Department of Sociology, Battelle-Tompkins Hall, American University, 4400 Massachusetts Avenue NW, Washington, DC 20016-8072, USA.
J Epidemiol Community Health. 2012 Oct;66 Suppl 2:ii95-99. doi: 10.1136/jech-2011-200508. Epub 2012 Jun 15.
Recent theorisation has pushed stigma research in new directions, arguing for a need to challenge the unequal power relations that impact groups most at risk for HIV-related stigma rather than locate stigma in the individual. Such a conceptualisation resonates with the growing emphasis on structural interventions for HIV prevention that attempt to alter the social context of risk.
The paper predominantly relies on longitudinal interviews conducted three times over a 2-year period with sex workers with varying degrees of involvement with the non-governmental organisation (NGO) and community-based organisation.
Recognising that stigma is socially constructed and structurally reproduced, the NGO helped mobilise marginalised and hitherto scattered female sex workers to form community-based organisations to challenge their disadvantaged status in society. The authors show how stigma alleviation strategies presented a contradiction: emboldening one group of female sex workers to self-identify as sex workers while making others reluctant to access the intervention-run clinic.
The paper builds on a growing body of research that acknowledges the struggles in implementing structural interventions, particularly for NGOs working in regions with a diverse population of sex workers with varying needs. The authors argue that intervention goals of reducing stigma and increasing the use of sexually transmitted infection services do not have to conflict and, in fact, must go hand-in-hand for an implementation to be considered a structural intervention.
最近的理论研究推动了耻辱感研究的新方向，认为有必要挑战那些对艾滋病毒相关耻辱感影响最大的不平等权力关系，而不是将耻辱感归咎于个人。这种概念化与越来越强调针对艾滋病毒预防的结构干预措施相呼应，这些措施试图改变风险的社会环境。
本文主要依赖于对性工作者进行的三次纵向访谈，这些性工作者在不同程度上参与了非政府组织和社区组织。
认识到耻辱感是社会构建和结构性再现的，非政府组织帮助动员边缘化和迄今为止分散的性工作者组成社区组织，以挑战她们在社会中的不利地位。作者展示了耻辱感减轻策略如何构成矛盾：一方面鼓励一群性工作者自我认同为性工作者，另一方面又使其他人不愿意接受干预管理的诊所。
本文建立在越来越多的研究基础上，这些研究承认在实施结构干预措施方面存在困难，特别是对于在性工作者人口多样化且需求各异的地区开展工作的非政府组织而言。作者认为，减少耻辱感和增加性传播感染服务使用的干预目标不一定相互冲突，实际上，为了被视为结构干预措施，两者必须齐头并进。
