Evaluating Structural Interventions for HIV Prevention Among Sex Workers and their Clients in India
Investigator: Kim Blankenship, Ph.D.
Project Parivartan, which means "long-term change", is supported by the Bill and Melinda Gates Foundation's Avahan India AIDS Initiative to research and evaluate structural interventions among high-risk groups in six Indian states with the highest HIV prevalence: Andhra Pradesh, Karnataka, Tamil Nadu, Maharashtra, Manipur, and Nagaland. Through a $2.1 million grant across 3 years, Avahan asked Yale to evaluate the work of CARE India, which was funded to build the capacity of Avahan partners to implement community-led structural interventions (CLSI). CLSI involves mobilizing communities to develop and direct their own structural interventions (i.e. interventions that alter the context within which individuals engage in health behaviors or make health related decisions). As one component of its work, Project Parivartan seeks to systematically document and analyze the implementation of CLSI, as well as its impact at the individual, community, and structural level. Process indicators will be monitored using several methodologies including embedded ethnographers to observe the intervention's development and focus group discussions and key informant interviews with intervention staff and key stakeholders in the community. Outcome indicators will be monitored using the aforementioned methods as well as an annual serial cross-sectional survey with sex workers. Of particular interest will be such outcomes as: condom use with different partners, experiences of violence and harassment, extent of collective identity, degree of sex worker integration into the community, and the policy environment.
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