P2-S2.17 Community-Led Structural Invention's promise for HIV prevention: a case study from the Ashodaya Samithi Sex Worker Collective of Mysore, India.
Bibliographic record
Abstract
Background As evidence has revealed the role of broader political, economic and local environmental factors in shaping HIV epidemic transmission patterns, new approaches have emerged that move beyond addressing individual risk behaviour to addressing the structural forces that condition risk. Within this context, Community-Led Structural Interventions (CLSI) aimed at reducing sex workers' vulnerability have demonstrated successes in reducing STI and HIV transmission in India. Methods A comprehensive CLSI, know as Ashodaya Samithi, was initiated in the South Indian district of Mysore. Established in 2004 by the India AIDS Initiative (Avahan), Ashodaya is funded through the Bill and Melinda Gates Foundation and implemented by Karnataka Health Promotion Trust. Four-years into its inception, the project lays claim to significant successes. The collective has reported a reduction in STIs, an increase in condom use, and the mobilisation of 1500 sex workers. Our research describes and analyzes sex workers' participation as it unfurled across various phases of collectivisation. Qualitative, community-based research methodologies were utilised including; 40 open-ended interviews, participant observations and focus groups. Drawing upon these findings we explored how a community of sex workers came to develop the ability to recognise, challenge and significantly alter an array of unequal power relations that shape HIV vulnerability in their everyday lives. Results Our research demonstrates the promise CLSI projects hold for preventing the spread of HIV. Ashodaya's success depends on its ability to set new community norms, create a safer working environment, improve stakeholder relationships, and provide a supportive network. The interrelated processes of mobilisation, collectivisation, sex-worker identity, and political action, which transformed day-to-day vulnerability to HIV for Mysore sex workers demonstrates how complex HIV prevention remains. Conclusions Findings from the Ashodaya collective offer valuable lessons for public health practice. The Ashodaya collective demonstrates how CLSI strategies can be employed to help transform the very vulnerabilities that endanger health and sustain STI and HIV transmission. The collective provides an example of the positive impact of CLSIs and provides evidence for strategies that steer away from individual or education based public health programs, to those that engage with structural inequities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.014 | 0.004 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".