Sex workers have to negotiate stigma, stress and violence and suffer from high rates of depression. Scholars have found that depression is significantly associated with the risk of becoming HIV infected. Sex workers in India are especially at risk of suffering from depression due to the constellation of cultural challenges tha they face. However, there is very little scholarship on depression among sex workers in India, and its association with elevated levels of HIV risk. While HIV risk reduction interventions with Indian sex workers such as the Sonagachi HIV Intervention Program (SHIP) and the Gates Foundation-funded CARE-Saksham program have sought to reduce the risk environment that sex workers operate in, they have not addressed depression and its effects on risk behaviors in this population. The lack of attention to sex workers'mental health issues is part of a larger lacuna in mental health services in the country. Despite the presence of an estimated 70 million persons living with a mental illness in India, mental health services are scarce and hard to access for marginalized communities like sex workers. This research addresses this vacuum in research and services by designing, implementing and testing the Depression Reduction Implemented by Sex workers to stop HIV Transmission Intervention (DRISHTI, or "vision" in Bengali and Hindi) aimed at managing depression symptoms to improve attitudes, motivation and self-efficacy with regard to safe sexual practices in order to ultimately reduce sexual risk practices. DRISHTI combines proven peer-support processes among sex workers with a cognitive behavioral group therapy modality to address depression and HIV risk in this population.
Sex workers suffering from depression are at high risk of engaging in sexually risky practices. This research design implements and tests DRISHTI, an intervention that seeks to reduce depression in order to ultimately reduce HIV-related risky sexual behaviors among sex workers.