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The importance of sex-worker interventions: the case of Avahan in India
  1. Marie Laga1,
  2. Christine Galavotti2,
  3. Sundar Sundaramon3,
  4. Rob Moodie4
  1. 1Institute of Tropical Medicine, Antwerp, Belgium
  2. 2US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  3. 3Independent consultant and member technical panel AVAHAN, Chennai, India
  4. 4Victoria Health Promotion Foundation, Melbourne, Australia
  1. Correspondence to Dr Marie Laga, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium; mlaga{at}

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Since the very beginning of the HIV epidemic, sex workers have been at increased risk for HIV, because of multiple partners, and highly vulnerable because of environmental and structural barriers that prevent them from accessing services or having control over their activities.1 Experience with feasible and effective prevention programmes has been accumulating for more than 20 years. In Democratic Republic of Congo,2 Côte d'Ivoire3 and Bolivia,4 HIV and or STI rates among sex workers declined as a result of individual interventions including condom promotion, STI care and risk-reduction messages. Experience from the Dominican Republic5 and India6 7 illustrated the effectiveness of contextual interventions to reduce the vulnerability of sex workers and create an enabling environment.

So far, large-scale implementation of sex-worker interventions to reduce either risks or vulnerability has lagged behind. Most countries today still do not have a national plan to address the needs for this population, and worldwide less than 50% of sex workers have access to a minimum of prevention services.1 8 India is clearly an exception!

The government of India has supported sex-worker interventions in many high-prevalence districts since the mid-1990s, adopting mainly individual risk-reduction strategies such as condom distribution and outreach. In 2005, the Bill and Melinda Gates Foundation's Avahan India AIDS Initiative was launched to increase the coverage of interventions for most at-risk populations, adopting a more holistic approach to prevention for …

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