Community development for HIV prevention among males who have sex with males in Bangladesh : rhetoric or reality?

Abstract

The “Males’ Sexual Health Society” (MSHS, pseudonym) has been implementing HIV-prevention programmes for males-who-have-sex-with-males (MSM) in Bangladesh since the 1990s, aiming to employ a community development (CD) approach. MSM refers here to a diversity of homosexually-active biological males with differing gender and sexual identities, so that the focus for ‘community development’ is not straightforward. This doctoral research aimed to examine how ‘community’ and ‘identity’ are constructed by MSHS while using CD as an approach, who holds the dominant power in constructing these concepts, and whether and how participation of different gender and sexual identity groups are ensured by the MSHS. Case-study research focused on MSHS’s operations in a city in Bangladesh. Interviews were conducted with beneficiaries, staff and board-members, as well as donors. Documentary analysis and non-participant observations were also employed. The data analysis adopted a social constructionist perspective and used techniques associated with grounded theory. The findings suggest that the agency has focused on constructing a community of ‘Kothi’, who are feminized males and commonly engaged in sex work. The agency is wielding power to assert the Kothi identity as the pre-eminent basis for community development but some MSM are working within the agency’s structure not directly to challenge this dominant discourse but to work with it to broaden it out and reintroduce diverse legitimated identities. The agency founders regarded community development as a means of reducing vulnerability to HIV infection but also as a means of funding and legitimating political organising among local MSM. The agency has enabled the participation of MSM already identifying as Kothi and encouraging some MSM to embrace this identity for the first time. Some beneficiaries reported empowerment for example through vocational education and sexual negotiation skills. Though rhetorically emphasising bottom-up decision-making, in practice power is largely held by the agency’s board, top management and increasingly donors. But it is also clear that beneficiaries have not merely been the ‘objects’ of community development, with some constructing nuanced and contingent identities, for example embracing mixed identities or inviting non-Kothi-identified partners to agency activities. More recently there are concerns that donors’ increasing power is hampering the more intangible but perhaps crucial aspects of community development most valued by beneficiaries. In conclusion community development has proceeded in complex ways, enabling as well as directing, and producing diversity as well as cohesion.