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Chakrapani V, Loganathan V, Saha P, Bose DL, Khan N, Aurora T, Narayan J, Mukherjee J, Hadi SU, Dewan C. Engagement of vulnerable communities in HIV prevention research in India: a qualitative investigation. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:12. [PMID: 38273406 PMCID: PMC10811827 DOI: 10.1186/s40900-024-00542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Meaningful community engagement (CE) in HIV prevention research is crucial for successful and ethically robust study implementation. We conducted a qualitative study to understand the current CE practices in HIV prevention research and to identify expressed and implicit reasons behind translational gaps highlighted by communities and researchers. METHODS For this exploratory qualitative study, we recruited a purposive sample of participants from Indian government-recognised key populations such as men who have sex with men, transgender women, people who inject drugs and female sex workers; general population adults and adolescents/youth; and researchers. We conducted 13 virtual focus groups (n = 86) between July and October 2021. Data were explored from a critical realist perspective and framing analysis (i.e., examining how the participants framed the narratives). RESULTS Participants reported that study communities, especially those from key populations, were primarily involved in data collection, but not necessarily with optimal training. Involvement of communities before the start of the study (e.g., obtaining feedback on the study's purpose/design) or once the study is completed (e.g., sharing of findings) were highlighted as priorities for meaningful engagement. Participants suggested meaningful CE in all stages of the study: (1) before the study-to get inputs in finalising the study design, drafting comprehensible informed consent forms and culturally-appropriate data collection tools, and deciding on appropriate monetary compensation; (2) during the study-adequate training of community field research staff; and (3) after the study-sharing the draft findings to get community inputs, and involving communities in advocacy activities towards converting evidence into action, policy or programs. Timely and transparent communications with communities were explicitly stated as critical for gaining and maintaining trust. Mutual respect, reciprocity (e.g., appropriate monetary compensation) and robust community feedback mechanisms were considered critical for meaningful CE. CONCLUSIONS The findings highlighted the translational gaps and priority areas for capacity building to strengthen CE in HIV prevention research. It is not only important to engage communities at various stages of research but to understand that trust, dignity, respect, and reciprocity are fundamentally preferred ways of meaningful community engagement.
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Affiliation(s)
- Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), 119/2, Mathura Flats, Anna Nagar West Extension, Chennai, 600101, India.
| | - Vijayalakshmi Loganathan
- Centre for Sexuality and Health Research and Policy (C-SHaRP), 119/2, Mathura Flats, Anna Nagar West Extension, Chennai, 600101, India
| | - Paromita Saha
- IAVI, Unit No. 810, 8th Floor, Emaar Capital Tower - 1, Mehrauli Gurugram Road, Sikandarpur, Sector 26, Gurugram, Haryana, 122002, India
| | - Devi Leena Bose
- IAVI, Unit No. 810, 8th Floor, Emaar Capital Tower - 1, Mehrauli Gurugram Road, Sikandarpur, Sector 26, Gurugram, Haryana, 122002, India
| | - Nabeela Khan
- IAVI, Unit No. 810, 8th Floor, Emaar Capital Tower - 1, Mehrauli Gurugram Road, Sikandarpur, Sector 26, Gurugram, Haryana, 122002, India
| | - Tiara Aurora
- Quicksand Design Studio, 7A, Sanskriti Kendra, Anandagram, MG Road, Aya Nagar, New Delhi, 110047, India
| | - Jyoti Narayan
- Quicksand Design Studio, 7A, Sanskriti Kendra, Anandagram, MG Road, Aya Nagar, New Delhi, 110047, India
| | - Joyeeta Mukherjee
- IAVI, Unit No. 810, 8th Floor, Emaar Capital Tower - 1, Mehrauli Gurugram Road, Sikandarpur, Sector 26, Gurugram, Haryana, 122002, India
| | - Saif Ul Hadi
- IAVI, Unit No. 810, 8th Floor, Emaar Capital Tower - 1, Mehrauli Gurugram Road, Sikandarpur, Sector 26, Gurugram, Haryana, 122002, India
| | - Chitrangna Dewan
- Quicksand Design Studio, 7A, Sanskriti Kendra, Anandagram, MG Road, Aya Nagar, New Delhi, 110047, India
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Probst U. Health insurance for the good European citizen? Migrant sex workers' quests for health insurance and the moral economy of health care. Soc Sci Med 2023; 319:115190. [PMID: 35835595 DOI: 10.1016/j.socscimed.2022.115190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/17/2022] [Accepted: 06/30/2022] [Indexed: 12/28/2022]
Abstract
