Sonagachi Project Research Articles

Participation as a Health Communication Strategy in HIV/AIDS Intervention Projects: an Examination of a Project Targeting Commercial Sex Workers in India

ABSTRACTThis article examines how participation frames health communication strategies in the Sonagachi Project. The current research, which involves a study of 37 commercial female sex workers in a red-light district of India, investigates how the participation of target audiences in the enunciation of health problems in HIV/AIDS intervention projects engenders change. The study analyzed how a participatory framework in an HIV/sexually transmitted infection intervention project among sex workers addresses sociostructural constraints that affect the lives of the sex workers. The article aims to investigate how participation engages the sex workers in roles of power and decision-making within a health intervention program directed toward curbing sexually transmitted infections.

Reading Kolkata’s Space of Prostitution as a Political Society

The present article builds upon the idea of political society to read a red-light district in the city of Kolkata. The district is the biggest in Asia and it has given its name to the biggest movement of the sex workers—Sonagachi Project. This article is an attempt to view the subaltern space as a resistant space and a political society by highlighting their habitat, economic and political roles. Being outside the ambit of citizenry, these societies exert their aspiration for acknowledgement of their anomaly. Their present situation has a colonial legacy that disempowers them but from which they have started recovering. Though their role of emancipation was also present in the colonial times, it got more explicit in the current decades. However, the emancipator journey is often not linear and shows signs of sporadic bumpiness. Highlighting on such events and histories, the article relies upon archival references, news and informal observation of the place.

Intervention program impacting Indian sex-workers facing socio-economic disparities

Purpose – Since the first case of AIDS was reported in 1986, several HIV/AIDS intervention program operates at the national and regional level in India, to control the spread of this epidemic. The purpose of this paper is to evaluate one intervention program in a major city of India – Kolkata that targets specifically the commercial sex-workers challenged with socio-economic-health disparities. This intervention program called the Durbar Mahila Samanwaya Committee (DMSC) is located in the Sonagachi area and nicknamed as the “Sonagachi Project.” Design/methodology/approach – The behavioral change of about 500 sex-workers participating in the survey was studied in 2005. The data were collected from the focus groups of the sex-workers; official records and DMSC officials were also interviewed to collect data. The “short-term” outcome and the “long-term” impact of the program were compared with a baseline survey conducted in 1992 by another study. Findings – Participants experienced increased awareness of the disease, increased literacy rate and increased social and economical empowerment. The incidence of HIV/AIDS has gone down significantly among this high-risk group due to safe-sex practice. Social implications – This community-based organization adopts a unique method of engaging the sex-workers as peer educators to train other sex-workers about safe-sex practices and has become the role model for sex-workers in other parts of the world to fight socio-economic-health disparities. Originality/value – This research was conducted by directly contacting the program directors and members of the Sonagachi project and in that sense is first hand information. It gives valuable insights into the struggles these sex-workers had to go through to gain social and economic empowerment.

Consistent Condom Use by Female Sex Workers in Kolkata, India: Testing Theories of Economic Insecurity, Behavior Change, Life Course Vulnerability and Empowerment.

Consistent condom use (CCU) is the primary HIV/STI prevention option available to sex workers globally but may be undermined by economic insecurity, life-course vulnerabilities, behavioral factors, disempowerment, or lack of effective interventions. This study examines predictors of CCU in a random household survey of brothel-based female sex workers (n = 200) in two neighborhoods served by Durbar (the Sonagachi Project) in Kolkata, India. Multivariate logistic regression analyses indicated that CCU was significantly associated with perceived HIV risk, community mobilization participation, working more days in sex work, and higher proportion of occasional clients to regular clients. Exploratory analyses stratifying by economic insecurity indicators (i.e., debt, savings, income, housing security) indicate that perceived HIV risk and community mobilization were only associated with CCU for economically secure FSW. Interventions with FSW must prioritize economic security and access to social protections as economic insecurity may undermine the efficacy of more direct condom use intervention strategies.

How Can Community Health Programmes Build Enabling Environments for Transformative Communication? Experiences from India and South Africa

Much research has examined how to empower the poor to articulate demands for health-enabling living conditions. Less is known about creating receptive social environments where the powerful heed the voices of the poor. We explore the potential for 'transformative communication' between the poor and the powerful, through comparing two well-documented case studies of HIV/AIDS management. The Entabeni Project in South Africa sought to empower impoverished women to deliver home-based nursing to people with AIDS. It successfully provided short-term welfare, but did not achieve local leadership or sustainability. The Sonagachi Project in India, an HIV-prevention programme targeting female sex workers, became locally led and sustainable. We highlight the strategies through which Sonagachi, but not Entabeni, altered the material, symbolic and relational contexts of participants' lives, enabling transformative communication and opportunities for sexual health-enabling social change.

Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases

The Sonagachi Project was initiated in Kolkata, India in 1992 as a STD/HIV intervention for sex workers. The project evolved to adopt strategies common to women's empowerment programs globally (i.e., community mobilization, rights-based framing, advocacy, micro-finance) to address common factors that support effective, evidence-based HIV/STD prevention. The Sonagachi model is now a broadly diffused evidence-based empowerment program. We previously demonstrated significant condom use increases among female sex workers in a 16 month replication trial of the Sonagachi empowerment intervention (n=110) compared to a control community (n=106) receiving standard care of STD clinic, condom promotion, and peer education in two randomly assigned rural towns in West Bengal, India (Basu et al., 2004). This article examines the intervention's impacts on 21 measured variables reflecting five common factors of effective HIV/STD prevention programs to estimate the impact of empowerment strategies on HIV/STD prevention program goals. The intervention which was conducted in 2000-2001 significantly: 1) improved knowledge of STDs and condom protection from STD and HIV, and maintained STD/HIV risk perceptions despite treatment; 2) provided a frame to motivate change based on reframing sex work as valid work, increasing disclosure of profession, and instilling a hopeful future orientation reflected in desire for more education or training; 3) improved skills in sexual and workplace negotiations reflected in increased refusal, condom decision-making, and ability to change work contract, but not ability to take leave; 4) built social support by increasing social interactions outside work, social function participation, and helping other sex workers; and 5) addressed environmental barriers of economic vulnerabilities by increasing savings and alternative income, but not working in other locations, nor reduced loan taking, and did not increase voting to build social capital. This study's results demonstrate that, compared to narrowcast clinical and prevention services alone, empowerment strategies can significantly impact a broader range of factors to reduce vulnerability to HIV/STDs.

Mobilizing collective identity to reduce HIV risk among sex workers in Sonagachi, India: The boundaries, consciousness, negotiation framework

The significantly low rate of HIV infection and high rate of condom use among sex workers in Kolkata, India is partially attributable to a community-led structural intervention called the Sonagachi Project which mobilizes sex workers to engage in HIV education, formation of community-based organizations and advocacy around sex work issues. This research examines how Sonagachi Project participants mobilize collective identity and the manner in which collective identity influences condom use. Using purposive sampling methods, 46 Sonagachi Project participants were selected in 2005 for in-depth qualitative interviews. Taylor and Whittier's (Taylor, V & Whittier, N (1992). Collective identities in social movement communities: lesbian feminist mobilization. In A. Morris & C. Mueller (Eds.) Frontiers in social movement theory. New Haven, CT: Yale University Press) model of identity-formation through boundaries, consciousness and negotiation was used to interpret results. Subjects mobilized collective identity by (1) building boundaries demarcating in-group sex workers from out-group members, (2) raising consciousness about sex work as legitimate labor and the transformative change that results from program participation, and (3) negotiating identity with out-group members. This research establishes a conceptual link between the boundaries, consciousness and negotiation framework of collective identity mobilization and condom use. Condom use among sex workers is motivated by each element of the boundaries, consciousness and negotiation model: condoms mark boundaries, enunciate the consciousness that sex with clients is legitimate labor, and help negotiate the identity of sex workers in interactions with clients.

Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review

To systematically review the evidence for effectiveness of HIV and sexually transmitted infection (STI) prevention interventions in female sex workers in resource poor settings. Published and unpublished studies were identified through electronic databases (Cochrane database, Medline, Embase, and Web of Science), hand searching and contacting experts. Randomized-controlled-trials and quasi-experimental studies were included if they were conducted in female sex workers from low and middle income settings; if the exposure was described; if the outcome was externally measurable, it was after the discovery of HIV, and if follow-up was longer than 6 months. A priori criteria were used to extract data. Meta-analysis was not performed due to the heterogeneity of studies. Twenty-eight interventions were included. Despite methodological limitations, the evidence suggested that combining sexual risk reduction, condom promotion and improved access to STI treatment reduces HIV and STI acquisition in sex workers receiving the intervention. Strong evidence that regular STI screening or periodic treatment of STIs confers additional protection against HIV was lacking. It appears that structural interventions, policy change or empowerment of sex workers, reduce the prevalence of STIs and HIV. Rigorous evaluation of HIV/STI prevention interventions in sex workers is challenging. There is some evidence for the efficacy of multi-component interventions, and/or structural interventions. The effect of these interventions on the wider population has rarely been evaluated.

