Durbar Mahila Samanwaya Committee


Dr. Smarajit Jana will supervise the Indian research team. He will lead the DMSC research team that will recruit and interview subjects. Moreover, he will be in charge of recruiting community members to form the Community Action Board (CAB). He will organize and supervise meetings of the CAB. Dr. Jana will also assist the PI in the design of the study, refining the research tool (RPAR), implementing the RPAR tool, development and implementation of the evaluation phase, and analysis of results. Dr. Jana will devote 35% FTE to this project for 12 months.

A legal consultant will work collaboratively with the Indian research team in order to research laws pertaining to sex work and substance use. He/she will present legal information and findings at CAB meetings. The legal consultant will be hired for 10% FTE for 3 months.

DMSC’s Director of Research Operations will work under the supervision of Dr. Jana to coordinate research and training activities. He will identify teams of interviewers, ensure that they adhere to research protocol, supervise their activities, help Dr. Jana organize and run CAB meetings and organize the training sessions conducted by the U.S. research team. He will be responsible for translation and transcription services and ensure proper storage of the data. Finally, he will assist the legal consultant in researching and documenting laws pertaining to sex work and substance use. He will devote 17% FTE to this project for the full duration of the project (12 months).

An on-field coordinator will be appointed who will accompany research teams out in the field and provide direct supervision to research teams. He/she will help the Director of Research ensure fidelity to the research protocol, provide regular reports to the Director of Operations about the progress of the research and problem solve when the need arises during interviews. The coordinator will be properly trained in IRB protocol and will ensure that the proper protocol is followed. He will assist the legal consultant in conducting research. The on-field coordinator will be responsible for proper maintenance of interview equipment and the transfer of data from recorders to the appropriate storage device. He will devote 17% FTE to this project for 4 months (months 3-7).

Total staff budget is Rs. 5,64,333

Source of Foreign funds:

National Institutes of Health, United States (NIH). The funding was allocated by the NIH for a research call titled ”Administrative Supplements for U.S.- India Bilateral collaborative Research on the Prevention of HIV/AIDS (notification no.: NOT-AI-07-022)

Objectives of the project:

Commercial sex and drug use are important and overlapping drivers of the HIV epidemic in India. Laws and law enforcement practices play a substantial role in affecting the risk environment of sex workers and substance users by influencing the availability of healthcare services, the uptake of new prevention services and by helping to shape societal norms associated with sex work and substance use. This supplement is designed to test whether a Rapid Policy Assessment and Response (RPAR) intervention carried out by a grassroots NGO (Durbar Mahila Samanwaya Committee [DMSC]) can identify and foster changes in laws and law enforcement practices that will enhance HIV prevention among sex workers and drug users in Kolkata. A secondary purpose is to test whether conducting a legal RPAR can meaningfully enhance DSMC’s capacity as an HIV-prevention organization.

The specific aims of the supplement are:

to collaborate with DMSC to conduct an RPAR in Kolkata, India, to document laws, law enforcement practices and policies influencing the health risk environment for sex workers and injection drug users;

to build the capacity of DMSC to work with other community organizations to address legal and policy barriers to community health;

to evaluate the RPAR as a tool to collect data, increase the capacity of an NGO and identify and implement new interventions; and

to disseminate the research results.

Expected outcomes

The immediate outcomes of this research will be:

An established community action board comprising sex workers, substance users,police personnel and other stake holders from the community that will continue to identify and implement strategies to modify laws and local enforcement practices that influence HIV risk.

A final report that will: a) document the results of research on laws and enforcement practices targeting sex workers and substance users, b) serve as an RPAR manual to guide future RPAR implementation in other Indian sites.

Trained personnel in DMSC that will enable it to implement the RPAR in other sex work sites it is operating in.

Data on the feasibility of the RPAR in an Indian setting that will be the basis of a larger U.S. National Institute of Health grant to implement the RPAR more widely in India

Long-term outcomes of this research are expected to be:

Modification of local legal and policy enforcement practices in order to reduce HIV risk among sex workers and substance users in Sonagachi, Kolkata.

Research and strategies to help modify national laws that influence HIV risk among sex workers and substance users.

Implications for Indian National Health Programs or Priorities:

This research addresses several national medical priorities:

it seeks to reduce HIV risk in a population that is at highest risk of getting infected and spreading it,

by addressing the legal barriers to care and the legal rights of a disadvantaged population, it addresses NACO’s stated goal of “ensure(ing) protection/promotion of human rights including right to access health care system”,

by developing DMSC’s capacity to address legal structures, it addresses another NACO objective of “generate(ing) a feeling of ownership” of HIV-prevention efforts among local bodies and

by addressing structural legal factors influencing HIV risk, the impact of the research is potentially large and can affect a large population of people at HIV risk.

Did the initiating Institute or the proposer undertake any collaborative work with any foreign agency in the past and if so, with what result?

The National Institutes of Health (NIH), USA has initiated several projects internationally that implement structural interventions to lower HIV risk. In particular, the parent project of this supplement, with Zita Lazzarini as P.I. was sponsored by the National Institute on Drug Abuse (part of NIH, USA). Over the last three and half years the RPAR has been implemented in three countries (Poland, Ukraine, and Russia) and a simplified version, the RPA (without the community intervention component) has been implemented in Kazakhstan.