European health insurance systems have become increasingly fragmented due to neoliberal health care reforms and the privatization of health care. Attempts to enable transnational access to public health care services throughout the European Union (EU) have contributed to this process by spreading ideas of EU citizens as consumers having to make informed choices about health insurance. However, marginalized populations such as EU migrant sex workers are presented with only limited choices within these systems. This article highlights how these limitations in access to health insurance are not only related to financial precarities, but are also caused by underlying racialized, classist, and sexualized assumptions about citizenship and belonging which influence the legal framework of both national and EU-wide health insurance provision. Based on ethnographic research with migrants from eastern EU countries involved in sex work in Berlin, the article discusses their attempts to gain access to health insurance as a salient example of the moral economy of health insurance provision in a supposedly universal health care system. Following how migrant sex workers from eastern European countries experience and negotiate exclusions from health insurance systems, the article addresses how meanings and interpretations of health insurance change towards an understanding of health insurance not as a right, but as a privilege for those conforming to narrow ideas of European citizenship. This indicates that current restructurings of health insurance systems are not only characterized by increasing privatization. Equally, the (re-)emergence of links between access to health insurance and restrictive ideas of belonging and citizenship rights are undermining aspirations for transnationally available universal health care.
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Affiliation(s)
- Ursula Probst
- Institute of Social and Cultural Anthropology, Freie Universität Berlin, Landoltweg 9-11, 14195 Berlin, Germany.
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Bungay V, Guta A, Slemon A, Varcoe C, Comber S. The Ethics of Financial Incentivization for Health Research Participation Among Sex Workers in a Canadian Context. QUALITATIVE HEALTH RESEARCH 2022; 32:942-955. [PMID: 35349393 DOI: 10.1177/10497323221089877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Research incentivization with sex workers is common, yet limited guidance exists for ethical incentives practice. We undertook a critical qualitative inquiry into how researchers (n = 17), community services staff (n = 17), and sex workers participating in research (n = 53) perceive incentives in a Canadian context. We employed an interpretive thematic approach informed by critical perspectives of relational autonomy for analysis. Four themes illustrate how (un)ethical use of incentives is situated in transactional micro-economies among groups experiencing severe marginalization: i) transactional research economy, ii) incentive type: assumptions and effects, iii) incentive amount: too much too little?, and iv) resistance, trauma, and research-related harm. Paternalistic assumptions about capacities of sex workers to act in their own best interests conflicted with participants' rights and abilities for self-determination; with researchers maintaining ultimate decision-making authority. Power differentials create conditions of harm. Safe, equitable approaches concerning research incentive use must redress relations of power that perpetuate oppression.
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Affiliation(s)
- Vicky Bungay
- School of Nursing, 8166University of British Columbia, Vancouver, BC, Canada
| | - Adrian Guta
- School of Social Work, 8637University of Windsor, Windsor, ON, Canada
| | - Allie Slemon
- School of Nursing, 8166University of British Columbia, Vancouver, BC, Canada
| | - Colleen Varcoe
- School of Nursing, 8166University of British Columbia, Vancouver, BC, Canada
| | - Scott Comber
- Rowe School of Business, 3688Dalhousie University, Halifax, NS, Canada
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Sinha S, Prasad I. Examining hopes, aspirations, and future plans of women in non-brothel-based sex work in Kolkata, India. CULTURE, HEALTH & SEXUALITY 2021; 23:913-926. [PMID: 32452748 DOI: 10.1080/13691058.2020.1740793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 03/06/2020] [Indexed: 06/11/2023]
Abstract
Sex work can offer a quick way of making money and is the only profession in which women may earn more in fewer hours when compared to other available jobs. However, most studies with sex workers in India are based on socially biased assumptions about sex work; that is, women are either coerced or trafficked into sex work. Limited attention has been paid to the voices of non-brothel-based sex workers in India. Drawing data from a larger ethnographic study conducted between December 2009 and July 2010, this paper analyses how women sex workers operating from non-brothel-based sex work settings in Kolkata, India, foresee their future. Unlike the popular 'victim imagery' of women sex workers in the Global South, this study found that women are not passive recipients of the trade; instead, they employ agency - sometimes transgressing the normative boundaries and at times reinscribing these boundaries to secure a future for themselves and their families. Therefore, to promote HIV preventive behaviour programmes reaching out to sex workers, non-governmental organisations (NGOs) must proactively inquire about women's future plans and assist them in materialising their future goals, which are mostly concerned with their children's future, a life free of stigma/shame, and financial security in old age.