Community development and HIV/STI-related vulnerability among female sex workers in Rio de Janeiro, Brazil

The Sonagachi Project of Kolkata, India has been recognized as a model community development and human immunodeficiency virus/sexually transmitted infection (HIV/STI) prevention intervention among female sex workers. Limited research has been conducted regarding its applicability outside the South Asian context. This study sought to document the process and effectiveness of integrating community development activities based on the Sonagachi model into an ongoing HIV/STI peer education program with female sex workers in Rio de Janeiro, Brazil. Structured cross-sectional surveys examining HIV/STI-related behaviors and community development measures were conducted among approximately 500 sex workers at pre- and post-intervention. We found that several community development components including social cohesion and mutual aid were significantly associated with consistent condom use among sex workers and their paying clients at pre-intervention. However, only a minority of women actively engaged in community-building activities over the 18-month study period. In turn, limited changes in community development components and no significant increases in the HIV/STI-related protective behaviors assessed were documented. Findings indicate that internalized stigma and socioeconomic pressures may have constrained the scope and pace of community mobilization in this setting during the study observation period.

Challenging the stigma of sex work in India: material context and symbolic change

AbstractStigmatization and discrimination against social groups raise obstacles to the participation of their members in community interventions. Internalized stigma and a lack of empowering experiences promote fatalistic expectations that little can be achieved. This paper discusses how the Sonagachi Project in Kolkata, India, challenges stigma as part of its community development and health promotion efforts with sex workers, drawing on interviews with 19 sex workers involved in the Project and one group discussion among the Project's leaders. The internalized stigma of prostitution is challenged (1) by asserting that sex workers have rights which should be respected, (2) by claiming equivalence to other oppressed but politically successful groups and (3) by providing evidence of sex workers' positive achievements. These arguments are made plausible to sex workers by a material context that provides evidence and experience of the possibility of change. I conclude that interventions designed to problematize stigma and discrimination should back up the conceptual alternatives that they present by producing concrete changes to a community's living conditions. Copyright © 2006 John Wiley & Sons, Ltd.

The necessary contradictions of ‘community-led’ health promotion: A case study of HIV prevention in an Indian red light district

Health promotion interventions with marginalised groups are increasingly expected to demonstrate genuine community participation in their design and delivery. However, ideals of egalitarian democratic participation are far removed from the starting point of the hierarchical and exploitative social relations that typically characterise marginalised communities. What scope is there for health promotion projects to implement ideals of community leadership within the realities of marginalisation and inequality? We examine how the Sonagachi Project, a successful sex-worker-led HIV prevention project in India, has engaged with the unequal social relations in which it is embedded. Our ethnographic study is based on observation of the Project's participatory activities and 39 interviews with a range of its stakeholders (including sex worker employees of the Project, non-sex-worker development professionals, brothel managers, sex workers’ clients). The analysis shows that the project is deeply shaped by its relationships with non-sex-worker interest groups. In order to be permitted access to the red light district, it has had to accommodate the interests of local men's clubs and brothel managers. The economic and organisational capacity to run such a project has depended upon the direct input of development professionals and funding agencies. Thus, the ‘community’ that leads this project is much wider than a local grouping of marginalised sex workers. We argue that, given existing power relations, the engagement with other interest groups was necessary to the project's success. Moreover, as the project has developed, sex workers’ interests and leadership have gained increasing prominence. We suggest that existing optimistic expectations of participation inhibit acknowledgement of the troubling work of balancing power relations. Rather than denying such power relations, projects should be expected to plan for them.

Evaluation of Sexually Transmitted Diseases/Human Immunodeficiency Virus Intervention Programs for Sex Workers in Calcutta, India

The Sonagachi Project in Calcutta, India, organized sex workers to improve working conditions. To compare rates of sexually transmitted diseases between the Sonagachi Project and other areas in which only the National AIDS Control Organization (NACO) interventions were implemented. A cross-sectional survey of randomly selected female sex workers. There was no difference in the prevalence of all STDs between the 2 areas; both were lower than reported in other surveys in 1992. Analysis using propensity scores also failed to demonstrate any difference. The number of preventive activities was similar in the Sonagachi and NACO-only areas but was more prevalent than in 1992. Sex workers in the Sonagachi area had better treatment-seeking behavior and attitudes. Both the Sonagachi and NACO strategies have resulted in lower STD rates, but the Sonagachi Project also increased the proportion who had an optimistic attitude and increased prevention and treatment-seeking behavior.

The Sonagachi Project: A Sustainable Community Intervention Program

High rates of HIV infection among sex workers in India indicate the importance of understanding the process of establishing a sustainable community intervention program. The Sonagachi Project, based in Calcutta, India, has been associated with lower HIV rates among sex workers as compared to other urban centers in India. The program defined HIV as an occupational health problem and included multifaceted, multilevel interventions addressing community (having a high-status advocate; addressing environmental barriers and resources), group (changing social relationships), and individual factors (improving skills and competencies related to HIV prevention and treatment). The Sonagachi Project's core concepts and strategies evolved as community needs were expressed and defined. In particular, the program was not initially conceptualized as a community empowerment project but emerged over time, allowing for project sustainability. Project components appear to be replicable across settings within India and worldwide.