Is Scale-Up of Community Mobilisation among Sex Workers Really Possible in Complex Urban Environments? 皇冠体育app Case of Mumbai, India
Abstract
Background
In the last decade, community mobilisation (CM) interventions targeting female sex workers (FSWs) have been scaled-up in India鈥檚 national response to the HIV epidemic. This included the Bill and Melinda Gates Foundation鈥檚 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.
Methods and Findings
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 鈥榮ex workers鈥�. This combined with urban redevelopment and gentrification of traditional red light areas, forcing dispersal and more 鈥榟idden鈥� ways of solicitation, further challenging outreach and collectivisation. Participants reported that brothel owners and 鈥榩imps鈥� continued to restrict access to sex workers and the heterogeneous 鈥榗ommunity鈥� 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.
Conclusion
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.
Citation
Kongelf, A.; Bandewar, S.V.S.; Bharat, S.; Collumbien, M. Is Scale-Up of Community Mobilisation among Sex Workers Really Possible in Complex Urban Environments? 皇冠体育app Case of Mumbai, India. PLoS ONE (2015) 10 (3) e0121014. [DOI: 10.1371/journal.pone.0121014]