[show abstract][hide abstract] ABSTRACT: The Bill and Melinda Gates Foundation has poured a tremendous amount of resources into epidemic prevention in India's high HIV prevalence zones, through their Avahan initiative. These community-centred programmes operate under the assumption that fostering community-based organisational development and empowering the community to take charge of HIV prevention and education will help to transform the wider social inequalities that inhibit access to health services. Focusing on the South Indian state of Karnataka, this paper explores a troubling set of local narratives that, we contend, hold broader implications for future programme planning and implementation. Although confronting stigma and discrimination has become a hallmark in community mobilisation discourse, communities of self-identified kothis (feminine men) who were involved in Avahan programme activities continued to articulate highly negative attitudes about their own sexualities in relation to various spheres of social life. Rather than framing an understanding of these narratives in psychological terms of 'internalized stigma', we draw upon medical anthropological approaches to the study of stigma that emphasise how social, cultural and moral processes create stigmatising conditions in the everyday lives of people. The way stigma continues to manifest itself in the self-perceptions of participants points to an area that warrants critical public health attention.
Culture Health & Sexuality 08/2013; · 1.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: In this paper we examined the role of Devadasi brothel madams in promoting safe sex practices among sex workers. Qualitative, in-depth interviews were conducted with twelve brothel madams as a follow-up of a larger cohort study that aimed to understand the patterns and determinants of sex workers migration from northern Karnataka to southern Maharashtra, in India. Our research identified that madams were ex-sex workers, who entered into sex work through the traditional Devadasi system and currently manage Devadasi sex workers in their own brothels. The social and kinship relations between the madams and the sex workers form the basis on which these brothels function. Brothel madam's role in the promotion of safe sex and their influence on sex workers in seeking health care is tied to reciprocal kinship relations, reveals an important area of opportunity for HIV prevention efforts to fully exploit these positive aspects of these relationships within intervention design and service delivery to achieve more desirable health outcomes and to effectively address HIV risk and vulnerabilities within the context of brothel environment.
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Since the completion of three clinical trials indicating that voluntary medical male circumcision (VMMC) is an effective method to reduce men's chances of acquiring HIV, use of the procedure has been advocated in Kenya. Media messages shape popular understandings of the benefits and limitations of male circumcision. The objectives of this study were to (1) investigate promotion messages in a popular online newspaper to determine how the limitations of male circumcision are represented, and whether condom use is still being promoted; and (2) gain insight into popular understandings of the limitations of this new procedure through newspaper reader comments. METHODS: A content analysis was conducted on 34 online media articles published by the Daily Nation between January 1, 2008 and December 31, 2010. Information about condom promotion, partial immunity, limitations and complications of the procedure, as well as emergent themes, were analyzed. RESULTS: Results demonstrated an irregular and occasionally misleading presentation of these topics and a perceived lack of objective information about the risks and limitations of VMMC. CONCLUSIONS: There is a need for governmental and non-governmental public health organizations to engage with the media to improve risk messaging.
BMC Public Health 06/2012; 12(1):465. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Increasing sex workers' (SWs) access to and utilisation of health care services is a key part of HIV prevention. An HIV prevention project in Mysore, India, has been particularly successful in fostering a new norm of health care seeking among local SWs while facilitating community ownership of health care delivery. This paper describes how the use of occupational health ideologies, along with the creation of enabling environments, facilitated the uptake of project healthcare services and transformed power relationships between SWs and their healthcare providers. These changes led Mysore's SWs to initiate health-enhancing actions that moved beyond project imperatives to serve self-identified community needs.
Global Public Health 03/2012; 7(7):779-91. · 0.92 Impact Factor
[show abstract][hide abstract] ABSTRACT: There is a lack of information on sexual violence (SV) among men who have sex with men and transgendered individuals (MSM-T) in southern India. As SV has been associated with HIV vulnerability, this study examined health related behaviours and practices associated with SV among MSM-T.
Data were from cross-sectional surveys from four districts in Karnataka, India.
Multivariable logistic regression models were constructed to examine factors related to SV. Multivariable negative binomial regression models examined the association between physician visits and SV.
A total of 543 MSM-T were included in the study. Prevalence of SV was 18% in the past year. HIV prevalence among those reporting SV was 20%, compared to 12% among those not reporting SV (p = .104). In multivariable models, and among sex workers, those reporting SV were more likely to report anal sex with 5+ casual sex partners in the past week (AOR: 4.1; 95%CI: 1.2-14.3, p = .029). Increased physician visits among those reporting SV was reported only for those involved in sex work (ARR: 1.7; 95%CI: 1.1-2.7, p = .012).
These results demonstrate high levels of SV among MSM-T populations, highlighting the importance of integrating interventions to reduce violence as part of HIV prevention programs and health services.
PLoS ONE 01/2012; 7(3):e31705. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: To meet the HIV prevention needs of sex workers in India, some community-based organizations have begun integrating peer education and community mobilization into community-led structural interventions. As the role of community-based organizations continues to expand into new service areas, it is important to understand how these new interventions are received. This agency assessment was done in collaboration with Ashodaya Samithi in 2009. Ashodaya Samithi is a community-based organization led by female, male, and transgendered sex workers. In the past year, HIV-positive sex workers of Ashodaya have registered their own organization, known as Ashraya. Based on qualitative findings, this study describes how community-based organizations can play an important role in improving access to care and antiretroviral treatment for sex workers. The rapid growth of Ashraya and its success at fostering social solidarity and large-scale structural interventions hold valuable lessons for community-based organizations and public health practitioners working in the field of HIV/AIDS.
Journal of HIV/AIDS & Social Services 01/2012; 11(2):152-168.
