HIV Prevention Among Sex Workers in India

According to the current study, HIV rates of only 10 percent have been observed among sex workers in Calcutta, compared to rates ranging from 50-90 percent in Bombay, Delhi and Chennai. Condom use has also risen in Calcutta in recent years, from 3 percent in 1992 to 90 percent in 1999. Such figures may reflect the impact of the Sonagachi Project, a sustainable community-level STD/HIV intervention.

The World Health Organization selected the Sonagachi Project as a model of STD/HIV intervention. To demonstrate under controlled conditions that the project was responsible for the results in Calcutta, project staff designed and conducted a two-community trial to document the efficacy of the program. An external research team designed the assessment and conducted the analysis.

Two small communities in northeastern India were matched on size, socioeconomic status and number of sex workers and randomly assigned to an intervention and control condition. Each community's red-light area consisted of about 350 sex workers; 100 such workers were randomly selected in each area.

The Sonagachi Project was replicated including community organizing and advocacy, peer education, condom and social marketing and establishment of a health clinic. The enhanced intervention group included training by a team of local peer educators. The goals were to build skills and confidence in providing education and to foster empowerment and advocacy for local sex workers. The investigators conducted a baseline assessment with three follow-up assessments every 5-6 months over a 15-month period.

The researchers found overall condom use increased significantly in the intervention community (39 percent) versus the control community (11 percent), and the proportion of consistent condom users increased 25 percent in the intervention community compared to a 16 percent decrease in the control community.

"This study supports the efficacy of the Sonagachi model intervention in increasing condom use and maintaining low HIV prevalence among sex workers," the researchers found. "Too often, effective interventions are conceptualized based on theories of social change launched by university researchers. This intervention was designed by the community, is sustained by the community, and is taken to new communities by sex workers," they concluded. "Greater emphasis must be placed on interventions arising from communities if HIV prevention programs are to be sustained and broadly implemented."

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