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.

Declines in risk behaviour and sexually transmitted infection prevalence following a community-led HIV preventive intervention among female sex workers in Mysore, India.

OBJECTIVE: To investigate the impact on sexual behaviour and sexually transmitted infections (STI) of a comprehensive community-led intervention programme for reducing sexual risk among female sex workers (FSW) in Mysore, India. The key programme components were: community mobilization and peer-mediated outreach; increasing access to and utilization of sexual health services; and enhancing the enabling environment to support programme activities. METHODS: Two cross-sectional surveys among random samples of FSW were conducted 30 months apart, in 2004 and 2006. RESULTS: Of over 1000 women who sell sex in Mysore city, 429 participated in the survey at baseline and 425 at follow-up. The median age was 30 years, median duration in sex work 4 years, and the majority were street based (88%). Striking increases in condom use were seen between baseline and follow-up surveys: condom use at last sex with occasional clients was 65% versus 90%, P < 0001; with repeat clients 53% versus 66%, P < 0.001; and with regular partners 7% versus 30%, P < 0.001. STI prevalence declined from baseline to follow-up: syphilis 25% versus 12%, P < 0.001; trichomonas infection 33% versus 14%, P < 0.001; chlamydial infection 11% versus 5%, P = 0.001; gonorrhoea 5% versus 2%, P = 0.03. HIV prevalence remained stable (26% versus 24%), and detuned assay testing suggested a decline in recent HIV infections. CONCLUSION: This comprehensive HIV preventive intervention empowering FSW has resulted in striking increases in reported condom use and a concomitant reduction in the prevalence of curable STI. This model should be replicated in similar urban settings across India.