Swendeman Dallas, Basu Ishika, Das Sankari, Jana Smarajit, Rotheram-Borus Mary Jane
Center for Community Health, University of California, Los Angeles, CA, USA.
Soc Sci Med. 2009 Oct;69(8):1157-66. doi: 10.1016/j.socscimed.2009.07.035. Epub 2009 Aug 28.
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.
索纳加奇项目于1992年在印度加尔各答启动，是一项针对性工作者的性传播疾病/艾滋病干预项目。该项目逐渐发展，采用了全球妇女赋权项目共有的策略（即社区动员、基于权利的框架构建、宣传倡导、小额融资），以应对支持有效、循证的艾滋病毒/性传播疾病预防工作的共同因素。索纳加奇模式现已成为一个广泛传播的循证赋权项目。我们之前在印度西孟加拉邦两个随机分配的农村城镇进行了一项为期16个月的索纳加奇赋权干预复制试验（n = 110），与接受性病诊所标准护理、避孕套推广和同伴教育的对照社区（n = 106）相比，试验结果显示女性性工作者的避孕套使用显著增加（巴苏等人，2004年）。本文研究了该干预措施对21个测量变量的影响，这些变量反映了有效艾滋病毒/性传播疾病预防项目的五个共同因素，以评估赋权策略对艾滋病毒/性传播疾病预防项目目标的影响。2000年至2001年实施的干预措施产生了显著效果：1）提高了对性传播疾病以及避孕套预防性病和艾滋病的认识，并且尽管接受了治疗，但仍保持对性传播疾病/艾滋病风险的认知；2）提供了一个框架，通过将性工作重新定义为正当工作来激励改变，增加职业披露，并灌输一种对更多教育或培训的渴望所反映出的充满希望的未来导向；3）提高了性方面和工作场所谈判的技能，表现为拒绝能力、避孕套决策能力以及更改工作合同能力的增强，但请假能力未提高；4）通过增加工作以外的社交互动、社会功能参与以及帮助其他性工作者建立了社会支持；5）通过增加储蓄和其他收入解决了经济脆弱性的环境障碍，但未在其他地点工作，也未减少借贷，且未增加投票以建立社会资本。本研究结果表明，与单纯的针对性传播和预防服务相比，赋权策略可以显著影响更广泛的因素，以降低感染艾滋病毒/性传播疾病的易感性。