[show abstract][hide abstract] ABSTRACT: Bhutan's sustained low HIV prevalence can be attributed to its political commitment to maintain isolation from foreign cultural influence. Recently, rising HIV prevalence has coincided with the increase in human traffic along Bhutan's borders. The majority of infections, occurring primarily through sexual contact, have appeared in the urban environments that are situated along the main transport routes. This qualitative study explored the sexual networks that form at entertainment venues in the capital city of Thimphu. To more fully understand sexual network formation at theses venues, one must take into account an emerging modernity that reflects a convergence of cultural, economic and political influences emanating from Bhutan's unique 'middle-path' modernisation scheme. The growing appearance of transactional sex in Thimphu not only points to an emergent form of exploitation wrought by larger economic transformations and widening social inequalities; the power inequalities that surround its practice are also significantly exacerbated by the local cultural politics and moral ideologies that arise as Bhutan proceeds along the path towards global capitalism. Discourses of Bhutanese sexual morality articulate with broader political economic transformations to forcefully position village women engaging in transactional sex within a field of power relations that leaves them open to various forms of subjugation.
[show abstract][hide abstract] ABSTRACT: Employing community-based approaches, the spatialization of sexual risk among men-who-have-sex-with-men (MSM) at local cruising spots was explored in South India. To move beyond individualistic and structural deterministic understandings of sexual risk the study examined how erotic associations and networks formed and dissolved as social actors connect to each other through their material world (which includes other bodies). Crowding was important for safely establishing intimacy in public but also created contexts of discrimination and violence, particularly for feminine-acting males. Risk itineraries drawn by MSM anticipated fluctuating levels of risk, enabling them to avoid dangerous situations. Although sexual typologies connected gender nonconforming males to HIV prevention networks, they reinforce the exclusion of men who did not identify with sexual minority identities. Future work must therefore address the HIV prevention needs of men whose identities cannot be readily separated from "the general population".
Health & Place 06/2011; 17(5):1090-7. · 2.42 Impact Factor
[show abstract][hide abstract] ABSTRACT: Evidence from community-led HIV prevention projects suggests that structural interventions may result in reduced rates of HIV and STIs. The complex relationship between empowerment and confronting stigma, discrimination and physical abuse necessitates further investigation into the impact that such interventions have on the personal risks for sex workers. This article aims to describe lived experiences of members from a sex worker's collective in Mysore, India and how they have confronted structural violence. The narratives highlight experiences of violence and the development and implementation of strategies that have altered the social, physical, and emotional environment for sex workers. Building an enabling environment was key to reducing personal risks inherent to sex work, emphasizing the importance of community-led structural interventions for sex workers in India.
AIDS Care 01/2011; 23(1):69-74. · 1.60 Impact Factor
[show abstract][hide abstract] ABSTRACT: Research on the HIV vulnerability of men who have sex with men (MSM) in India has tended to focus on aggregates of individual risk behaviours. However, such an approach often overlooks the complexities in the sexual networks that ultimately underpin patterns of spread. This paper analyses a set of sexual contact network (SCN) snapshots in relation to ethnographic findings to reorientate individual-level explanations of risk behaviour in terms of more complex systems.
Fifteen community researchers conducted a 2-month ethnographic study in three cities in Karnataka to generate descriptions of the risk environments inhabited by MSM. SCNs were reconstructed by two methods. First, initial participants, defined as nodes of various sexual networks, were purposively sampled. In each site, six nodes brought in three sexual partners separately as participants. In all sites, 72 participants completed 431 surveys for their 7-day sexual partners. Second, each site determined four groups representing various sexual networks, each group containing four individuals. In all sites, 48 participants completed 334 surveys for their regular sexual partner.
Considerable differences were observed between sites for practically all included behavioural variables. On their own, these characteristics yielded contradictory interpretations with respect to understanding contrasts in HIV prevalence at each site. However, viewing these variables in relation to SCNs and ethnographic data produced non-linear interpretations of HIV vulnerability which suggested importance to local interventions.
SCN data may be used with existing data on risk behaviour and the structural determinants of vulnerability to re-tailor more tightly focused interventions.
[show abstract][hide abstract] ABSTRACT: Growing public health attention has been placed on the HIV vulnerability of males who sell sex to males in India. However, there is little research that outlines the trajectories through which males come to be involved in practicing sex work in India. Locating "male sex work" within a vibrant social, political, and erotic landscape, this article explores the intertwining of "sexual subjectivity" and "sex work." The authors refer to 70 sexual life histories generated from research conducted in Mysore to unsettle dominant public health notions that regard male sex work as rooted solely in poverty or as a decontexualized "behavioral risk factor." Such perspectives are countered by demonstrating how male sex work in Mysore encompasses a complex interplay between self-realization, sexual desire, social interaction, and public health discourse. Local conceptualizations of selfhood are discussed to suggest the limitations of prevailing empowerment discourses that advance Western notions of individuality.
Medical Anthropology Quarterly 07/2009; 23(2):142-60. · 1.30 Impact Factor
[show abstract][hide abstract] ABSTRACT: Growing public health attention has been placed on the HIV vulnerability of males who sell sex to males in India. However, there is little research that outlines the trajectories through which males come to be involved in practicing sex work in India. Locating “male sex work” within a vibrant social, political, and erotic landscape, this article explores the intertwining of “sexual subjectivity” and “sex work.” The authors refer to 70 sexual life histories generated from research conducted in Mysore to unsettle dominant public health notions that regard male sex work as rooted solely in poverty or as a decontexualized “behavioral risk factor.” Such perspectives are countered by demonstrating how male sex work in Mysore encompasses a complex interplay between self-realization, sexual desire, social interaction, and public health discourse. Local conceptualizations of selfhood are discussed to suggest the limitations of prevailing empowerment discourses that advance Western notions of individuality.