Communicating with High risk groups such as Sex Workers (SWs) for promoting health seeking behavior, safer sex, uptake of counseling and testing for HIV and other aspects related to the prevention, care and treatment of HIV is a constant challenge. There are issues that relate to literacy, language, idiom, culture, type of sex work, availability of time and space for interaction, individual and group behavioral patterns, risk perception and perceived relevance. The strong influence of contextual factors and norms, stigma and discrimination and constant migration further compound the challenge. Large metropolises such as the Mumbai-Thane region also bring in their own set of constraints and challenges. The Bill & Melinda Gates Foundation supported FHI360 Aastha project has created concepts that address these challenges and has developed and effectively used communication tools and materials that have proven consistently effective.

Well known communication principles such as Audience segmentation, Communication hooks, target group specific approaches and methods have been blended with marketing principles, behavioral social science and context relevant advocacy. Initiating contact, creating space for engagement, sequential interpersonal interaction and enhancement of behavior change factors have been addressed through a series of materials that are attention catching, entertaining and engaging with a high recall value. Strategic Behavior Communication (SBC) as practiced in Aastha has an evidence-based theoretical foundation grounded in behavioral science, utilizes the best practices from the marketing sector and integrates a number of key marketing principles. In Aastha, SBC is used to drive contextual or environmental as well as individual change in an effort to create enabling environments that make health-seeking and low-risk behaviors achievable. SBC strengthens STI and HIV prevention, treatment and care.

FHI 360 Aastha has also developed planning tools and quality criteria that are applied from inception to evaluation, to ensure the quality of SBC. One of the major innovations in Aastha has been the segmented SBC communication messages depending on the risk profiles of individual SWs.

For implementation, a Training of Trainers (ToT) module is developed by FHI 360 and training programs for master trainers are conducted. ToTs are conducted with Peer Educators (PEs) in addition to Outreach Workers (ORWs) for every new set of SBC materials introduced in the field. The PE Master Trainers are mentored to disseminate the training to their respective fellow PEs as well to the Aastha Gat (SW self help groups) leaders within their micro- site on ways to use the SBC materials with the SWs based on their key message. As per the minimum service package every SW needs to receive one SBC session every month.

Community engagement through involvement in project as staff and participation in activities of the Aastha Gats and Community Based Organization is an important aspect of all SBC materials. The SBC packages are improvised regularly to incorporate developments in the area of community engagement.

Additionally, there is a common component of Communication Hooks in all Packages. Beauty, money, welfare of their children and relationship with their regular partners are priority areas for all SWs. These are used as hooks to attract the SWs, build rapport, sustain their interest and initiate dialogue with them regarding risk behaviors and desired behavior change. The SBC material is designed to help them achieve stability and happiness in relation to their priority areas and thus encourage health living.

This manual details the use of each SBC materials developed and used under the Aastha project. It will serve as a ready guide to agencies working in the field of HIV/AIDS, who wish to adapt and use similar communication methods. We are happy to share our tried and tested methods of SBC with other allies in the fight against HIV and request that FHI 360 Aastha project be acknowledged in case of replication.

Dr Sanjeevsingh Gaikwad,
Director Maharashtra Program, FHI 360