Outreach & community
Purposeful outreach is concerned with behaviour change through the provision of consistent and quality HIV prevention efforts It requires making contact with the key population in their own sites without waiting for them to seek out project workers. It recognises that the meaning and purpose of outreach for the project and the community may be different and seeks to strike a balance between the project and community needs and interests. It entails listening to and understanding the community; being sensitive to the variations and nuances between the needs of female sex workers, MSM and hijras, as individuals and as communities.

The key programme objectives for which the project engages in outreach to sustain behaviour change are:

• Correct and consistent condom use
• Timely and complete treatment of STI.

Outreach seeks to promote and sustain behaviour change at the individual and community levels on two fronts: safer sexual behaviour; and health-seeking behaviour. Outreach is tailored to the behaviour change cycle. The purpose and periodicity of outreach is planned based on assessments of barriers to and processes of behaviour change among sex workers as individuals and as communities.

Experience shows that to achieve these two behaviour change objectives, the project needs to address the sex workers’ needs in addition to sexual health since these are responsible for their vulnerability such as the sex work environment, or the lack of a collective identity. Hence, it is vital that outreach addresses and/or supports interventions that reduce vulnerability.

The situation analysis reveals that female sex workers, MSM and hijras encounter multiple barriers to behaviour change as they engage in multi-partner sex with high partner load and low condom use. Their low risk perception, low social status and inequitable relations vis-à-vis their partners and service providers may not empower them to insist upon condom use or to seek services in the mainstream. Therefore, outreach is about linking resources or services to female sex workers, MSM and hijras, and their regular partners. Moreover, in India, soliciting in the case of female sex workers and homosexuality in the case of MSM and hijras is illegal and deemed anti-social or immoral. This increases their vulnerability due to harassment by law enforcement agencies and social discrimination. Thus, the outreach strategies are situated within an STI and HIV risk and vulnerability reduction framework wherein outreach and linkages to services are directed towards enabling behaviour change among key population while simultaneously enabling the environment and mobilising the community. Such a comprehensive approach seeks to empower the community to adopt safe sex and treatment norms and behaviours.

Guiding principles of outreach Respect to community: wherein sex workers are valued as human beings with rights to confidentiality, dignity, and a safe and secure life and work environment. Team work: that bridges gaps between project staff, service providers and community, through building relationships of mutual respect, trust, acceptance and learning, and delivery of quality outreach and services. Self-representation/empowerment: that builds capacities of sex workers as leaders, participants and “natural owners” of HIV prevention programmes and empowers sex workers as part of the solution to their problems.

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