P2-S2.05 Mobilising female sex workers to access outreach and medical services: a case study from Solapur district, Maharashtra, South India

Abstract

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.