AVAHAN PRINCIPLES AND EXPERIENCE ON COMMUNITY

INVOLVEMENTJuly 23, 2014

Sameer Kumta

Senior Programme Officer

• Avahan overview

• Why community mobilization?

• How community mobilization is critical for HIV prevention? Data from programs

• Lessons learnt

• Way forward

2

AGENDA

• Avahan overview

• Why community mobilization?

• How community mobilization is critical for HIV prevention? Data from programs

• Lessons learnt

• Way forward

3

AGENDA

4

AVAHAN GOALSAvahan Phase I Avahan Phase II Avahan Phase III

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Build and operate key population program at scale• Demonstrate program at scale with coverage,

quality• Declining HIV infection trends in core, bridge,

general population

Transfer the program to governmentSustain funding / management

Foster and disseminate lessons learnt within India and worldwide

Risk and Vulnerability reduction for sustained HIV impact

SCALE AND FOCUS

Source: Avahan routine monitoring data, all six states

Avahan Design Choices

Focus on MARPs

…and geographies most affected

Proven package of interventions

Integrated approach

Simultaneous and rapid scale up

• 6 states, 82 districts, 600+ towns• Combined State Population ~ 300 million• High risk groups covered – over 320,000

– FSW – 221,800– High risk MSM and Transgenders 81,600– IDU – 18,000

• Bridge population covered Men at risk – ~5 million

• Avahan overview

• Why community mobilization?

• How community mobilization is critical for HIV prevention? Data from programs

• Lessons learnt

• Way forward

6

AGENDA

7

COMMUNITY MOBILIZATION STRENGTHENS RISK REDUCTION

Targeted Interventions

Consistent Condom Use

Reported STIs Reduced

8

SUSTAINABILITY IS DRIVEN THROUGH AN INVESTMENT IN COMMUNITY

Targeted Interventions

Structural Interventions

Organizational Development

Sustainable

Consistent Condom Use

Reported STIs Reduced

• Avahan overview

• Why community mobilization?

• How community mobilization is critical for HIV prevention? Data from programs

• Lessons learnt

• Way forward

9

AGENDA

VIOLENCE IS ASSOCIATED WITH LESS ACCESS TO SERVICES

FSW experienced vi-olence

FSW did not experience violence

55.4

75.5Consistent condom use p<0.001

Source: IBBA Karnataka State, Karnataka Health Promotion Trust (KHPT), 2006-7 also see Beatty et al., BMC Pub Health, 2010

FSW experienced vi-olence

FSW did not experience violence

5

2.6

Infected with Gonorrheap=0.01

FSW experienced vi-olence

FSW did not experience violence

84.9 89.6Contacted by a Peerp<0.001

Pe

rce

nta

ge

Pe

rce

nta

ge

Pe

rce

nta

ge

Pe

rce

nta

ge

FSW experienced vi-olence

FSW did not experienced violence

59

68.1p=0.004

Ever visited a clinic

Pe

rce

nta

ge

11

COLLECTIVE IDENTITY AND AGENCY ARE ASSOCIATED WITH CONDOM USE

RED = significant at the .05 level or better

Source: Blankenship K; Power, community mobilization, and condom use practices among female sex workers in Andhra Pradesh, India: AIDS 2008

• Avahan overview

• Why community mobilization?

• How community mobilization is critical for HIV prevention? Data from programs

• Lessons learnt

• Way forward

12

AGENDA

Community organizational development helps to sustain the HIV response• Organizational development: leadership, governance etc.

• Incorporation of democratic processes at the CO’s

Enabling environment critical to build community collectives and ownership• Provide an opportunity for informal sharing and discussion (DIC – safe spaces)

• Identifying local champions, build a sense of self worth

• Facilitate exchanges and exposures- sharing of best practices

• Invest and groom community leaders to take the ownership

• Critical Role of promoters as facilitators and mentors

• Building effective governance and management systems

• Building and sustaining community organizations is a long term process

13

LESSONS LEARNT

Community mobilization requires dedicated effort/ capacity development• Cadre of community leaders, community workers required

• On site mentoring support in addition to classroom based training

• Community to community learning through exposure visits can be a powerful tool

Organized communities build greater accountability to ensure access• Thematic committees - condom, outreach, clinic services and advocacy

– Represent the issues with appropriate authority

– Assess the demand and ensure the supply

• Report card to monitor the supply and flagging the stock outs

• Connect with police and legal services (para legal volunteers)

• Linkages with Government schemes and entitlements

14

LESSONS LEARNT

• Avahan overview

• Why community mobilization?

• How community mobilization is critical for HIV prevention? Data from programs

• Lessons learnt

• Way forward

15

AGENDA

16

WAY FORWARD: TRANSFER OWNERSHIP TO COMMUNITIES

Avahan III

“Capacitated Communities”

Sustained epidemic impact

Biomedical risks

Structural barriers

Vulnerabilities

Objective

Risks/ barriers

Process/System to address risks

Government funded system

(TIs)

Crises & Violence Social & Economic

Service delivery

Commodities, access to treatment etc.

Community Level Processes

Advocacy for service

delivery

Crisis response system

Social protection

Financial security

Organizational development

1 2 3 4 5

• Our partnership with the Department of AIDS Control (DAC) and Government of India

• All our Grantees

• Implementing NGOs and Community Based Organizations (CBOs)

• Our Communities

17

ACKNOWLEDGEMENTS