Background Solapur in south India is a district to which large numbers of female sex workers (FSWs) migrate from nearby states. The district also holds a number of jatras (religious festivals), in which thousands of people assemble for a short duration of time at a specific location, and where FSWs find a ready market for their services. We are implementing an HIV prevention program in the district among approximately 2525 FSWs, with a view to reducing the transmission of HIV and STIs, and improving their health seeking behaviour.
Methods Services provided include condom promotion and distribution, and clinic visits for STI detection and treatment. Strategies used for mobilising the community include outreach planning using a peer-educator based approach, development of site-wise social and local hotspot analysis maps, provision of voluntary HIV counselling and testing services in public-private partnerships, and provision of night outreach clinics in brothels. Those FSWs accessing the program are registered with a unique identification number and each outreach contact or clinic visit is recorded using a standard format, with type of service rendered. Peer cards and clinic forms are used to record individual outreach and clinical services provided, and information is entered into a computerised database at local level. The system is web-enabled to avoid double counting, and local implementation units can access information on the provision of services to any particular FSW at multiple clinics across the district.
Results Over a nine-month period in 2010, 51% (1,298) of the FSWs visited the clinic each month, and 88% (2214) visited the clinic at least once in a quarter. 31% of newly identified FSWs received presumptive STI treatment within 1 month of initial contact. 86% of the women reported condom use at last sex with a commercial sex partner. 1,051 FSWs were tested for HIV, and 4% of them tested positive. 91% of positive FSWs were linked to care services, including assessment for anti-retroviral therapy.
Conclusions Mobilising the FSW community to utilise clinic services on a regular basis is a challenge, especially in a context of high levels of migration, with frequent turnover. This requires a multi-faceted strategy and effective outreach planning, using micro-plans at local site level. Providing health services close to the community and at convenient times is very important for achieving high levels of coverage.
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