Avahan PRINCIPLES AND EXPERIENCE ON COMMUNITY INVOLVEMENT

1. Avahan PRINCIPLES AND EXPERIENCE ON COMMUNITY INVOLVEMENT July 23, 2014 Sameer Kumta Senior Programme Officer

2. agenda • Avahan overview • Why community mobilization? • How community mobilization is critical for HIV prevention? Data from programs • Lessons learnt • Way forward

3. agenda • Avahan overview • Why community mobilization? • How community mobilization is critical for HIV prevention? Data from programs • Lessons learnt • Way forward

4. Avahan Goals Avahan Phase I Avahan Phase II Avahan Phase III 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 • Build and operate key population program at scale • Demonstrate program at scale with coverage, quality • Declining HIV infection trends in core, bridge, general population Transfer the program to government Sustain funding / management Foster and disseminate lessons learnt within India and worldwide Risk and Vulnerability reduction for sustained HIV impact

5. SCALE AND FOCUS • 6 states, 82 districts, 600+ towns • Combined State Population ~ 300 million • High risk groups covered – over 320,000 • FSW – 221,800 • High risk MSM and Transgenders 81,600 • IDU – 18,000 • Bridge population covered Men at risk – ~5 million Avahan Design Choices Focus on MARPs …and geographies most affected Proven package of interventions Integrated approach Simultaneous and rapid scale up Source: Avahan routine monitoring data, all six states

6. agenda • Avahan overview • Why community mobilization? • How community mobilization is critical for HIV prevention? Data from programs • Lessons learnt • Way forward

7. Community Mobilization Strengthens Risk Reduction Consistent Condom Use Targeted Interventions Reported STIs Reduced

8. Sustainability is driven through an investment in community Targeted Interventions Sustainable Consistent Condom Use Structural Interventions Reported STIs Reduced Organizational Development

9. agenda • Avahan overview • Why community mobilization? • How community mobilization is critical for HIV prevention? Data from programs • Lessons learnt • Way forward

10. Violence is Associated With Less Access To Services Percentage Percentage Percentage Percentage Percentage Source: IBBA Karnataka State, Karnataka Health Promotion Trust (KHPT), 2006-7 also see Beatty et al., BMC Pub Health, 2010

11. COLLECTIVE IDENTITY AND AGENCY ARE ASSOCIATED WITH CONDOM USE RED = significant at the .05 level or better Source: Blankenship K; Power, community mobilization, and condom use practices among female sex workers in Andhra Pradesh, India: AIDS 2008

12. agenda • Avahan overview • Why community mobilization? • How community mobilization is critical for HIV prevention? Data from programs • Lessons learnt • Way forward

13. LESSONS LEARNT • Community organizational development helps to sustain the HIV response • Organizational development: leadership, governance etc. • Incorporation of democratic processes at the CO’s • Enabling environment critical to build community collectives and ownership • Provide an opportunity for informal sharing and discussion (DIC – safe spaces) • Identifying local champions, build a sense of self worth • Facilitate exchanges and exposures- sharing of best practices • Invest and groom community leaders to take the ownership • Critical Role of promoters as facilitators and mentors • Building effective governance and management systems • Building and sustaining community organizations is a long term process

14. LESSONS LEARNT • Community mobilization requires dedicated effort/ capacity development • Cadre of community leaders, community workers required • On site mentoring support in addition to classroom based training • Community to community learning through exposure visits can be a powerful tool • Organized communities build greater accountability to ensure access • Thematic committees - condom, outreach, clinic services and advocacy • Represent the issues with appropriate authority • Assess the demand and ensure the supply • Report card to monitor the supply and flagging the stock outs • Connect with police and legal services (para legal volunteers) • Linkages with Government schemes and entitlements

15. agenda • Avahan overview • Why community mobilization? • How community mobilization is critical for HIV prevention? Data from programs • Lessons learnt • Way forward

16. Avahan III Way forward: transfer ownership to communities Risks/ barriers Service delivery Biomedical risks Structural barriers Vulnerabilities Social & Economic Commodities, access to treatment etc. Crises & Violence Process/System to address risks Government funded system (TIs) Community Level Processes 1 2 3 4 5 Organizational development Advocacy for service delivery Crisis response system Social protection Financial security Objective Sustained epidemic impact “Capacitated Communities”

17. ACKNOWLEDGEMENTS • Our partnership with the Department of AIDS Control (DAC) and Government of India • All our Grantees • Implementing NGOs and Community Based Organizations (CBOs) • Our Communities