Lessons from Avahan


"Launched in 2003 with financial backing from the Bill and Melinda
Gates Foundation, Avahan is the world’s  largest HIV prevention programme.
from large scale prevention efforts – findings from Avahan
’ is a newly
published supplement in BMC Public Health, Edited by Lalit Dandona and
Eric Benotsch, that documents the role of the initiative in the fight against
HIV/AIDS in India. 

Avahan involved 134 local non-governmental organizations that implemented
the project in 6 regions of India, targeting individuals most at risk of
contracting HIV. This included female sex workers and their clients, men who
have sex with men, truck drivers and injecting drug users. The programme of
prevention was tailored to the specific needs of the population in India and
implemented a number of evidence-based interventions: peer-led outreach and
behavior change communication; services for STI testing and care and condom
promotion and distribution; and harm reduction for intravenous drug users.

Of paramount importance to the success of Avahan was creating an enabling
environment in the communities where the programme operated; for example,
police harassment or violence against women, which might discourage uptake of
services or use of condoms was addressed, a cash transfer system with cell
phones for the sex workers was implemented, and shower facilities for were truck
drivers built. Thus Avahan employed a combination of evidence-based and common
sense interventions, and to great effect.

Garung et al
report that more than 331,000 female sex workers, 89,000 men who have sex with
men and transgenders, and 10,000 injecting drug users visited sexually
transmitted infection clinics through Avahan between 2005 and 2009, and the
rate of diagnosis of sexually transmitted infections decreased substantially over
this period. Overall it has been estimated that Avahan averted more than
100,000 new HIV infections in a 5 years period between 2003 and 2008.

As Bea Vuylsteke and Marie Laga state in their Commentary: “For
the first time, it has been shown, with a prospective design, that a large
scale targeted HIV prevention programme, including standardized programme
packages reinforced with community mobilization approaches, is possible and

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One Comment


Thanks for directing me to the review of Avahan on BMC Public Health! The Gates initiative reminds us that when structural interventions and community mobilization are added to a mix of prevention services, the synergy achieved with combination HIV prevention is evident. BMC’s is a great collection of articles, and I’m excited to look through them.

You might be interested in another piece on Avahan – a case study, from AIDSTAR-One. The case study highlights as some of Avahan’s important successes: using, not just collecting, data; intensive use of human resources; & building authentic community ownership. Noted challenges include monitoring qualitative and emotive aspects of the program, coordination of the program at scale, and replication.

The case study is available for low-bandwidth viewing & download at:

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