No-One-Size-Fits-All: Addressing the Social and Structural Dimensions of Sex Worker Vulnerability to HIV Through Community Mobilization in Avahan

Abstract

While community mobilization (CM) is increasingly recognized as a structural intervention, analyses of the various ways in which it is conceptualized and operationalized for HIV prevention remain relatively scant. This chapter contributes further to understandings of CM interventions in HIV prevention – their implementation and impact – by focusing on the Avahan India AIDS Initiative (Avahan), a multi-level, multi-component intervention launched in December 2003 by the Bill & Melinda Gates Foundation (BMGF) to control the spread of HIV in six high-prevalence states of India. Drawing on the method of Critical Interpretive Synthesis (CIS), this chapter systematically reviews published articles, reports and monographs focused on CM among female sex workers (FSW) under Avahan. It discusses commonalities and differences in the way that CM has been conceptualized, operationalized, and implemented among FSW across Avahan, as well as results of evaluations in three different areas: service outcomes, epidemic outcomes, and social outcomes. While this review of the evidence points to promising results related to the use of CM to reduce FSW vulnerability to HIV, it also documents a number of challenges related to its implementation and evaluation. The chapter concludes with a discussion of these challenges and their implications for future research.