Vassall, A., Chandrashekar, S., Pickles, M., et al. PLoS One (October 2014), 9(10): e110562.
The authors of this cost-effectiveness analysis found that the addition of community mobilization (CM) and empowerment interventions to a core package of HIV prevention interventions could improve the impact of HIV prevention interventions for female sex workers (FSWs). The analysis was based on data gathered between 2004 and 2011 from two districts in Karnataka, India: Belgaum and Bellary. A package of core HIV prevention services provided by Avahan’s nongovernmental organization partners included outreach through peers, behavior change communication, condom distribution, and clinical services for sexually transmitted infections (STIs). To empower FSWs, CM services and actions to create an "enabling environment" were added to core services. Incremental costs for CM and empowerment were US$307,711 in Belgaum and US$592,903 in Bellary. The incremental mean impact of CM and empowerment was 1,256 infections averted in Belgaum, and 2,775 infections averted in Bellary, compared to regions where no CM and empowerment activities were implemented. The authors concluded that investing in CM and empowerment was cost-effective, and noted that with the CM activities, the FSWs also received broader benefits, including access to income generation, education, and other social entitlements. They recommended including sustained funding for CM and empowerment activities as part of HIV prevention for FSWs in India, and suggested that program managers consider scaling up similar interventions in other countries.