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Affiliation(s)
- Sunny Sinha
- School of Social Work, Maywood University, Scranton, PA, USA
| | - Indulata Prasad
- School of Social Transformation, Arizona State University, Tempe, AZ, USA
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Nabunya P, Kiyingi J, Witte SS, Sensoy Bahar O, Jennings Mayo-Wilson L, Tozan Y, Nabayinda J, Mwebembezi A, Tumwesige W, Mukasa B, Namirembe R, Kagaayi J, Nakigudde J, McKay MM, Ssewamala FM. Working with economically vulnerable women engaged in sex work: Collaborating with community stakeholders in Southern Uganda. Glob Public Health 2021; 17:1215-1231. [PMID: 33881949 DOI: 10.1080/17441692.2021.1916054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03583541.
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Affiliation(s)
- Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.,International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.,International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA
| | - Susan S Witte
- School of Social Work, Columbia University, New York, NY, USA
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.,International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Yesim Tozan
- School of Global Public Health, New York University, New York, NY, USA
| | - Josephine Nabayinda
- International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA
| | - Abel Mwebembezi
- International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA.,Reach the Youth (RTY) Uganda, Kampala, Uganda
| | - Wilberforce Tumwesige
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.,International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Rashida Namirembe
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Janet Nakigudde
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mary M McKay
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.,International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA
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Hammond N, van Hooff J. "This Is Me, This Is What I Am, I Am a Man": The Masculinities of Men Who Pay for Sex with Women. JOURNAL OF SEX RESEARCH 2020; 57:650-663. [PMID: 31414893 DOI: 10.1080/00224499.2019.1644485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This paper draws on theories of masculinity to explore men's motivations for beginning and continuing to pay for sex with women. Based on in-depth interviews with 35 male clients of female sex workers in the UK during 2007/2008, our findings suggest that a desire to pay for sex is often entrenched in notions of hegemonic masculinity such as sex as a drive, or need for a variety of experiences and partners and is rationalized as an economic exchange. Yet, the men interviewed also expressed a need for intimacy, female friendship and conversation in a controlled environment, which challenged dominant masculine ideals. For participants, there was often an overlap between various motivational factors, and accounts were complicated by the anxieties and disappointments the men expressed about their non-commercial relationships and the intimacy and emotion frequently attached to encounters with sex workers. The pathologization of men who engage with paid sexual services fails to account for participants' complex, diverse motivations, which should be understood in the context of other relationships and gender relations rather than as a distinct type of interaction. We find that the theory of hegemonic masculinity provides a useful but partial account of the range of behaviors and characteristics expressed in paid-for sex, which participants use to negotiate the expectations, ambivalences and disappointments of everyday life and relationships.
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Affiliation(s)
- Natalie Hammond
- Department of Social Care and Social Work, Manchester Metropolitan University
- Department of Sociology, Manchester Metropolitan University
| | - Jenny van Hooff
- Department of Social Care and Social Work, Manchester Metropolitan University
- Department of Sociology, Manchester Metropolitan University
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Bekker LG. HIV control in young key populations in Africa. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:442-444. [PMID: 31105054 DOI: 10.1016/s2352-4642(19)30112-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 03/22/2019] [Indexed: 11/28/2022]
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