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Community Mobilization Challenging Gender Power Imbalances: Women Sex Workers’ Capacity to Engage in Health-Enhancing Practices in Southern India

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Abstract

Research on women sex workers’ condom use with non-paying intimate partners suggests social norms of gender power in these relationships constrain women’s health-enhancing sexual practice. Theorizing gender relations and sexual practice as structural informs our analysis of elements of community mobilization interventions (CMI) that link to sex workers’ capacity to engage consistently in health-enhancing practices, in this case, condom use. We use data from a survey of women (who exchanged sex for money in the preceding 12 months) conducted in the context of an HIV-prevention intervention in southern India. Results of multinomial logistic regression indicate: higher odds of health-enhancing sexual practice with intimate partners and paying clients among women sex workers expressing collective efficacy; lower odds of health-diminishing sexual practice with clients among women sex workers empowered through peer interactions; lower odds of health-diminishing sexual practice with clients and lower odds of health-enhancing sexual practice with partners among women sex worker living in households structured by normative gender power relations. We suggest future research on how CMI promoting health-enabling social environments with women in sex work contribute to their capacity to engage in health-enhancing practices.

Resumen

La investigación sobre el uso del condón por trabajadoras sexuales con parejas íntimas que no pagan sugiere que las normas de relaciones de género restringen la práctica sexual más segura en estas relaciones. Teorizar las relaciones de género y la práctica sexual como estructurales informa el análisis de aspectos de las intervenciones de movilización comunitaria (CMI) vinculados a la capacidad de las trabajadoras sexuales para adoptar el uso habitual de prácticas que mejoran la salud, en este caso, el uso del condón. Utilizamos datos de una encuesta de mujeres (que intercambiaron sexo por dinero en los 12 meses anteriores) realizada en el contexto de una intervención de prevención del VIH. La regresión logística multinomial indica: mayores probabilidades de prácticas sexuales que mejoran la salud con parejas íntimas y clientes que pagan entre mujeres que expresan eficacia colectiva; menores probabilidades de prácticas sexuales que disminuyen la salud con clientes entre mujeres empoderadas por las interacciones entre pares; menores probabilidades de prácticas sexuales que disminuyen la salud con los clientes así como menores probabilidades de prácticas sexuales que mejoran la salud con parejas íntimas entre mujeres en hogares estructurados por el poder normativo de género. Sugerimos investigaciones futuras sobre como las intervenciones de movilización comunitaria (CMI) que promueven prácticas sexuales que mejoran la salud entre las trabajadoras sexuales contribuyen a su capacidad para adoptar dichas prácticas.

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Data Availability

See https://dataverse.harvard.edu/dataverse/Avahan for information on accessing data from Project Parivartan.

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Acknowledgements

This work was supported by the Bill & Melinda Gates Foundation (BMGF) (Grant No. OPP30183; PI K. Blankenship). The views expressed herein are those of the authors and do not necessarily reflect official policy or position of BMGF.

Funding

This work was supported by the Bill & Melinda Gates Foundation (BMGF) (Grant No. OPP30183; PI K. Blankenship).

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Authors and Affiliations

  1. Department of Sociology, American University, Watkins Building 111, 4400 Massachusetts Ave, NW, Washington, DC, 20016, USA

    Gay Young & Kim M. Blankenship

  2. Department of Sociology and Criminal Justice, Old Dominion University, Norfolk, VA, 23529, USA

    Mona J. E. Danner

  3. Independent Gender and Development Consultant, Silver Spring, MD, 20910, USA

    Lucía Fort

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  1. Gay Young
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  2. Mona J. E. Danner
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  3. Lucía Fort
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  4. Kim M. Blankenship
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GY, KB and MD. The first draft of the manuscript was written by GY and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Gay Young.

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All authors declare that they have no conflict of interest.

Ethical Approval

This research was approved by the Institutional Review Boards at American University and at Duke University, the Human Investigations Committee at Yale University, and the VHS-YRG Care Medical Centre Institutional Review Board in Chennai, India.

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Informed consent was obtained from all individual participants in the study.

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Young, G., Danner, M.J.E., Fort, L. et al. Community Mobilization Challenging Gender Power Imbalances: Women Sex Workers’ Capacity to Engage in Health-Enhancing Practices in Southern India. AIDS Behav 26, 1238–1250 (2022). https://doi.org/10.1007/s10461-021-03481-9

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