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Sex Worker or Prostitute? Labels do matter: Evidence from a community-level intervention trial of the Sonagachi Project, India

Dallas Swendeman, MPH, Center for Community Health, University of California, Los Angeles, 10920 Wilshire, Suite 350, Los Angeles, CA 90024-6521, 310-794-6144, metacom@ucla.edu, Mary Jane Rotheram-Borus, PhD, Department of Psychiatry, University of California, Los Angeles, 10920 Wilshire, Suite 350, Los Angeles, CA 90024-6521, Peter A. Newman, PhD, Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1A1, Canada, Sung-Jae Lee, PhD, Neuropsychiatric Institute/Center for Community Health, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, and Robert E. Weiss, PhD, Department of Biostatistics, UCLA, 51-269 CHS, Los Angeles, CA, CA 90095.

Background: The Sonagachi Project is a STD/HIV intervention program based in Calcutta, India, that has evolved in partnership with sex-workers since 1992. The project defines new collective and individual identities as “workers” versus “prostitutes.” A constellation of behaviors are tied to this identity including self-protective and self-care behaviors, and increased power in working and community relationships. This is one aspect of a holistic set of mutually reinforcing support and prevention strategies that include peer education, condom social marketing, community organizing, worker’s/human rights activism, micro-credit saving/lending, reproductive health care, children’s education, and anti-trafficking self-regulatory boards.

Method: The Sonagachi intervention was replicated in a “naïve” red-light area in West Bengal, India. A control community received reproductive health care as standard care. Sex-workers were randomly selected in each community (n=200) and interviewed four times over 18 months. Multivariate regression analyses were conducted to examine a summary measure of empowerment (e.g., work related negotiation, social cohesion with other sex-workers, money management, etc.).

Results: Increases in condom use were previously reported (39% intervention vs. 11% control; B = 0.3447, p = 0.002). Increased empowerment in the intervention compared to control community (B = 3.101, p < 0.001) parallel the condom use results.

Conclusion: Theories of gender and ethnic identity suggest that “identities” play a pivotal role in shaping behavior, and vice-versa. Health-related interventions may draw upon this concept as one tool to facilitate and reinforce behavior change. Empirical evidence of this effect is scant, but emerging. The Sonagachi project provides one example of this potential.

Learning Objectives:

Keywords: STD Prevention, HIV Interventions

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Sex Workers: Voluntary and Forced

The 132nd Annual Meeting (November 6-10, 2004) of APHA