Kongelf Anine, Bandewar Sunita V S, Bharat Shalini, Collumbien Martine
London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London United Kingdom.
Independent Senior Researcher in Global Health, Bioethics and Program Evaluation, C-5, Mantri Avenue-I, Panchavati, Pashan Rd, Pune, India.
PLoS One. 2015 Mar 26;10(3):e0121014. doi: 10.1371/journal.pone.0121014. eCollection 2015.
In the last decade, community mobilisation (CM) interventions targeting female sex workers (FSWs) have been scaled-up in India's national response to the HIV epidemic. This included the Bill and Melinda Gates Foundation's Avahan programme which adopted a business approach to plan and manage implementation at scale. With the focus of evaluation efforts on measuring effectiveness and health impacts there has been little analysis thus far of the interaction of the CM interventions with the sex work industry in complex urban environments.
Between March and July 2012 semi-structured, in-depth interviews and focus group discussions were conducted with 63 HIV intervention implementers, to explore challenges of HIV prevention among FSWs in Mumbai. A thematic analysis identified contextual factors that impact CM implementation. Large-scale interventions are not only impacted by, but were shown to shape the dynamic social context. Registration practices and programme monitoring were experienced as stigmatising, reflected in shifting client preferences towards women not disclosing as 'sex workers'. This combined with urban redevelopment and gentrification of traditional red light areas, forcing dispersal and more 'hidden' ways of solicitation, further challenging outreach and collectivisation. Participants reported that brothel owners and 'pimps' continued to restrict access to sex workers and the heterogeneous 'community' of FSWs remains fragmented with high levels of mobility. Stakeholder engagement was poor and mobilising around HIV prevention not compelling. Interventions largely failed to respond to community needs as strong target-orientation skewed activities towards those most easily measured and reported.
Large-scale interventions have been impacted by and contributed to an increasingly complex sex work environment in Mumbai, challenging outreach and mobilisation efforts. Sex workers remain a vulnerable and disempowered group needing continued support and more comprehensive services.
在过去十年中，印度在应对艾滋病流行的国家行动中扩大了针对女性性工作者的社区动员干预措施。这包括比尔及梅琳达·盖茨基金会的阿瓦汉项目，该项目采用商业方法进行大规模的规划和管理实施。由于评估工作的重点是衡量有效性和健康影响，到目前为止，对于社区动员干预措施在复杂城市环境中与性工作行业的相互作用几乎没有进行分析。
2012年3月至7月期间，对63名艾滋病干预措施实施者进行了半结构化深入访谈和焦点小组讨论，以探讨孟买女性性工作者预防艾滋病的挑战。主题分析确定了影响社区动员实施的背景因素。大规模干预措施不仅受到动态社会环境的影响，而且被证明塑造了这种环境。登记做法和项目监测被认为具有污名化作用，这反映在客户偏好转向不透露自己是“性工作者”的女性身上。这与城市重建以及传统红灯区的高档化相结合，迫使性工作者分散并采用更“隐蔽”的招揽方式，进一步挑战了外展和集体化工作。参与者报告称，妓院老板和“皮条客”继续限制与性工作者的接触，女性性工作者的异质性“社区”仍然分散，流动性很高。利益相关者的参与度很低，围绕艾滋病预防的动员也缺乏说服力。由于强烈的目标导向使活动偏向于那些最容易衡量和报告的方面，干预措施在很大程度上未能满足社区需求。
大规模干预措施受到孟买日益复杂的性工作环境的影响，并加剧了这种复杂性，对外展和动员工作构成挑战。性工作者仍然是一个脆弱且无权的群体，需要持续支持和更全面的服务。
