSWs in southern Karnataka. METHODS: From January-April 2015, 6 focus group discussions, 47 in-depth interviews, and 427 interviewer-administered questionnaires were completed by female sex workers. All participants were 18 years of age or older and practiced sex work. Qualitative data were coded for key themes and emergent categories. Univariate descriptive analysis was employed to summarise the quantitative data. RESULTS: Qualitative. PrEP was described as an exciting new prevention technology that places control in the hands of FSWs and provides a "double safety" in combination with condom use. Participants expressed agreement that women who may experience more HIV risk in their occupational environments should be prioritized for enrollment into a demonstration project. Quantitative. 406 participants (95%) expressed interest in PrEP. Participants prioritized the inclusion of FSWs under the age of 25 (79%), those who do not use condoms when clients offer more money (58%), who do not consistently use condoms with regular partners (57%), who drink alcohol regularly (49%), and who do not use condoms consistently with clients (48%). DISCUSSION: This feasibility study indicated strong interest in PrEP and a desire to move forward with the demonstration project. Participants expressed their responses in terms of public health discourses surrounding risk, pointing to the importance of situating PrEP scale up within the trusted spaces of community-based organizations as a means of supporting PrEP uptake and adherence.