Identifying the 'start point', India
In Andhra Pradesh, the Alliance has commissioned the Mexican National Institute of Public Health (INSP), an independent research institute, to work with the Administrative Staff College of India (ASCI), a local research agency, to evaluate the Frontiers Prevention Project.
The Frontiers Prevention Project is an Alliance multi-country prevention-focused initiative which aims to slow the spread of HIV and build up effective and sustainable community responses. The programme in Andhra Pradesh develops and carries out a package of community-based activities with ‘key populations’. The state has one of the highest HIV prevalence rates in India, a country with more than five million people living with HIV/AIDS.
To lay the foundations for the evaluation work, a large-scale survey was carried out from July 2003 to April 2004 to identify a ‘baseline’, or starting point, against which the programme’s subsequent impact can be assessed. The survey focused on two key populations (female sex workers and men who have sex with men) in 40 geographic sites in 13 districts of Telangana and Rayalseema regions. It used questionnaires developed by an international team, with input and participation from key populations and other organisations.
Training was given to key population facilitators, which included how to interview and how to take blood and urine samples (to measure rates of sexually transmitted infections).These trainers in turn contacted community members. Both the interviews and samples were carried out confidentially, with people’s names not linked to their data.
In total, the survey involved 6,648 sex workers and 6,661 men who have sex with men. The data gathered covered general information (such as age and level of education), alongside details of their awareness, situation and behaviour in relation to HIV/AIDS, sexually transmitted infections and use of condoms.
The survey produced important findings. For example, among the 86% of men who have sex with men who are aware of HIV, only 6% have taken an HIV test. It also revealed a number of more specific findings – many of which reinforced the efforts of the Alliance country office in India and its partners, but also showed the need to refocus some aspects of their work. For example, as well as identifying that the number of sex workers who either never or inconsistently use condoms with clients varies greatly (from 7% to 84% in different sites), the survey also showed that use is lowest among those who are streetbased, do not know that HIV is preventable, and do not participate in a support group.
The findings were fed back and confirmed during a workshop – involving staff, members of key populations and other organisations – with particular attention paid to how they should influence the future focus and priorities of the programme. In addition, they were shared internationally, including through articles in journals and presentations at the XVth International AIDS Conference in Bangkok.
In the future, the findings of the survey will also be used for policy and advocacy work in India and globally – providing solid evidence for decision-makers of the needs, resources and gaps of ‘key populations’ in relation to HIV/AIDS.
