Community Mobilization Challenging Gender Power Imbalances: Women Sex Workers’ Capacity to Engage in Health-Enhancing Practices in Southern India

Young, Gay; Danner, Mona J. E.; Fort, Lucia; Blankenship, Kim M.

doi:10.1007/s10461-021-03481-9

Cited by 2 publications

(2 citation statements)

References 33 publications

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“…Important aspects of this include presence of supportive social networks and relationships of trust [34 ▪ ,35]. Although not always clearly defined or conceptualized, community mobilization has been shown to be possible to catalyse and nurture even in contexts where there is initially much distrust and lack of solidarity among people who sell sex [36]. Local policing practice and interpretations of law and policy also affect sex workers, and can change unexpectedly, such as use of coronavirus disease 2019 (COVID-19) related restrictions to constrain sex workers’ and other key populations’ ability to access services [37].…”

Section: Selling Sex and Hiv Riskmentioning

confidence: 99%

HIV prevention in individuals engaged in sex work

Busza

Matambanadzo

Phiri³

et al. 2022

Current Opinion in Infectious Diseases

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Purpose of reviewPeople who sell sex remain at disproportionate risk of acquiring HIV and should be prioritized for evidencebased HIV prevention programmes delivered at sufficient scale and intensity for effectiveness. Although new biomedical tools are becoming available, many basic lessons learned early in the HIV pandemic remain salient today and need renewed attention. Recent findingsNew preexposure prophylaxis formulations, distribution systems, and delivery mechanisms are being successfully trialled and implemented, adding to well established prevention tools such as male and female condoms and lubricants. The importance of social support networks and community ownership of programmes has been consistently reaffirmed. Serious challenges remain in optimizing HIV prevention for sex workers, including providing services at the scale and intensity necessary for population level impact, addressing culturally sensitive issues of gender identity and sexual orientation, and protecting adolescents and young people who may sell sex. Pervasive social stigma, often reinforced by criminalization and police harassment, further constrain sex workers access to available services and prevention tools. SummaryMeaningful community engagement and addressing the multiple social determinants of vulnerability at individual, community, and structural levels remain at the core of preventing HIV among people involved in selling sex.

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Section: Selling Sex and Hiv Riskmentioning

confidence: 99%

HIV prevention in individuals engaged in sex work

Busza

Matambanadzo

Phiri³

et al. 2022

Current Opinion in Infectious Diseases

View full text Add to dashboard Cite

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“…Nonetheless, many successful examples of programmes to support FSW's health and well-being exist, and those that are underpinned by community-led and community-based strategies to empower FSW to work collectively toward shared goals have consistently shown advantages over provision of biomedical tools or individual behaviour change messages alone (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

We carried her in a wheelbarrow to the clinic”: Process evaluation of the AMETHIST intervention combining microplanning with self-help groups to improve HIV prevention and treatment among female sex workers in Zimbabwe

Machingura,

Madimutsa,

Makamba

et al. 2024

Preprint

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Background The Adapted Microplanning to Eliminate Transmission of HIV in Sex Transactions (AMETHIST) randomized controlled trial tested a combination of Microplanning (peer-led risk-differentiated support) and self-help groups (SHGs) to reduce the proportion of female sex workers (FSW) at risk of acquiring or transmitting HIV infection in Zimbabwe. The trial found overall high levels of FSW engagement with treatment which further improved in intervention sites. HIV prevention uptake, however, was low and not affected by AMETHIST. Methods We conducted a mixed methods process evaluation to assess implementation, explore FSW perceptions, and understand the trial’s outcomes. We integrated routine programme statistics, qualitative data, and an endline respondent driven sampling survey among 4444 FSW to consider fidelity of implementation, feasibility of delivery, and acceptability. We also examined whether the intervention triggered changes hypothesised in its programme theory. Results Microplanning was successfully introduced, with peers effectively providing risk-differentiated support. Early difficulties related to mapping sex work “hotspots”, maintaining contact with mobile FSW, and some resistance to regular risk assessments, but double the number of new FSW registered at intervention clinics compared to comparison sites (8443 v 3824), and significantly more HIV tests were performed (11882 vs 6808). SARS-COV2S disrupted the intervention, particularly SHG. Fewer groups were established than planned, and lockdowns prevented group members meeting in person and participating in collective activities. Nonetheless, 30 of 65 established SHG remained active after two years, and more SHG members registered with clinics than those reached by microplanning alone (82 cv 76% p,0.001). Increased service use did not increase effective prevention. Over 80% FSW reported condomless sex and PrEP adherence was insufficient to achieve protection. Qualitative data show FSW prefer to “wait” until HIV seroconversion before taking daily medication. They feared conflation of ART with PrEP and resulting stigma. Concerns about side effects and immediate financial priorities undermined perceived future benefits of PrEP and condoms. Conclusions Strengthening HIV prevention should consider how to improve FSW’s hope and agency alongside reducing stigma and supporting collective rights and action. Trial Registration The Pan African Clinical Trials Registry registered the trial 2nd July 2020 (PACTR202007818077777) which was after randomisation but before any research data were collected.

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Community Mobilization Challenging Gender Power Imbalances: Women Sex Workers’ Capacity to Engage in Health-Enhancing Practices in Southern India

Cited by 2 publications

References 33 publications

HIV prevention in individuals engaged in sex work

HIV prevention in individuals engaged in sex work

We carried her in a wheelbarrow to the clinic”: Process evaluation of the AMETHIST intervention combining microplanning with self-help groups to improve HIV prevention and treatment among female sex workers in Zimbabwe

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