Power, Community Mobilization, and Condom Use Practices among Female Sex Workers in Andhra Pradesh, India,”

Department of Sociology, Duke Global Health Institute, Duke University, Durham, North Carolina 27708, USA.
AIDS (London, England) (Impact Factor: 5.55). 01/2009; 22 Suppl 5(Suppl 5):S109-16. DOI: 10.1097/01.aids.0000343769.92949.dd
Source: PubMed


We used a structural interventions framework to analyse the associations between power and condom use among a sample of female sex workers (FSW), and how exposure to a local community mobilization intervention (CMI) affects these associations.
Data came from a cross-sectional survey of 812 FSW in the East Godavari district of Andhra Pradesh, India, recruited through respondent-driven sampling.
We identified three types of power - collective power, control over work, and economic power, and three dimensions of collective power - collective identity, efficacy, and agency. Multivariate logistic regression analysis was used to analyse the relationship of these three types of power and exposure to a CMI with consistent condom use with clients.
A total of 803 respondents exchanged sex with an occasional or regular client in the 7 days before the interview. Multivariate logistic regression shows that control over both the type of sex [adjusted odds ratio (AOR) 1.70, 95% confidence interval (CI) 1.23-2.34] and the amount charged (AOR 1.56, 95% CI 1.12-2.16), and economic dependence (AOR 0.54, 95% CI 0.35-0.83) are associated with consistent condom use as is programme exposure (AOR 2.09, 95% CI 1.48-2.94). The interaction between programme exposure and collective agency was also significant (chi-square 6.62, P = 0.01). Among respondents who reported both programme exposure and high levels of collective agency, the odds ratio of consistent condom use was 2.5 times that of other FSW.
A structural interventions framework is useful for understanding HIV risk among FSW. More needs to be done to promote FSW control over work and access to economic resources.

