IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0110562.html
   My bibliography  Save this article

Community Mobilisation and Empowerment Interventions as Part of HIV Prevention for Female Sex Workers in Southern India: A Cost-Effectiveness Analysis

Author

Listed:
  • Anna Vassall
  • Sudhashree Chandrashekar
  • Michael Pickles
  • Tara S Beattie
  • Govindraj Shetty
  • Parinita Bhattacharjee
  • Marie-Claude Boily
  • Peter Vickerman
  • Janet Bradley
  • Michel Alary
  • Stephen Moses
  • CHARME India Group
  • Charlotte Watts

Abstract

Background: Most HIV prevention for female sex workers (FSWs) focuses on individual behaviour change involving peer educators, condom promotion and the provision of sexual health services. However, there is a growing recognition of the need to address broader societal, contextual and structural factors contributing to FSW risk behaviour. We assess the cost-effectiveness of adding community mobilisation (CM) and empowerment interventions (eg. community mobilisation, community involvement in programme management and services, violence reduction, and addressing legal policies and police practices), to core HIV prevention services delivered as part of Avahan in two districts (Bellary and Belgaum) of Karnataka state, Southern India. Methods: An ingredients approach was used to estimate economic costs in US$ 2011 from an HIV programme perspective of CM and empowerment interventions over a seven year period (2004–2011). Incremental impact, in terms of HIV infections averted, was estimated using a two-stage process. An ‘exposure analysis’ explored whether exposure to CM was associated with FSW’s empowerment, risk behaviours and HIV/STI prevalence. Pathway analyses were then used to estimate the extent to which behaviour change may be attributable to CM and to inform a dynamic HIV transmission model. Findings: The incremental costs of CM and empowerment were US$ 307,711 in Belgaum and US$ 592,903 in Bellary over seven years (2004–2011). Over a 7-year period (2004–2011) the mean (standard deviation, sd.) number of HIV infections averted through CM and empowerment is estimated to be 1257 (308) in Belgaum and 2775 (1260) in Bellary. This translates in a mean (sd.) incremental cost per disability adjusted life year (DALY) averted of US$ 14.12 (3.68) in Belgaum and US$ 13.48 (6.80) for Bellary - well below the World Health Organisation recommended willingness to pay threshold for India. When savings from ART are taken into account, investments in CM and empowerment are cost saving. Conclusions: Our findings suggest that CM and empowerment is, at worst, highly cost-effective and, at best, a cost-saving investment from an HIV programme perspective. CM and empowerment interventions should therefore be considered as core components of HIV prevention programmes for FSWs.

