Risk reduction and perceived collective efficacy and community support among female sex workers in Tamil Nadu and Maharashtra, India: the importance of context

Abstract

BackgroundEmpowering sex workers to mobilise and influence the structural context that obstructs risk reduction efforts is now seen an essential component of successful HIV prevention programmes. However, success depends on local programme environments and history.MethodsThe authors analysed data from the Integrated Behavioural and Biological Assessment Round I cross-sectional survey among female sex workers in Tamil Nadu and Maharashtra. The authors used propensity score matching to estimate the impact of participation in intervention activities on reduction of risk (consistent condom use) and vulnerability (perceived collective efficacy and community support).ResultsBackground levels of risk and vulnerability as well as intervention impact varied widely across the different settings. The effect size ATT of attending meetings/trainings on consistent condom use was as high as 21% in Tamil Nadu (outside of Chennai) where overall use was lowest at 51%. Overall, levels of perceived collective efficacy were low at the time of the survey; perceived community support was high in Tamil Nadu and especially in Chennai (93%) contrasting with 33% in Mumbai. Consistent with previous research, the context of Mumbai seems least conducive to vulnerability reduction, yet self-help groups had a significant impact on consistent condom use (ATT=10%) and were significantly associated with higher collective efficacy (ATT=31%).ConclusionsSignificant risk reduction can be achieved by large-scale female sex worker interventions, but the impact depends on the history of programming, the complexity of the context in which sex work happens and pre-existing levels of support sex workers perceive from their peers.

Female Sex Workers and Their Association with Self-Help Groups in Thane, Maharashtra, India: A Comparative Analysis in the Context of HIV Program Outcome

“…With regard to program exposure and subsequent outcome, our study showed consistent findings with the literature available [23] [28]. FSWs associated with SHGs had increasingly heard about health camps, accessed DIC, and heard of Anti-Retroviral Therapy (ART) in significant numbers.…”

“…Literature suggests that developing countries may continue to establish similar kind of groups as one of the structural intervention approaches to combat HIV/AIDS. Literature on the role of SHGs in generating awareness and exposure to HIV/AIDS prevention interventions among FSWs in developing country like India is limited, with focus on community mobilization, social capital and social support [21] [23].…”

HIV infection among female sex workers in concentrated and high prevalence epidemics

“…The majority of this work has been drawn from the Songachi and Avahan programs in India [64,65], with a smaller number of studies emerging from Latin America and the Caribbean [63]. The dynamic nature of community empowerment remains a methodological challenge for researchers and an area in need of more rigorous measurement and evaluation, in partnership with sex work communities [63].…”

Risk and Protective Factors Associated with Personal Mastery Among Sexual Minority African-American Female Sex Workers

“…There are no apparent studies of resilience among sexual minority female sex workers, yet, evidence shows that stressful events can lead to positive growth and coping behaviors among sexual minority women, and especially sexual minority women of color (Bonet, Wells, & Parsons, 2007; Balsam 2003). While such resilient behaviors have not been well studied among street-based female sex workers in the United States, international research with female sex workers indicates that better health outcomes are associated with protective factors such as self-efficacy (Ghimire, et al, 2011; Guha et al, 2012) and that HIV prevention efforts may be more effective if education, health care, and social support services are made available (Scheibe, Drame, & Shannon, 2012; Li, et al, 2010). As a result, researchers have recently advocated resilience-based interventions for HIV prevention and psychological functioning among female sex workers in China (Yuen, et al, 2013).…”