Structural stigma, sex work and HIV: contradictions and lessons learnt from a community-led structural intervention in southern India.
BACKGROUND
Recent theorisation has pushed stigma research in new directions, arguing for a need to challenge the unequal power relations that impact groups most at risk for HIV-related stigma rather than locate stigma in the individual. Such a conceptualisation resonates with the growing emphasis on structural interventions for HIV prevention that attempt to alter the social context of risk.


METHODS
The paper predominantly relies on longitudinal interviews conducted three times over a 2-year period with sex workers with varying degrees of involvement with the non-governmental organisation (NGO) and community-based organisation.


RESULTS
Recognising that stigma is socially constructed and structurally reproduced, the NGO helped mobilise marginalised and hitherto scattered female sex workers to form community-based organisations to challenge their disadvantaged status in society. The authors show how stigma alleviation strategies presented a contradiction: emboldening one group of female sex workers to self-identify as sex workers while making others reluctant to access the intervention-run clinic.


CONCLUSIONS
The paper builds on a growing body of research that acknowledges the struggles in implementing structural interventions, particularly for NGOs working in regions with a diverse population of sex workers with varying needs. The authors argue that intervention goals of reducing stigma and increasing the use of sexually transmitted infection services do not have to conflict and, in fact, must go hand-in-hand for an implementation to be considered a structural intervention.
Department of Sociology, Battelle-Tompkins Hall, American University, 4400 Massachusetts Avenue NW, Washington, DC 20016-8072, USA. monica.biradavolu@american.edu
Monica Rao
MR
Biradavolu
Kim M
KM
Blankenship
Asima
A
Jena
Nimesh
N
Dhungana
D019058:Community Networks / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007194:India; D007407:Interviews as Topic; D009938:Organizations; D011209:Power, Psychological; D015397:Program Evaluation; D036301:Qualitative Research; D020377:Self Efficacy; D011477:Sex Work / Q000523:psychology*; D060386:Sex Workers / Q000523:psychology*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D057545:Social Stigma; D012944:Social Support; D012959:Socioeconomic Factors