Online Program

Community-led structural interventions as a model of empowerment for health and development: The sonagachi / durbar intervention with sex workers in India

Tuesday, November 5, 2013

Dallas Swendeman, PhD, MPH, Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, UCLA Center for HIV Identification, Prevention & Treatment Services (CHIPTS), Los Angeles, CA
Smarajit Jana, MD, Durbar Mahila Samanwaya Committee (DMSC / Durbar), Kolkata, West Bengal, India
ISSUES: Public health interventions face linked challenges mobilizing community participation while navigating community and external priorities and constraints. Those disproportionately vulnerable to disease are often disempowered, lacking the capacities to participate meaningfully or enact changes engendered by interventions. This is particularly salient for women due to persistent gender-based inequities globally. Marginalized communities must ultimately be empowered to be able participate in interventions while addressing other priorities linked to disease risk.

DESCRIPTION: Community-led structural interventions (CLSI) exemplify an empowerment approach. The CLSI model was derived from the Sonagachi Project (Durbar) HIV/STI intervention program with sex workers, a model for the Gates Foundation's scale-up of HIV prevention in India. Durbar evolved from a traditional treatment and prevention services model into an empowerment and community development model with dozens of interventions taking a multi-sectoral response to structural drivers of HIV/AIDS.

LESSONS LEARNED: We synthesized a generalizable CLSI model for incrementally replicating empowerment processes in three stages reflecting Durbar's evolution: 1) community-led implementation through task sharing across intervention components; 2) nurturing a CBO partner for community-led decision-making and action (beyond scope of the intervention); and 3) supporting community ownership by the CBO. Public health professionals mobilize resources and high status networks, advocate for and with the community, create participation opportunities, complement community strengths and weaknesses, and nurture empowerment.

RECOMMENDATIONS: Empowerment interventions are inherently complex and context dependent, which challenges replication efforts based on specific intervention strategies. Public health interventions can adopt an empowerment approach by replicating CLSI processes of community-led implementation, partnership, and ownership.

Learning Areas:

Advocacy for health and health education
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related research
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Demonstrate how public health interventions can incorporate empowerment processes through incremental replication of community-led structural intervention processes of community-led implementation (e.g., through task sharing), community-led decision-making and action, and community-led ownership.

Keyword(s): HIV/AIDS, Community Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principal of multiple grants focusing on HIV prevention among sex workers and other high risk populations. Among my scientific interests has been the evaluation of empowerment strategies for preventing HIV and STDs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.