Ujwala

Ujwala (meaning towards a bright future) project was designed based on the programme learnings of the Abhaya project that Alliance India had successfully implemented in 2013-16 to enhance access to sexual and reproductive health services for female sex workers. With the support from Mac AIDS Funds and Tides Foundation, Ujwala project was rolled out in April 2017 in three cities:  Delhi, Warangal, and Ahmedabad. The main objective of the project is to mitigate and prevent gender-based violence (GBV) against women in sex work, and strategically provide sexual reproductive health services (SRH) with the aim to improve the uptake of HIV services including prevention, testing, treatment, and care and support.  The project works with implementing partners, Sakijyot in Ahmedabad, Gujarat, Anchal Trust in Delhi, and Rudhrama Devi Mahila Mandali in Warangal, Telangana.

Leveraging the existing sex worker’s targeted intervention (TI) programme of State AIDS Control Society in the three states, Ujwala project provides additional support and builds their capacity to address the unmet needs of HIV and SRH services. In addition, the project seeks to understand and respond to the rapidly changing sex work environment in India, which is moving beyond the traditional sites, and reach women in sex work who operate virtually and remain unreached by the national HIV programme. An impact assessment study was carried out to acquire an in-depth understanding of the sexual reproductive health needs of female sex workers registered with TIs instituted under Ujwala project in three implementing sites. In addition, the study looked into all the objectives of the Ujwala project and how they have impacted lives and coping of female sex workers to mitigate risks and vulnerabilities associated with sex work in different contexts.

Project Highlights

• Moving away from the traditional outreach strategy around HIV testing, Ujwala project devised an outreach strategy to identify and work with peer-volunteers. This proved to be a successful strategy as the project has been able to identify 30 soliciting sites, 50 spa/massage/beauty parlours and build rapport with 500 women operating in sex work from the parlours.
• Our continued advocacy efforts with important stakeholders like the police, lawyers, doctors and hospitals highlighting the health needs of women in sex work resulted in district medical and health officer deputing doctors and nurses for regular health camps at the ‘hot spots’ for women in sex work.
• Enabling access to services to male gatekeepers and regular partners of women in sex work has been one of the best practices of the project as that helps women to access HIV and SRH services during working hours with ease.
• The project has managed to demystify the virtual network of women in sex work and generated considerable evidence to demonstrate that reaching out to the women soliciting sex work through virtual networks is possible. The project organised three health camps in the Spas of Delhi and reached 620 women who are not covered by the TIs enabling them to access SRH and HIV testing facilities.

• With the guidance and support from NACO organised National consultation on ‘Changing Patterns of Sex Work in India’ with stakeholders and development partners. Through the two day consultation, a national framework was developed for reaching out to the women in sex work soliciting sex through virtual platforms.

• Some of the key findings of the impact assessment study were that the soliciting of sex work is rapidly shifting to virtual networks. Young women predominantly enter the profession through beauty parlours and spas and most of them do not associate themselves as women in sex work. Evidence from the project suggests that interventions working with women in sex work should address the immediate needs of the women for retaining them in HIV care, and the interventions should integrate information, counselling and access to SRH services including contraception, medical termination of pregnancy and post-abortion care etc. This will help in retaining women in HIV care

Project Results (April 2018 to March 2019)

• 1033 women were registered among 3 sites improving access to HIV testing and SRH services, out of 1033 women, 600 women i.e. 58% are below 24 years
• 484 women were tested for HIV of which 4 women tested positive for HIV
• 701 women treated for gynaecological issues such as heavy bleeding, white discharge, UTI, sore breast, RTI etc.
• 251 women in sex work accessed SRH services such as oral pills, emergency contraception pills, sterilization, Copper T, medical termination of pregnancy and pap smear testing.
• 125 women were treated for STI
• 32 advocacy, stakeholders, gatekeepers meetings conducted covering 725 local leaders, health care providers and other key stakeholders.
• 50 FSWs received Income Generation Programme (IGP) support and 7 women got social entitlements service.
• 54 women reported of GBV were capacitated to address the GBV through individual counselling and preparing safety goals.

Project Results in reaching the unreached women in sex work soliciting through virtual networks:

• 700 women were counselled and provided with information on safe sex, menstrual hygiene, identifying and need for treating sexually transmitted infects and urinary tract infects
• 400 women were provided with additional referral services
• 158 women successfully accessed at least one of the comprehensive SRH services package
• 72 women who tested for HIV, 2 women and 1 male gatekeeper tested positive for HIV and 3 of them were linked and initiated on ART