AEGiS-11IAC: Factors for change: a comparative study of AIDS interventions among sexworkers in an organised setting with an unorganised stigmatised setting.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Factors for change: a comparative study of AIDS interventions among sexworkers in an organised setting with an unorganised stigmatised setting.

Int Conf AIDS 1996 Jul 7-12; 11:483 (abstract no. Pub.D.1295)
Kumar MS, Pradeep K, Uma S; Valasaravakkam, Madras, India. Fax: 91.44.4827263.

ISSUE: What are the socio economic and environmental factors that bring about sustained behavior change for AIDS prevention among sex workers? Does the attitude of the women themselves and that of the society towards them and towards sex and sexuality play a role in determining behavior? How can these factors be modified to make AIDS prevention programs more effective?

PROJECT: CAN's targeted interventions with sex workers and their clients in Madras city since 1993 (March) and in Mahabalipuram (a tourist town 56 KMs from Madras) since February 1995. Due to greater stigma and repression the sex trade in Madras is underground and operates through clandestine networks (there is no redlight area), in Mahabalipuram there is open and visible lodge based prostitution. Peer education for sex workers, use of brokers room boys at lodges as condom sales agents, increased access to health and STD care, counseling and other referral services are provided.

RESULTS: Consistent usage of condoms in all sex encounters went up from less than 5% in Madras (March 93) to 51% (December 95) while in Mahabalipuram it went up from 7% (March 95) to 68% (Jan 96). Though STD prevalence rates are not available the incidence rates in Mahabalipuram have gone down due to better access and increased health seeking behavior.

LESSONS LEARNED: The better social status accorded to women in Mahabalipuram increased their bargaining power for condom use. The self perception and comfort levels with sexuality among the women in Mahabalipuram (70% of who come from the Devdasi Caste - traditional women in prostitution) also increases their control in the sex situation unlike in Madras where there is low comfort levels. Environmental factors like fear of police raids, arrest of women possessing condoms etc. in Madras also minimise condom usage rates. The community living also helps in making condom usage a norm in Mahabalipuram unlike in Madras where the women are scattered. The increased access to health care (through brothel-based health and message delivery systems) also increases the response to prevention.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Condoms, Prostitution, Sexually Transmitted Diseases, Coitus, Negotiating, Power (Psychology), India, Human, Female, Male, nursing, ICA11

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