Knowledge and exercise of human rights, and barriers and facilitators to claiming rights: a cross-sectional study of female sex workers and high-risk men who have sex with men in Andhra Pradesh, India.

Deepika Ganju,Parimi Prabhakar,Rajatashurva Adhikary,Sangram Kishor Patel

doi:10.1186/s12914-016-0102-2

Deepika Ganju, Parimi Prabhakar + Show 2 more

Open Access

https://doi.org/10.1186/s12914-016-0102-2

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Abstract

BackgroundHIV prevention interventions recognize the need to protect the rights of key populations and support them to claim their rights as a vulnerability reduction strategy. This study explores knowledge of human rights, and barriers and facilitators to claiming rights, among female sex workers (FSWs) and high-risk men who have sex with men (HR-MSM) who are beneficiaries of a community mobilization intervention in Andhra Pradesh, India.MethodsData are drawn from a cross-sectional survey (2014) among 2400 FSWs and 1200 HR-MSM. Human rights awareness was assessed by asking respondents if they had heard of human rights (yes/no); those reporting awareness of rights were asked to spontaneously name specific rights from the following five pre-defined categories: right to health; dignity/equality; education; property; and freedom from discrimination. Respondents were classified into two groups: more knowledgeable (could identify two or more rights) and less knowledgeable (could identify one or no right). Univariate and bivariate analyses and chi-square tests were used. Data were analyzed using STATA 11.2.ResultsOverall 17% FSWs and 8% HR-MSM were not aware of their rights. Among those aware, 62% and 31% respectively were aware of just one or no right (less knowledgeable); only around half (54% vs 57%) were aware of health rights, and fewer (20% vs 16%) aware of their right to freedom from discrimination. Notably, 27% and 17% respectively had not exercised their rights. Barriers to claiming rights among FSWs and HR-MSM were neighbors (35% vs 37%), lack of knowledge (15% vs 14%), stigma (13% vs 22%) and spouse (19% FSWs). Community organizations (COs) were by far the leading facilitator in claiming rights (57% vs 72%).ConclusionsThe study findings show that awareness of human rights is limited among FSWs and HR-MSM, and a large proportion have not claimed their rights, elevating their HIV vulnerability. For a sustained HIV response, community mobilization efforts must focus on building key populations’ awareness of rights, and addressing the multiple barriers to claiming rights, with a view to creating a safe environment where vulnerable groups can demand and use services without fear of stigma, discrimination and violation of rights.

Highlights

HIV prevention interventions recognize the need to protect the rights of key populations and support them to claim their rights as a vulnerability reduction strategy
Our study focuses only on Female sex worker (FSW) and high-risk men who have sex with men (MSM) (HR-MSM) and not other key populations, such as injecting drug users (IDUs), because the HIV epidemic in Andhra Pradesh state is largely FSW and MSM driven, while Injecting drug user (IDU)-driven epidemics are concentrated in other states of India such as Manipur and Nagaland [36]
While the majority (57%) of FSWs were in the older age group (≥30 years), did not have any formal education (56%) and were currently married (67%), in contrast, over three-fifths (62%) of HR-MSM were in the younger age group (

Summary

Introduction

HIV prevention interventions recognize the need to protect the rights of key populations and support them to claim their rights as a vulnerability reduction strategy. Studies from India document that both FSWs and MSM experience widespread human rights violations, including sexual and physical violence [1,2,3,4,5]; unlawful arrest and detention [6]; and HIV-related stigma and discrimination [7,8,9,10,11,12,13,14]; and are deprived of social benefits and entitlements otherwise accessed by the general population [15,16,17]. The links between socio-economic and political factors and HIV vulnerability are well documented [31, 32], and where individuals and communities are able to realize their social, economic, civil and political rights – to education, free association, information and, most importantly, non-discrimination – the individual and societal impact of HIV are reduced

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