HIV/AIDS is a topic that is not spoken about in Jodhpur, a small city located in one of the most conservative states of India. Tradition is strong and standards are stringent, and the society is one in which certain things become taboo and clandestine in an attempt to hide shame and dishonorable activities. At the same time, because living here is a struggle for many, sex work is not uncommon among women attempting to support a family. The necessarily secretive nature of Jodhpur’s prostitution increases the health risks involved, one of the most predominant of which is the risk of contracting HIV/AIDS. The aim of the project, conducted in conjunction with PCB Trust, a local NGO, is to assess and address the low rate of HIV/AIDS testing, which is provided free of charge by the government at the Integrated Counseling and Testing Centre (ICTC), among Jodhpur’s Female Sex Worker (FSW) population. The project first assessed the reasons for the low attendance at the ICTC. This assessment consisted of informal staff interviews and a review of annual reports, nine Peer Educator interviews, and one hundred and four FSW field surveys. The primary problem exposed by the assessment was an education gap between the Peer Educators, who are certain FSWs trained by the NGO to educate their communities, and the FSWs themselves. After research to determine the most effective method of intervention, a culturally-appropriate, image-only brochure with audio accompaniment was developed to address the problem of low health education levels amongst a low-literate audience.

1. Health in the Hotspots:
Assessing and Increasing HIV/AIDS Testing Among Female Sex
Workers in Jodhpur, India
Nelson, Jessica C., Patterson, Caroline E., Ramos, Irma N.
Jessica C. Nelson, University of Louisville, Brown Fellows Class of 2013
Personal Background and Previous Experience Needs Assessment Methodology
A senior student at the University of Louisville studying Physics and Part 1: An internal assessment of the organization’s annual reports and
English in preparation for medical school. Her previous efforts have interviews with the staff of the TI Program.
included study of English throughout Greece, work in a clinic in rural Part 2: Interviews with 9 of the 13 Peer Educators concerning their
Thailand, and volunteering in Abuja, Nigeria. Jessica’s career goals
experiences with the ICTC (Integrative Counseling and Treatment
include earning a joint MD/MPH degree in International Health and
Center) and possible solutions to improve low testing rate.
working as a surgeon in the developing world.
The 2012 summer was an independent, self-designed public health Part 3: Surveys of 104 of the city’s female sex workers conducted in 11 Interviewing a female sex worker, far right, in Chandpole Hotspot.
project in a developing nation (India). The Foundation for Sustainable hotspot communities to assess HIV knowledge and ICTC accessibility.
Development supported homestay and non-government organization Assessment Conclusions
(NGO) placement. Needs Assessment Findings
Part 1 1. A significant knowledge gap exists between Peer Educators and the female sex workers.
Project Background The NGO’s annual reports showed the current low HIV/AIDS testing Likely contributors to the issue are the illiteracy of the majority of female sex workers
PCB (PC Bhandari) Trust, a local NGO in Jodhpur, is contracted by rate: 29.6%. Additionally, reports identified only one HIV+ case, and the inability of the Peer Educators to devote adequate time to explaining all of the
the Indian government to run Jodhpur’s Targeted Intervention (TI) suggesting that those that are HIV+ have not been tested. health risks to each individual sex worker.
Program. The TI Program aims to empower a target population of Prevalence of HIV among the Rajasthan’s female sex worker population is
800 female sex workers to live healthier lives in spite of their estimated to be nearly 5% and therefore, approximately 40 women may 2. Another likely contributor is the limited accessibility of the ICTC, which a large majority
disadvantages. HIV/AIDS transmission and prevention is an unknowingly be HIV+.
of the women stated was too far away and too time consuming to justify the trip.
important and extremely vulnerable aspect of their health. Free testing Reasons provided by NGO staff for low HIV testing rates included:
is provided by the government to the female sex workers at the local • Unwillingness to visit the clinic during rush hour Project Deliverables
Medical College. The Program functions by selecting one literate • Fear of being identified in public
female sex worker, or Peer Educator, from each Hotspot, or • Discrimination/stigmatization An educational program that presents materials in a way that is comprehensible for
neighborhood with a high concentration of sex workers. • Fear of financial loss illiterate women and that can be explored without the direct help of a Peer Educator was
The Peer Educators are responsible Part 2 developed. This intervention consisted of a brochure, that relied on culturally and
for meeting regularly with each 1. All Peer Educators agreed that the biggest obstacles of visiting the ICTC geographically appropriate images, was crafted by a local artist. The brochure explains the
female sex workers to distribute are distance and cost of transportation. essential concepts of HIV/AIDS transmission and prevention. One brochure for each
condoms and to complete referrals 2. Four of nine Peer Educators stated that the ICTC holds inconvenient sex worker will be distributed via the Peer Educators. Additionally, each Peer Educator
to various testing and STI (Sexually hours.
will receive an MP3 player containing a 9-minute audio accompaniment, recorded in
Transmitted Infection) clinics. 3. Five of nine Peer Educators stated that female sex workers need to be
better educated.
Marwari, that guides the viewer through the brochure and provides extra details and
There are 13 Hotspots, mapped by
PCB Trust, each containing about Part 3 clarifications. Peer Educators will manage and distribute the audio players in a manner
60 sex workers. All sex work is that best suits their hotspot.
secret and home-based and most To address the issue of HIV/AIDS testing
women have husbands and children accessibility, grant proposals to procure
Map of Jodhpur’s Hotspots
that are unaware of the nature of
ongoing support for a Mobile Testing Unit
their work.
via a grant-making foundation or the
Indian government were drafted and left
Project Aim ready for submission by the staff of the
PCB Trust. Final image in a series of paintings showing the typical progression of HIV/AIDS
From May 2010 to April 2011, the rate of HIV testing
among referred female sex workers was 29.6%. Acknowledgments
The aim of the project is to assess the reasons for a low rate Special thanks to the James Graham Brown Foundation for funding and
of HIV/AIDS testing among Jodhpur’s female sex worker supporting the enrichment experience, to Dr. Irma N. Ramos for mentoring the
population and to suggest implementation of measures to project, to the Foundation for Sustainable Development for providing in-country
improve testing rates. support, the NGO placement, and project structure, Vijay Prajatap and the Umaid
Heritage Art School for the brochure’s art work, and the staff of PCB Charitable
Trust for supervising and implementing the project.