Implementing Comprehensive HIV/STI Programmes with Sex Workers Implementing Comprehensive HIV/STI Programmes with | Page 162

6 Programme Management and Organizational Capacity-building Figure 6.1 Programme logic model for a multi-component programme with sex workers Target services: Based on mapping and size estimation in each district, focusing on highest density, highest risk first. Implement multi-component intervention package for sex workers. Free prevention commodities (male latex condoms, female condoms, lubricant): Adequate supply to meet estimated need established through multiple channels. GOAL: Adequate condoms such that no penetrative sex act goes unprotected. Clinical services: accessible, acceptable referrals or services established for: • Reproductive health, STIs, hormone replacement therapy • Voluntary HIV testing and counselling • HIV care and treatment • Tuberculosis, opioid substitution therapy, other Key Intervention Outputs Outcomes Impact Parallel promotion of condoms to male clients through social marketing and increased outlets in hotspots. Community outreach workers recruited, trained, helped to develop and use micro-planning tools (carry out mapping, size estimation, monitoring and planning). Organizational development activities initiated (e.g. drop-in centres established, leadership and organizational development of community groups). Structural interventions supported: violence response teams, police sensitization, legal support, journalist and legal training, access to social entitlements. • Population estimates of sex workers done • Maps of sex workers and hotspots completed • Increase in sex worker contacts and coverage • Sex worker communitybased groups (CBGs) formed and represent local groups • Networks of CBGs strengthened • Crisis response established • Decreased police harassment • Sex workers serve as selfadvocates • Discrimination against sex workers decreased • Media portray sex workers positively • Ability to reach sex workers increases • Ability to implement programme increases • Increased and sustained demand for services • Increased ability to organize and selfadvocate Community committees established. Monitoring of service coverage and quality, routine programme data generation and analysis, corrective action taken ➜ increased coverage and service quality • Social norms support safe sex behaviour • Increase in condom use, voluntary HIV testing and counselling • Increase in adherence to antiretroviral therapy Decrease in HIV incidence in general population • Improved treatmentseeking behaviour • Increased STI clinic use, HIV testing, ART coverage • Decrease in HIV incidence in sex workers • Decrease in mortality of sex workers • Increase in agency5 of sex workers • Decrease in prevalence of curable STIs • Increase in ART coverage Source: Avahan India AIDS Initiative 5 Agency in this context (and in other parts of this chapter where the word clearly does not mean “organization”) refers to the choice, control and power that a sex worker has to act for her/himself. 140