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Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases

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  • Swendeman, Dallas
  • Basu, Ishika
  • Das, Sankari
  • Jana, Smarajit
  • Rotheram-Borus, Mary Jane

Abstract

The Sonagachi Project was initiated in Kolkata, India in 1992 as a STD/HIV intervention for sex workers. The project evolved to adopt strategies common to women's empowerment programs globally (i.e., community mobilization, rights-based framing, advocacy, micro-finance) to address common factors that support effective, evidence-based HIV/STD prevention. The Sonagachi model is now a broadly diffused evidence-based empowerment program. We previously demonstrated significant condom use increases among female sex workers in a 16 month replication trial of the Sonagachi empowerment intervention (n = 110) compared to a control community (n = 106) receiving standard care of STD clinic, condom promotion, and peer education in two randomly assigned rural towns in West Bengal, India (Basu et al., 2004). This article examines the intervention's impacts on 21 measured variables reflecting five common factors of effective HIV/STD prevention programs to estimate the impact of empowerment strategies on HIV/STD prevention program goals. The intervention which was conducted in 2000-2001 significantly: 1) improved knowledge of STDs and condom protection from STD and HIV, and maintained STD/HIV risk perceptions despite treatment; 2) provided a frame to motivate change based on reframing sex work as valid work, increasing disclosure of profession, and instilling a hopeful future orientation reflected in desire for more education or training; 3) improved skills in sexual and workplace negotiations reflected in increased refusal, condom decision-making, and ability to change work contract, but not ability to take leave; 4) built social support by increasing social interactions outside work, social function participation, and helping other sex workers; and 5) addressed environmental barriers of economic vulnerabilities by increasing savings and alternative income, but not working in other locations, nor reduced loan taking, and did not increase voting to build social capital. This study's results demonstrate that, compared to narrowcast clinical and prevention services alone, empowerment strategies can significantly impact a broader range of factors to reduce vulnerability to HIV/STDs.

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  • Swendeman, Dallas & Basu, Ishika & Das, Sankari & Jana, Smarajit & Rotheram-Borus, Mary Jane, 2009. "Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases," Social Science & Medicine, Elsevier, vol. 69(8), pages 1157-1166, October.
    • Handle: RePEc:eee:socmed:v:69:y:2009:i:8:p:1157-1166
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    References listed on IDEAS

