Project Parivartan, which means "long-term change," as well as "metamorphosis," conducts research on implementing structural interventions among high-risk groups in six Indian states with the highest HIV prevalence: Andhra Pradesh, Karnataka, Tamil Nadu, Maharashtra, Manipur, and Nagaland.
Structural interventions (Sis) in HIV prevention seek to alter social, economic, political and normative factors that make up the risk environments for HIV infection where individuals live and work, and community-led structural interventions (CLSI) involve mobilizing communities to develop and direct such structural interventions to reduce their own HIV risk, with particular emphasis on community participation and ownership. Parivartan works with CARE India, who coined the term CLSI, as well as numerous other organizations funded by the Bill and Melinda Gates Foundation's Avahan India AIDS Initiative to systematically document and analyze the implementation and impact of CLSI across various contexts.
For the past two and a half years, in Rajahmundry, Andhra Pradesh, CARE India's SAKSHAM project has been developing a model CLSI demonstration project with female sex workers. Parivartan's interdisciplinary team of researchers closely follows the project, observing the daily activities of both the intervention staff and the sex workers with whom they work. Periodic interviews are also conducted with staff and members of the sex work and general community. One particular set of interviews relies on an approach developed in part by one of Parivartan's research team members, Scott Burris, J.D., called Rapid Policy Assessment and Response (RPAR). Collaborating with The Lawyers Collective HIV/AIDS Unit, based in Mumbai, Parivartan uses RPAR to identify ways in which law and the way law is put into practice increase or can reduce the risk of HIV among sex workers in Rajahmundry.
To date, more than 200 qualitative interviews have been conducted. Preliminary findings indicate that the intervention has already increased sex workers' awareness of HIV and other sexually transmitted infections, their knowledge and use of condoms, and their confidence and sense of self worth. Also, according to sex workers, some problems with police harassment seem to have declined. At the same time, their increased visibility and self confidence has also led to the targeted harassment and their arrest when they do not "show respect." Arrests to fulfill police quotas appear to continue as well.
In April 2006, in order to corroborate these and other preliminary results from interviews and observations, Parivartan implemented a large-scale survey of 813 sex workers. The survey will be repeated in 2007 to assess further, the impact of the intervention on sex workers lives and the structural factors that put them at risk. The survey uses an innovative network-based recruiting method called Respondent Driven Sampling (RDS), developed by one of Parivartan's research team members, Douglas Heckathorn, Ph.D.
In addition to Parivartan's focused work in Rajahmundry, team members also conduct site visits with other Avahan grantees to observe the implementation of CLSI in other contexts. Several such site visits have been completed, and others are planned, in order to identify strategies that can increase the likelihood of successfully implementing CLSI, and the conditions under which these strategies will be more or less successful. Ultimately, this information can be used by others, in India or elsewhere, to replicate CLSI with various populations in different contexts.
For further information and materials, please visit the Project Parivartan Web site at
http://cira.med.yale.edu/parivartan/.