The results of the RPAR in Poland, Ukraine, Russia indicate that small teams of local investigators can be successfully trained to collect and interpret existing data including “law on the books”, epidemiological information, and criminal justice data. Using these data they can recruit, organize and facilitate a Community Action Board to analyze the possible problems or gaps in laws and public policy that interfere with effective prevention of HIV among IDUs and care and treatment of IDUs who become infected.

The successful completion of the RPAR in Poland, Ukraine and Russia included identification of key findings from the RPAR process, production of an Action Plan and Final report by the team and the local CAB, and beginning of implementation of the Action Plan. This suggests that the research teams successfully integrated qualitative data and existing data, analyzed the data with the local CAB and translated the findings and analysis into an Action Plan. This demonstrates the basic feasibility of the entire RPAR process in the first three countries of implementation.

The RPAR implemented in these three countries and the RPA underway in Kazakhstan all focused on the law and policy environment around injection drug use and the transmission of HIV. These RPARs and RPA included identical sampling of 40 interviews per site, plus three focus groups and a Community Action Board. The RPAR proposed for Sonagachi seeks to describe a more complex HIV risk environment, the intersection of sex work and drug use. For that reason the number of interviews have been increased (to 62), and the focus groups have been eliminated. We believe that this change in interviews and other elements of the research plan are responsive to the different focus of this RPAR.

Administration And Control Over Project

Justification of Indian Investigator for collaboration / financial assistance from foreign funding agency

The U.S. research team headed by the P.I. Zita Lazzarini, J.D. has implemented the RPAR in Poland, Ukraine, Russia and Kazakhstan. The team has the expertise to train DMSC personnel in implementing the RPAR in Sonagachi, Kolkata. The funding that the U.S team will receive from the U.S. National Institute of Health will allow U.S team members to allocate the required time for the research, travel to India to guide the implementation of the RPAR and to help build DMSC’s capacity to sustain responses and interventions at the legal structural level. DMSC scientists have successfully worked with one of the U.S. team members (Dr. Toorjo Ghose) in the past in examining HIV interventions for sex workers in Sonagachi. Past experience with collaborating with international researchers like Dr. Ghose, as well as the evidence of successful RPAR implementation by the U.S. team in several international sites indicates that the Indian investigator and DMSC will benefit greatly through collaborative work with the U.S team.

Justification of foreign Investigator for having collaboration with an Indian investigator / institution

DMSC has worked extensively with sex workers in Kolkata and has addressed several structural issues that raise their risk of HIV infection. Dr. Jana of DMSC is one of India’s leading experts on HIV interventions and will be instrumental in guiding the research, building the Community Action Board and sustaining interventions that will be identified through the RPAR. DMSC’s core of research scientists who have engaged in collaborative research with international teams of scientists in the past, facilitates the prospect of a smooth implementation of the RPAR. Moreover, DMSC has links to several NGOs that work with substance users in the Sonagachi area. Collaboration with DMSC thus allows the U.S team of researchers to 1) fulfill one of the goals of the RPAR, which is to build capacity in a local NGO, 2) gain access to the population of sex workers and substance users in the Sonagachi area, and 3) access the research skills that DMSC can provide. Collaboration with DMSC is thus essential to the success of the research.

New Project Involving Foreign Collaboration

Title of Project : Reducing HIV Risk in Vulnerable Populations: Rapid Policy Assessment and Response.
Name of Indian Institution :
Durbar Mahila Samanwaya Committee.

University of Connecticut

School of Medicine Division of Medical Humanities, 
Health Law, and Ethics
263 Farmington Avenue, MC 6325
Farmington, CT 06030-6325

Collaborating Scientist:
Zita Lazzarini, MPH, J.D. (P.I.)

Director & Associate Professor,
Division of Medical Humanities, Health Law, and Ethics
University of Connecticut School of Medicine
263 Farmington Avenue, MC 6325
Farmington, CT 06030-6325
Phone: 860.679.5494
Fax: 860.679.5464
Email: lazzarini@nso.uchc.edu

University of Pennsylvania

School of Social Policy & Practice
3701 Locust Walk
Philadelphia, PA 19104-6214

Collaborating Scientist:
Toorjo Ghose, Ph.D.

Assistant Professor 
Penn School of Social Policy & Practice
University of Pennsylvania 
3701 Locust Walk
Philadelphia, PA 19104-6214
Phone: 215.898.5511
Fax: 215.573.2099
Email: toorjo.ghose@yale.edu

Temple University

Beasley School of Law 
1719 North Broad St. 
Philadelphia, PA 19122

Collaborating Scientist:
Scott Burris, J.D.

Temple University, Beasley School of Law 
1719 North Broad St.
Philadelphia, PA 19122 

Fenway Community Health 

7 Haviland Street 
Boston, MA 02115

Collaborating Scientist:
Patricia Case. Ph.D.

Research Scientist
Fenway Community Health
7 Haviland Street 
Boston, MA 02115 
Ph no.: 617-267-0900

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