Suggested Citation

  • Anna Vassall & Sudhashree Chandrashekar & Michael Pickles & Tara S Beattie & Govindraj Shetty & Parinita Bhattacharjee & Marie-Claude Boily & Peter Vickerman & Janet Bradley & Michel Alary & Stephen M, 2014. "Community Mobilisation and Empowerment Interventions as Part of HIV Prevention for Female Sex Workers in Southern India: A Cost-Effectiveness Analysis," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-10, October.
    • Handle: RePEc:plo:pone00:0110562
    DOI: 10.1371/journal.pone.0110562
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0110562
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0110562&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0110562?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Ghose, Toorjo & Swendeman, Dallas & George, Sheba & Chowdhury, Debasish, 2008. "Mobilizing collective identity to reduce HIV risk among sex workers in Sonagachi, India: The boundaries, consciousness, negotiation framework," Social Science & Medicine, Elsevier, vol. 67(2), pages 311-320, July.
    2. Beattie, T.S.H. & Mohan, H.L. & Bhattacharjee, P. & Chandrashekar, S. & Isac, S. & Wheeler, T. & Prakash, R. & Ramesh, B.M. & Blanchard, J.F. & Heise, L. & Vickerman, P. & Moses, S. & Watts, C., 2014. "Community mobilization and empowerment of female sex workers in karnataka state, south india: Associations with hiv and sexually transmitted infection risk," American Journal of Public Health, American Public Health Association, vol. 104(8), pages 1516-1525.
    3. Kerrigan, D. & Moreno, L. & Rosario, S. & Gomez, B. & Jerez, H. & Barrington, C. & Weiss, E. & Sweat, M., 2006. "Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic," American Journal of Public Health, American Public Health Association, vol. 96(1), pages 120-125.
    4. Naila Kabeer, 1999. "Resources, Agency, Achievements: Reflections on the Measurement of Women's Empowerment," Development and Change, International Institute of Social Studies, vol. 30(3), pages 435-464, July.
    5. Rhodes, Tim & Singer, Merrill & Bourgois, Philippe & Friedman, Samuel R. & Strathdee, Steffanie A., 2005. "The social structural production of HIV risk among injecting drug users," Social Science & Medicine, Elsevier, vol. 61(5), pages 1026-1044, September.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Konrad, Renata A., 2019. "Designing awareness campaigns to counter human trafficking: An analytic approach," Socio-Economic Planning Sciences, Elsevier, vol. 67(C), pages 86-93.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Lianne A Urada & Donald E Morisky & Nymia Pimentel-Simbulan & Jay G Silverman & Steffanie A Strathdee, 2012. "Condom Negotiations among Female Sex Workers in the Philippines: Environmental Influences," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-9, March.
    2. Goldenberg, Shira M. & Strathdee, Steffanie A. & Gallardo, Manuel & Rhodes, Tim & Wagner, Karla D. & Patterson, Thomas L., 2011. ""Over here, it's just drugs, women and all the madness": The HIV risk environment of clients of female sex workers in Tijuana, Mexico," Social Science & Medicine, Elsevier, vol. 72(7), pages 1185-1192, April.
    3. Konrad, Renata A., 2019. "Designing awareness campaigns to counter human trafficking: An analytic approach," Socio-Economic Planning Sciences, Elsevier, vol. 67(C), pages 86-93.
    4. Swendeman, Dallas & Basu, Ishika & Das, Sankari & Jana, Smarajit & Rotheram-Borus, Mary Jane, 2009. "Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases," Social Science & Medicine, Elsevier, vol. 69(8), pages 1157-1166, October.
    5. Helen M. Haugh & Alka Talwar, 2016. "Linking Social Entrepreneurship and Social Change: The Mediating Role of Empowerment," Journal of Business Ethics, Springer, vol. 133(4), pages 643-658, February.
    6. Rao, Nitya, 2017. "Assets, Agency and Legitimacy: Towards a Relational Understanding of Gender Equality Policy and Practice," World Development, Elsevier, vol. 95(C), pages 43-54.
    7. DeJaeghere, Joan & Pellowski Wiger, Nancy & Le, Hue & Luong, Phuong & Ngo, Nga Thi Hang & Vu, Thanh Thi & Lee, Jongwook, 2022. "Why do aspirations matter for empowerment?: Discrepancies between the A-WEAI domains and aspirations of ethnic minority women in Vietnam," World Development, Elsevier, vol. 159(C).
    8. K. Gayathri Reddy & Varsha, P. S. & L. N. Sudheendra Rao & Amit Kumar, 2019. "Exploring dimension, perceived individual tension and capacity building measure of women empowerment in India," Asian Journal of Empirical Research, Asian Economic and Social Society, vol. 9(5), pages 111-131, May.
    9. Jocelyn Elmes & Morten Skovdal & Kundai Nhongo & Helen Ward & Catherine Campbell & Timothy B Hallett & Constance Nyamukapa & Peter J White & Simon Gregson, 2017. "A reconfiguration of the sex trade: How social and structural changes in eastern Zimbabwe left women involved in sex work and transactional sex more vulnerable," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-22, February.
    10. Alice W Clark & T V Sekher, 2007. "Can Career-Minded Young Women Reverse Gender Discrimination?," Working Papers 179, Institute for Social and Economic Change, Bangalore.
    11. Fast, Danya & Small, Will & Wood, Evan & Kerr, Thomas, 2009. "Coming 'down here': Young people's reflections on becoming entrenched in a local drug scene," Social Science & Medicine, Elsevier, vol. 69(8), pages 1204-1210, October.
    12. chatterjee, susmita, 2017. "Empowerment translated to transition," MPRA Paper 80067, University Library of Munich, Germany.
    13. Alkire, Sabina & Meinzen-Dick, Ruth & Peterman, Amber & Quisumbing, Agnes & Seymour, Greg & Vaz, Ana, 2013. "The Women’s Empowerment in Agriculture Index," World Development, Elsevier, vol. 52(C), pages 71-91.
    14. Bussolo,Maurizio & Ezebuihe,Jessy Amarachi & Munoz Boudet,Ana Maria & Poupakis,Stavros & Rahman,Tasmia & Sarma,Nayantara, 2022. "Social Norms and Gender Equality : A Descriptive Analysis for South Asia," Policy Research Working Paper Series 10142, The World Bank.
    15. Rania Salem & Yuk Fai Cheong & Kathryn M. Yount, 2018. "Is Women’s Work a Pathway to their Agency in Rural Minya, Egypt?," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 136(2), pages 807-831, April.
    16. Alice Tianbo Zhang & Sasmita Patnaik & Shaily Jha & Shalu Agrawal & Carlos F. Gould & Johannes Urpelainen, 2022. "Evidence of multidimensional gender inequality in energy services from a large-scale household survey in India," Nature Energy, Nature, vol. 7(8), pages 698-707, August.
    17. Amjad Ali & Marc Audi & Chan Bibi & Yannick Roussel, 2021. "The Impact of Gender Inequality and Environmental Degradation on Human Well-being in the Case of Pakistan: A Time Series Analysis," International Journal of Economics and Financial Issues, Econjournals, vol. 11(2), pages 92-99.
    18. Lone Badstue & Patti Petesch & Cathy Rozel Farnworth & Lara Roeven & Mahlet Hailemariam, 2020. "Women Farmers and Agricultural Innovation: Marital Status and Normative Expectations in Rural Ethiopia," Sustainability, MDPI, vol. 12(23), pages 1-22, November.
    19. O'Hara, Corey & Clement, Floriane, 2018. "Power as agency: A critical reflection on the measurement of women’s empowerment in the development sector," World Development, Elsevier, vol. 106(C), pages 111-123.
    20. Rao, Nitya & Singh, Chandni & Solomon, Divya & Camfield, Laura & Sidiki, Rahina & Angula, Margaret & Poonacha, Prathigna & Sidibé, Amadou & Lawson, Elaine T., 2020. "Managing risk, changing aspirations and household dynamics: Implications for wellbeing and adaptation in semi-arid Africa and India," World Development, Elsevier, vol. 125(C).

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0110562. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.