Abstract
BackgroundAvahan, the India AIDS Initiative, delivers HIV prevention services to high-risk populations at scale. Although the broad costs of such HIV interventions are known, to-date there has been little data available on the comparative costs of reaching different target groups, including female sex workers (FSWs), replace with ‘high risk men who have sex with men (HR-MSM) and trans-genders.MethodsCosts are estimated for the first three years of Avahan scale up differentiated by typology of female sex workers (brothel, street, home, lodge based, bar based), HR-MSM and transgenders in urban districts in India: Mumbai and Thane in Maharashtra and Bangalore in Karnataka. Financial and economic costs were collected prospectively from a provider perspective. Outputs were measured using data collected by the Avahan programme. Costs are presented in US$2008.ResultsCosts were found to vary substantially by target group. Non-governmental organisations (NGOs) working with transgender populations had a higher mean cost (US $116) per person reached compared to those dealing primarily with FSWs (US $75-96) and MSWs (US $90) by the end of year three of the programme in Mumbai. The mean cost of delivering the intervention to HR-MSMs (US $42) was higher than delivering it to FSWs (US $37) in Bangalore. The package of services delivered to each target group was similar, and our results suggest that cost variation is related to the target population size, the intensity of the programme (in terms of number of contacts made per year) and a number of specific issues related to each target group.ConclusionsBased on our data policy makers and program managers need to consider the ease of accessing high risk population when planning and budgeting for HIV prevention services for these populations and avoid funding programmes on the basis of target population size alone.
Highlights
Avahan, the India AIDS Initiative, delivers HIV prevention services to high-risk populations at scale
An examination of the number of contacts made per person reached shows that programme intensity differed by Population reached at least once a year
In Mumbai/ Thane on average, by 2008, each brothel- based and bar-based female sex workers (FSWs) reached was contacted around 4.4-4.8 times per year
Summary
The India AIDS Initiative, delivers HIV prevention services to high-risk populations at scale. Female sex workers (FSW) are the largest group, with Avahan targeting an estimated 310,000 FSWs. In India, FSWs are categorized into different typologies, based on where they recruit or solicit clients and not where they live or entertain the clients [6,7]. The major typologies are street based (SB), bar based (BG), brothel based (BB), lodge based (LB), home based (HB), dhaba based and highway based. These categories are often overlapping and fluid [4]. Avahan mapping in four southern states found that 60% of female sex work in India is street based, 9% brothel based, 12% are lodge based, 19% home based and others. While one sub-set of hijras is involved in blessing during births, marriages and ceremonies, another is involved in begging, and a third is involved in sex work
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