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    1. Ghose, Toorjo & Swendeman, Dallas & George, Sheba & Chowdhury, Debasish, 2008. "Mobilizing collective identity to reduce HIV risk among sex workers in Sonagachi, India: The boundaries, consciousness, negotiation framework," Social Science & Medicine, Elsevier, vol. 67(2), pages 311-320, July.
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    2. Lu Gram & Joanna Morrison & Jolene Skordis-Worrall, 2019. "Organising Concepts of ‘Women’s Empowerment’ for Measurement: A Typology," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 143(3), pages 1349-1376, June.
    3. Bidhubhusan Mahapatra & Monika Walia & Sangram Kishor Patel & Madhusudana Battala & Saradiya Mukherjee & Prachi Patel & Balakrishnan Subramanium & Yamini Atmavilas & Niranjan Saggurti, 2020. "Sustaining consistent condom use among female sex workers by addressing their vulnerabilities and strengthening community-led organizations in India," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-17, July.
    4. Altman, Lara & Kuhlmann, Anne K. Sebert & Galavotti, Christine, 2015. "Understanding the black box: A systematic review of the measurement of the community mobilization process in evaluations of interventions targeting sexual, reproductive, and maternal health," Evaluation and Program Planning, Elsevier, vol. 49(C), pages 86-97.
    5. Sarafian, Isabelle, 2012. "Process assessment of a peer education programme for HIV prevention among sex workers in Dhaka, Bangladesh : A social support framework," Social Science & Medicine, Elsevier, vol. 75(4), pages 668-675.
    6. Tan, Judy Y. & Huedo-Medina, Tania B. & Warren, Michelle R. & Carey, Michael P. & Johnson, Blair T., 2012. "A meta-analysis of the efficacy of HIV/AIDS prevention interventions in Asia, 1995–2009," Social Science & Medicine, Elsevier, vol. 75(4), pages 676-687.
    7. Anu Kasmel & Pernille Tanggaard, 2011. "Evaluation of Changes in Individual Community-Related Empowerment in Community Health Promotion Interventions in Estonia," IJERPH, MDPI, vol. 8(6), pages 1-20, May.
    8. Kumar, Neha & Raghunathan, Kalyani & Arrieta, Alejandra & Jilani, Amir Hamza & Chakrabarti, Suman & Menon, Purnima & Quisumbing, Agnes R., 2018. "Social networks, mobility, and political participation: The potential for women’s self-help groups to improve access and use of public entitlement schemes in India," IFPRI discussion papers 1751, International Food Policy Research Institute (IFPRI).
    9. Annie George & Kim M Blankenship, 2015. "Peer Outreach Work as Economic Activity: Implications for HIV Prevention Interventions among Female Sex Workers," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-14, March.
    10. Lianne A. Urada & Andrés Gaeta-Rivera & Jessica Kim & Patricia E. Gonzalez-Zuniga & Kimberly C. Brouwer, 2021. "Mujeres Unidas: Addressing Substance Use, Violence, and HIV Risk through Asset-Based Community Development for Women in the Sex Trade," IJERPH, MDPI, vol. 18(8), pages 1-17, April.
    11. Kumar, Neha & Raghunathan, Kalyani & Arrieta, Alejandra & Jilani, Amir & Chakrabarti, Suman & Menon, Purnima & Quisumbing, Agnes R., 2019. "Social networks, mobility, and political participation: The potential for women’s self-help groups to improve access and use of public entitlement schemes in India," World Development, Elsevier, vol. 114(C), pages 28-41.
    12. Lianne A Urada & Donald E Morisky & Nymia Pimentel-Simbulan & Jay G Silverman & Steffanie A Strathdee, 2012. "Condom Negotiations among Female Sex Workers in the Philippines: Environmental Influences," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-9, March.
    13. Ryan, Martha S. & Nambiar, Devaki & Ferguson, Laura, 2019. "Sex work-related stigma: Experiential, symbolic and structural forms in the health systems of Delhi, India," Social Science & Medicine, Elsevier, vol. 228(C), pages 85-92.
    14. M Eugenia Socías & Jean Shoveller & Chili Bean & Paul Nguyen & Julio Montaner & Kate Shannon, 2016. "Universal Coverage without Universal Access: Institutional Barriers to Health Care among Women Sex Workers in Vancouver, Canada," PLOS ONE, Public Library of Science, vol. 11(5), pages 1-15, May.
    15. Biradavolu, Monica R. & Blankenship, Kim M. & George, Annie & Dhungana, Nimesh, 2015. "Unintended Consequences of Community-Based Monitoring Systems: Lessons from an HIV Prevention Intervention for Sex Workers in South India," World Development, Elsevier, vol. 67(C), pages 1-10.
    16. Lianne A. Urada & Janie Simmons & Betty Wong & Kiyomi Tsuyuki & Gerlita Condino-Enrera & Laufred I. Hernandez & Nymia Pimentel Simbulan & Anita Raj, 2016. "A human rights-focused HIV intervention for sex workers in Metro Manila, Philippines: evaluation of effects in a quantitative pilot study," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 61(8), pages 945-957, November.
    17. Sangram Kishor Patel & Parimi Prabhakar & Anrudh Kumar Jain & Niranjan Saggurti & Rajatashuvra Adhikary, 2016. "Relationship between Community Collectivization and Financial Vulnerability of Female Sex Workers in Southern India," PLOS ONE, Public Library of Science, vol. 11(5), pages 1-12, May.

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