Sex workers in Karnataka adopt community networking strategy to meet needs during Covid-19

Thousands of sex workers, especially those living with HIV, in parts of Karnataka adopted an inspiring community-led response to meet their basic and emergency needs during Covid-19-induced lockdown.

The sudden loss of livelihood and lack of access to health care and social protection intensified their vulnerabilities, according to a group of 12 authors whose perspective paper was published in the September issue of WHO (World Health Organisation) South-East Asia Journal of Public Health.

For people living with HIV, the lockdown of Mysuru city immediately disrupted antiretroviral therapy (ART) access, as the majority of ART dispensation takes place through the government-run district hospital, although there are two private hospitals being part of the government ART programme, they said.

Between 200 and 250 people per day collect their medication from the district hospital. With the onset of Covid-19, and the lockdown, the district hospital initially became the only designated testing and treatment centre for Sars-CoV-2 in the city, which effectively halted regular ART distribution.

Ashodaya Samithi, an organisation of more than 6000 sex workers, launched an innovative programme of assistance in the districts of Mysuru, Chamarajanagara, Kodagu and Mandya.

Since access to ART was immediately disrupted, Mysuru- based Ashodaya adapted its HIV outreach programme to form an alternative, community-led system of distributing ART at discreet, private sites. WhatsApp messaging was used to distribute information on accessing government social benefits made available in response to the Covid-19 pandemic.

Other assistance included advisory messages posted in WhatsApp groups to raise awareness, dispel myths and mitigate violence, and regular, discreet phone check-ins to follow up on the well-being of members.

Amid the Covid-19 restrictions, community leaders adapted a community network-based strategy successfully utilised in their HIV outreach programme to form a community-led ART distribution system for sex workers, the authors said.

"Although Ashodayas response was initiated in Mysuru, it was quickly adopted by Ashodaya teams in the other (three) districts where they work", the perspective paper said.

Ashodaya has drawn on its vast experience in community mobilisation and outreach to swiftly respond to emerging issues and challenges resulting from the Covid-19 pandemic, helping to ensure continued access to treatment, social entitlements, psychosocial counselling, and accurate and up- to-date information, it was stated. In the period between the beginning of the Covid-19 pandemic and May 2020, Ashodaya was able to provide ART to 1,065 people, provide nutritional supplements to 270 people.

It ensured access to social protection for approximately 3,800 sexworkers, and it was in regular contact with over 5,500 others through calls and individual meetings.

The 12 authors are: Sushena Reza-Paul, Lisa Lazarus, Partha Haldar, Manisha Reza Paul, Bhagya Lakshmi, Manjula Ramaiah, Akram Pasha, Syed Hafeez Ur Rahman, K T Venukumar, M S Venugopal, Bharat Bhushan Rewari and Robert Lorway. "The lessons learnt from these activities represent an important opportunity to consider more sustainable approaches to the health of marginalised populations that can enablecommunity organisations to be better prepared to respond to other public health crises as they emerge", they said.