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    • "Community-led approaches (e.g., Sonagachi Project, Avahan Indian AIDS Initiative) may serve as models for this type of programme (Jana et al., 2004; Piot, 2010). Evidence suggests that these approaches have been successful in India in increasing condom use within commercial sex transactions through increased skills in condom use sexual negotiation and decision-making practices, social support and collectivization and reducing environmental barriers, along with improved knowledge of HIV/STIs and condom use (Blankenship, West, Kershaw, & Biradavolu, 2008; Ramanaik et al., 2014; Reza-Paul et al., 2008; Swendeman, Basu, Das, Jana, & Rotheram-Borus, 2009). Given that half of SWs have children with their main NPP and a quarter of them reported currently planning to have a child with their main NPP, our results suggest a substantial need for the integration of reproductive health programming within HIV/ STIs prevention. "
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    ABSTRACT: This study aimed to: (1) examine the relationship between interpersonal as well as social-demographic, cultural and structural factors, and condom non-use by sex workers' main intimate or other non-paying male sex partners (NPPs), as reported by a sample of sex workers; and (2) understand HIV/sexually transmitted infections (STIs) risk (e.g., numbers of sexual partners; condom use with different partners) among couples comprised of a sub-set of sex workers and their NPPs. Bivariate and multivariable logistic regression was used to identify factors associated with condom non-use at last sex by the main NPP, as reported by sex workers. Adjusted odds ratios and 95% confidence intervals are reported (AOR[95%CIs]). Data were drawn from cross-sectional surveys in Bagalkot District, Karnataka State, South India. Responses by sex workers whose main NPPs agreed to enrol in the study and the main NPP enroled were linked; these responses by couples (pairs of sex workers and NPPs) were examined for responses to sexual risk for HIV/STIs. Overall, this study included 257 sex workers and 76 NPPs. The data from 67 couples (88.2%) could be linked. In over a quarter of partnerships, at least one (SW or NPP) partner reported having another type of partner besides each other (and clients of SWs). In multivariable analysis, significantly increased odds of condom non-use at last sex with the main NPP were found for the following key factors: planning to have a child with their main NPP (AOR = 3.71[1.44-9.58]); and having decisions about condom use made by their main NPP (AOR = 9.87[4.03-24.16]) or both equally (AOR = 3.18[1.39-7.80]) (instead of by the sex workers herself). Our study highlights the potential risk for HIV/STI acquisition and transmission between NPPs and sex workers, and between NPPs and their non-sex workers wives and other sex partners. Study results underscore the need for HIV/STI prevention approaches that incorporate informed decision-making about childbearing and parenting, and empowerment strategies for sex workers within the context of NPPs.
    AIDS Care 08/2015; DOI:10.1080/09540121.2015.1050981 · 1.60 Impact Factor
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    • "Resources are conceptualized as the pre-conditions and catalysts for exercising choice (agency) and refer to the material, instrumental, personal, and social capacities that people can draw upon to secure their economic livelihoods and general wellbeing (Kabeer, 2001). The concept of resources runs parallel to ''structural factors'' commonly cited in HIV/AIDS research (e.g., Blankenship et al., 2008; Evans, Jana, & Lambert, 2010) and ''opportunity structures''used in other empowerment scholarship (e.g., Alsop & Heinsohn, 2005). Intervention programs, such as Durbar, are also considered key resources that can support agency and achievements (Kabeer, 2001). "
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    ABSTRACT: This article investigated the complex interplay of choice, socioeconomic structural factors, and empowerment influencing engagement in sex work. The analysis was focused on pathways into and reasons for staying in sex work from in-depth qualitative interviews with participants (n = 37) recruited from the Durbar community-led structural intervention in Kolkata, India. Kabeer's theory of empowerment focused on resources, agency, and achievements was utilized to interpret the results. Results identified that contexts of disempowerment constraining resources and agency set the stage for initiating sex work, typically due to familial poverty, loss of a father or husband as a breadwinner, and lack of economic opportunities for women in India. Labor force participation in informal sectors was common, specifically in domestic, construction, and manufacturing work, but was typically insufficient to provide for families and also often contingent on sexual favors. The availability of an urban market for sex work served as a catalyst or resource, in conjunction with Durbar's programmatic resources, for women to find and exercise agency and achieve financial and personal autonomy not possible in other work or as dependents on male partners. Resources lost in becoming a sex worker due to stigma, discrimination, and rejection by family and communities were compensated for by achievements in gaining financial and social resources, personal autonomy and independence, and the ability to support children and extended family. Durbar's programs and activities (e.g., savings and lending cooperative, community mobilization, advocacy) function as empowering resources that are tightly linked to sex workers' agency, achievements, and sex work pathways.
    Archives of Sexual Behavior 01/2015; 44(4). DOI:10.1007/s10508-014-0404-1 · 3.53 Impact Factor
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    • "These organizations have been established under the society act or legal profit companies, as per the Indian government guidelines [6]. In India, community mobilization efforts by NGOs have been in the nature of setting up community-based groups or organizations (CBOs) where individuals from the target population (such as female sex workers) come together to lead and implement HIV prevention interventions [7], [8], [9], [10]. However, such community mobilization efforts have not been able to adequately cover the huge volume of key populations groups at HIV risk: female sex workers (FSWs) (approx. "
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    ABSTRACT: The institutionalization of community mobilization is not well understood in literature. This paper aims to understand the role of the community-to-community learning strategy in the institutionalization of community mobilization among sex workers communities across eight districts of Andhra Pradesh, India. Data collected during baseline (March, 2010) and endline (June, 2012) under an HIV prevention project (SAKSHAM project) was used to investigate the strength (as score) of community mobilization based on two learning strategies: non-government organization (NGO)-to-community-based organization (CBO) strategy, and community-to-CBO strategy. The strength of community mobilization was assessed based on different parameters. The change in scores were computed as a percentage of the improvement to the total potential improvement from baseline to endline on specific indicators and overall. Most of the CBOs considered in the pre-post assessment had been registered during 2004-2008. At baseline, the community ownership and preparedness index scores for the eight CBOs under the community-to-CBO strategy ranged between 21.5 and 27.7 while the scores for the three CBOs under the NGO-to-CBO strategy ranged between 16.3 and 21.5. By endline, the strength of community mobilization among CBOs under the community-to-CBO strategy increased 18 points (equivalent to 23% potential improvement) whereas the strength of community mobilization among CBOs under the NGO-to-CBO strategy increased only 10 points (equivalent to 13% potential improvement). The average percentage difference in improvement between the strategies was 10% (p = 0.102). Further analyses indicate that a greater improvement in community-to-CBO learning strategy was noted around managerial capacities and engagement with stakeholders than other parameters. The community -to- CBO learning strategy presents promising results for HIV prevention with regard to institutionalization of community mobilization among sex workers communities. Findings support the scaling-up of community mobilization initiatives within HIV prevention interventions using well trained community members in India and elsewhere.
    PLoS ONE 03/2014; 9(3):e90592. DOI:10.1371/journal.pone.0090592 · 3.23 Impact Factor
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