Thinking globally about policy change as HIV prevention: Change over time in police interactions and HIV risk among female sex workers in andhra pradesh, India

BACKGROUND: Community mobilization interventions are a promising strategy for HIV prevention among female sex workers (FSWs). These interventions seek to organize FSWs so they may act collectively and challenge the power structures that contribute to HIV risk. Rigorous impact evaluation is difficult because change is expected at levels beyond the individual, including social-normative, policy and other structural levels. We examined changes over time in FSW reports of interactions with police in Rajahmundry, Andhra Pradesh, the location of a long-standing community mobilization intervention. METHODS: We analyzed cross-sectional data collected from FSWs (recruited through respondent driven sampling) at three time points (n=2276). We used multiple logistic regression to examine the association of FSW reports of negative police interactions and HIV risk behaviors. We also assessed whether these associations varied over time. RESULTS: FSW reports of giving gifts to police to avoid trouble, having police take condoms away, experiencing a workplace raid, and being arrested were associated with STI symptoms, inconsistent condom use, and acceptance of more money for sex without a condom (ORs ranging from 1.5 to 12.3). Significant improvements over time were noted in the proportion of FSWs reporting some negative police interactions. However, the pattern of associations between police interactions and HIV risk behavior did not change. CONCLUSIONS: Findings indicate improvements in FSW reports of interactions with police over time, in a setting where intervention exposure is widely dispersed among the FSW population. The intervention's strategies—including policy change around policing practices-- may be contributing to HIV risk reduction among FSWs.