Abstract
In Karnataka state, South India, we analyzed the role of membership in peer groups in reducing HIV-related risk and vulnerability among female sex workers (FSWs). Data from three surveys conducted in Karnataka, a behavioral tracking survey and two rounds of integrated biological and behavioral assessments (IBBAs), were analyzed. Using propensity score matching, we examined the impact of group membership on selected outcomes, including condom use, experience of violence, access to entitlements, and the prevalence of sexually transmitted infections, including HIV infection. Focus group discussions were conducted with the FSWs to better understand their perceptions regarding membership in peer groups. Peer group members participating in the IBBAs had a lower prevalence of gonorrhea and/or chlamydia (5.2 vs 9.6%, p<0.001), and of syphilis (8.2 vs 10.3%, p<0.05), compared to non-members. The average treatment effect for selected outcome measures, from the propensity score matching, showed that FSWs who were members of any peer group reported significantly less experience of violence in the past six months, were less likely to have bribed police to avoid trouble in the past six months, and were more likely to have obtained at least one formal identification document in the past five years, compared to non-members. In focus group discussions, group members indicated that they had more confidence in dealing with situations of forced sex and violence. Including community mobilization and peer group formation in the context of HIV prevention programing can reduce HIV-related risk and vulnerability among FSWs.
Highlights
There is growing evidence that community mobilization plays a powerful role in HIV prevention programing among marginalized communities such as female sex workers (FSWs)
Of the FSWs interviewed in the behavioral tracking survey (BTS), 76.7% belonged to a peer group or collective (Table 1)
By facilitating critical consciousness and the agency to take up collective action, can bring about structural change in power relationships (Pillai et al, 2011)
Summary
There is growing evidence that community mobilization plays a powerful role in HIV prevention programing among marginalized communities such as female sex workers (FSWs). Structural interventions aim to empower FSWs through the development of group solidarity that enables workers to collectively enforce safer norms in their interactions with clients, and to pursue collective action to improve their lives (Evans et al, 2010). Membership in collectives and groups enhances their social capital, resulting in a change in the public- and self-perception of women’s power (India HIV/AIDS Alliance, 2007; Halli, Ramesh, O’Neil, Moses, & Blanchard, 2006). This is reflected in their greater agency, enabling them to make decisions on issues affecting their lives. Membership in peer group collectives can improve awareness and knowledge levels of FSWs with regard to safe sex practices and promote better health-seeking behavior
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