Is Scale-Up of Community Mobilisation among Sex Workers Really Possible in Complex Urban Environments? The Case of Mumbai, India

In the last decade, community mobilisation (CM) interventions targeting female sex workers (FSWs) have been scaled-up in India's national response to the HIV epidemic. This included the Bill and Melinda Gates Foundation's Avahan programme which adopted a business approach to plan and manag...

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Bibliographic Details
Published in:PloS one Vol. 10; no. 3; p. e0121014
Main Authors: Kongelf, Anine, Bandewar, Sunita V. S., Bharat, Shalini, Collumbien, Martine
Format: Journal Article
Language:English
Published: United States Public Library of Science 26.03.2015
Public Library of Science (PLoS)
Subjects:
Access control
Acquired immune deficiency syndrome
AIDS
Analysis
Charities
Community
Condoms
Disease prevention
Disease transmission
Dispersal
Epidemics
Epidemiology
Female
HIV
Human immunodeficiency virus
Humans
India
Intervention
Occupational health
Prevention
Prostitution
Redevelopment
Residence Characteristics - statistics & numerical data
Sex
Sex industry
Sex oriented businesses
Sex Workers - statistics & numerical data
Sexually transmitted diseases
Social change
STD
Urban environments
Urban Population - statistics & numerical data
Workers
Working conditions
India
United Kingdom > UK
Mumbai India
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:In the last decade, community mobilisation (CM) interventions targeting female sex workers (FSWs) have been scaled-up in India's national response to the HIV epidemic. This included the Bill and Melinda Gates Foundation's 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. 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 'sex workers'. This combined with urban redevelopment and gentrification of traditional red light areas, forcing dispersal and more 'hidden' ways of solicitation, further challenging outreach and collectivisation. Participants reported that brothel owners and 'pimps' continued to restrict access to sex workers and the heterogeneous 'community' 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. 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.
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Competing Interests: The authors have declared that no competing interests exist.
Conceived and designed the experiments: MC SVSB SB. Performed the experiments: SVSB. Analyzed the data: AK SVSB MC. Wrote the paper: MC AK SVSB SB.
Current address: Norwegian Red Cross, Vestlia 4, Jessheim, Norway
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0121014