MatCH (Maternal, Adolescent and Child Health), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
Global Health. 2014 Jun 10;10:47. doi: 10.1186/1744-8603-10-47.
Female sex workers (FSWs) experience high levels of sexual and reproductive health (SRH) morbidity, violence and discrimination. Successful SRH interventions for FSWs in India and elsewhere have long prioritised community mobilisation and structural interventions, yet little is known about similar approaches in African settings. We systematically reviewed community empowerment processes within FSW SRH projects in Africa, and assessed them using a framework developed by Ashodaya, an Indian sex worker organisation.
In November 2012 we searched Medline and Web of Science for studies of FSW health services in Africa, and consulted experts and websites of international organisations. Titles and abstracts were screened to identify studies describing relevant services, using a broad definition of empowerment. Data were extracted on service-delivery models and degree of FSW involvement, and analysed with reference to a four-stage framework developed by Ashodaya. This conceptualises community empowerment as progressing from (1) initial engagement with the sex worker community, to (2) community involvement in targeted activities, to (3) ownership, and finally, (4) sustainability of action beyond the community.
Of 5413 articles screened, 129 were included, describing 42 projects. Targeted services in FSW 'hotspots' were generally isolated and limited in coverage and scope, mostly offering only free condoms and STI treatment. Many services were provided as part of research activities and offered via a clinic with associated community outreach. Empowerment processes were usually limited to peer-education (stage 2 of framework). Community mobilisation as an activity in its own right was rarely documented and while most projects successfully engaged communities, few progressed to involvement, community ownership or sustainability. Only a few interventions had evolved to facilitate collective action through formal democratic structures (stage 3). These reported improved sexual negotiating power and community solidarity, and positive behavioural and clinical outcomes. Sustainability of many projects was weakened by disunity within transient communities, variable commitment of programmers, low human resource capacity and general resource limitations.
Most FSW SRH projects in Africa implemented participatory processes consistent with only the earliest stages of community empowerment, although isolated projects demonstrate proof of concept for successful empowerment interventions in African settings.
性工作者（FSWs）经历着较高水平的性健康和生殖健康（SRH）发病率、暴力和歧视。在印度和其他地方，成功的 FSW 性健康干预措施长期以来一直优先考虑社区动员和结构干预，但在非洲环境中，对类似方法的了解甚少。我们系统地回顾了非洲 FSW SRH 项目中的社区赋权过程，并使用印度性工作者组织 Ashodaya 制定的框架对其进行了评估。
我们于 2012 年 11 月在 Medline 和 Web of Science 上搜索了非洲 FSW 健康服务的研究，并咨询了专家和国际组织的网站。使用广泛的赋权定义筛选标题和摘要，以确定描述相关服务的研究。提取关于服务交付模式和 FSW 参与程度的数据，并参考 Ashodaya 制定的四阶段框架进行分析。该框架将社区赋权概念化为从（1）最初与性工作者社区接触，到（2）社区参与有针对性的活动，到（3）所有权，最后，（4）社区行动的可持续性。
在筛选出的 5413 篇文章中，有 129 篇被纳入，描述了 42 个项目。FSW“热点”地区的针对性服务通常是孤立的，覆盖范围和范围有限，主要提供免费避孕套和性传播感染治疗。许多服务是作为研究活动的一部分提供的，并通过带有相关社区外展的诊所提供。赋权过程通常仅限于同伴教育（框架的第 2 阶段）。作为一项独立活动的社区动员很少有记录，虽然大多数项目都成功地接触了社区，但很少有项目进展到参与、社区所有权或可持续性。只有少数干预措施通过正式民主结构发展到促进集体行动（第 3 阶段）。这些报告显示，性行为谈判能力和社区团结得到了提高，行为和临床结果也有所改善。由于临时社区内部不团结、程序员承诺程度不同、人力资源能力低以及普遍资源限制，许多项目的可持续性受到削弱。
尽管孤立的项目证明了在非洲环境中成功赋权干预的概念验证，但非洲大多数 FSW SRH 项目实施的参与过程仅符合社区赋权的最早阶段。
