title: How effective is community mobilisation in HIV prevention among highly diverse sex workers in urban settings? The Aastha intervention experience in Mumbai and Thane districts, India.
abstract: BACKGROUND
  This paper examines the association between degree of confidence in collective efficacy and self-efficacy for condom use and empowerment among heterogeneous female sex workers (FSWs) in two metropolitan Indian cities with high HIV prevalence.
  
  
  METHODS
  The study utilises data from the Behavioural Tracking Survey, a cross-sectional behavioural study with 2106 FSWs recruited from 411 intervention sites in Mumbai and Thane. The key independent measures used determine the degree of confidence in collective efficacy (belief in the power to achieve goals and address problems together) and outcome measures included: self-efficacy for condom use with occasional clients and condom use with regular partners, self-confidence in handling a crisis situation and public speaking ability. Univariate and multivariate statistical methods were used to examine the study objectives.
  
  
  RESULTS
  Of the analytical sample of 2106 FSWs, 532 (25.3%) reported high degree of collective efficacy for achieving certain goals and 1534 (72.8%) reported collective efficacy for addressing specific problems. FSWs reporting a higher collective efficacy as compared with those reporting lower collective efficacy were as follows: more likely to negotiate condom use with occasional clients (60.3% vs 19.7%; adjusted OR (AOR) =6.3, 95% CI 4.8 to 8.4) as well as regular partners (62.8% vs 20.2%; AOR =6.4, 95% CI 4.9 to 8.4); confident in facing troublesome stakeholders (73.5% vs 38.8%; AOR =4.3, 95% CI 3.3 to 5.6), confident in supporting fellow FSWs in a crisis (76.1% vs 49.6%; AOR =2.9, 95% CI 2.2 to 3.7), received help from other FSWs when a client or partner was violent (73.9% vs 46.3%; AOR =3.5, 95% CI 2.7 to 4.5) and had stood up to the police or madams/brokers to help fellow FSWs in the past 1 year (5.8% vs 3.3%; AOR =2.7, 95% CI 1.5 to 4.9).
  
  
  CONCLUSIONS
  The results suggest that the strategy of collectivisation in HIV prevention programme has much broader benefits than merely the promotion of safer sex practices. Future HIV prevention interventions in India and elsewhere may include collectivisation as the core strategy within HIV prevention programmes.
authors: FHI 360 Maharashtra, 501-505 Balarama Building, Bandra-Kurla Complex, Bandra East, Mumbai 400 051, India. sgaikwad@fhi360.org
authors: Sanjeev Singh
authors: SS
authors: Gaikwad
authors: Amrita
authors: A
authors: Bhende
authors: Gaurav
authors: G
authors: Nidhi
authors: Niranjan
authors: N
authors: Saggurti
authors: Virupax
authors: V
authors: Ranebennur
mesh_terms: D000328:Adult; D019058:Community Networks / Q000458:organization & administration; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D007407:Interviews as Topic; D008297:Male; D011209:Power, Psychological; D040242:Risk Reduction Behavior; D021841:Safe Sex / Q000706:statistics & numerical data; D020377:Self Efficacy; D011477:Sex Work / Q000706:statistics & numerical data; D060386:Sex Workers / Q000523:psychology* / Q000706:statistics & numerical data; D012747:Sexual Partners; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult