title: Community mobilization and empowerment of female sex workers in Karnataka State, South India: associations with HIV and sexually transmitted infection risk.
abstract: OBJECTIVE
  We examined the impact of community mobilization (CM) on the empowerment, risk behaviors, and prevalence of HIV and sexually transmitted infection in female sex workers (FSWs) in Karnataka, India.
  
  
  METHODS
  We conducted behavioral-biological surveys in 2008 and 2011 in 4 districts of Karnataka, India. We defined exposure to CM as low, medium (attended nongovernmental organization meeting or drop-in centre), or high (member of collective or peer group). We used regression analyses to explore whether exposure to CM was associated with the preceding outcomes. Pathway analyses explored the degree to which effects could be attributable to CM.
  
  
  RESULTS
  By the final survey, FSWs with high CM exposure were more likely to have been tested for HIV (adjusted odd ratio [AOR] = 25.13; 95% confidence interval [CI] = 13.07, 48.34) and to have used a condom at last sex with occasional clients (AOR = 4.74; 95% CI =  2.17, 10.37), repeat clients (AOR = 4.29; 95% CI = 2.24, 8.20), and regular partners (AOR = 2.80; 95% CI = 1.43, 5.45) than FSWs with low CM exposure. They were also less likely to be infected with gonorrhea or chlamydia (AOR = 0.53; 95% CI = 0.31, 0.87). Pathway analyses suggested CM acted above and beyond peer education; reduction in gonorrhea or chlamydia was attributable to CM.
  
  
  CONCLUSIONS
  CM is a central part of HIV prevention programming among FSWs, empowering them to better negotiate condom use and access services, as well as address other concerns in their lives.
authors.affiliation: Tara S. H. Beattie, Lori Heise, Peter Vickerman, Charlotte Watts, and Sudha Chandrashekar are with the London School of Hygiene & Tropical Medicine, London, United Kingdom. Harnalli L. Mohan, Parinita Bhattacharjee, Shajy Isac, and Ravi Prakash are with the Karnataka Health Promotion Trust (KHPT), Bangalore, India. Tisha Wheeler is with the Futures Group, Durham, NC. Banadakoppa M. Ramesh, James F. Blanchard, and Stephen Moses are with The University of Manitoba, Winnipeg.
authors.forename: Tara S H
authors.initials: TS
authors.lastname: Beattie
authors.forename: Harnalli L
authors.initials: HL
authors.lastname: Mohan
authors.forename: Parinita
authors.initials: P
authors.lastname: Bhattacharjee
authors.forename: Sudha
authors.initials: S
authors.lastname: Chandrashekar
authors.forename: Shajy
authors.initials: S
authors.lastname: Isac
authors.forename: Tisha
authors.initials: T
authors.lastname: Wheeler
authors.forename: Ravi
authors.initials: R
authors.lastname: Prakash
authors.forename: Banadakoppa M
authors.initials: BM
authors.lastname: Ramesh
authors.forename: James F
authors.initials: JF
authors.lastname: Blanchard
authors.forename: Lori
authors.initials: L
authors.lastname: Heise
authors.forename: Peter
authors.initials: P
authors.lastname: Vickerman
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.forename: Charlotte
authors.initials: C
authors.lastname: Watts
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology; D019058:Community Networks / Q000706:statistics & numerical data; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007194:India / Q000453:epidemiology; D008875:Middle Aged; D011209:Power, Psychological; D015995:Prevalence; D012307:Risk Factors; D060386:Sex Workers / Q000523:psychology / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000635:transmission*; D055815:Young Adult