Fighting HIV By Empowering Sex Workers

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In talking about improving healthcare in areas of need, we often say we are "strengthening" communities, but what does that mean? In Maharashtra, India, strengthening communities means empowering some of its most marginalized groups—sex workers—to fight HIV.

In India, the word Mukta means freedom in several major languages. As with English, Mukta resounds with promise and hope. It's also the name of an HIV/AIDS prevention program run by Pathfinder International, and supported by the Avahan India AIDS initiative of the Bill & Melinda Gates Foundation.

Mukta works in dozens of towns and cities across Western India with those most at risk of HIV infection—mostly sex workers and men who have sex with other men. It offers them freedom, from ill-health for sure, but also from violence and stigma, from the disrespect of society, and from being denied health services.

For example, Mukta helps sex workers learn how to work together to get the services they deserve, from health and safety to their basic rights under India's vibrant democracy. It begins with health services and safe behaviors like condoms, but it moves on to so much more.

Sex worker groups that coalesced under Mukta are meeting elected leaders and police officers, medical staff, and leaders of the broader community. They've got the confidence to speak out and demand their rights.

This comes through collective action, and through knowledge that they gather themselves. Sex workers are also trained and employed to reach out to other members of their community. They spread the word about health, condoms, and medical awareness, but they also gather data and work to keep each other safe from all kinds of harm.

Let's start with the data. Reaching out to their peers, sex workers use tools that they've helped to develop—tools that take into account low literacy and the norms of their profession. They plan and map their communities. They track exposure to health and other risks, and use all of this information to build and empower their fellow sex-workers.

Call it community mobilization, call it agency; the outcomes have been wonderfully encouraging.

Through its first phase, Mukta saw sexually transmitted infections decline by roughly 30 percent among sex workers. People sought and received health services, made use of condoms, and addressed causes of violence. More women, children, and men had the chance to live healthier, safer lives. And the community has done it for itself.

It has become a model for HIV/AIDS prevention across Maharashtra and beyond.

The government of the western state of Maharashtra and the country's National AIDS Control Organization are enthusiastic implementers of their own versions of Mukta's tools and practices. The state authorities have designated the city a "learning site" and are sending other groups to find out what all the buzz is about.

In the city of Kolhapur, researchers from Harvard University have studied Mukta's work and made it part of their Global Health Delivery Project, taught to public health professionals from around the world. The innovative efforts of Mukta's local partner there, MSPSS [Muslim Samaj Prabodhan Va Shikshan Sanstha] are now known to students and practitioners in more than 20 countries.

Mukta's success—in Kolhapur and across Maharashtra—shows the importance of community leadership interventions and partnerships that are innovative, data-focused, and most importantly, scaled. These are HIV prevention programs that are actually owned and operated by their target groups, those most at risk. This is how we prevent HIV. This is how we save—and keep improving—peoples' lives.

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