Social Control Vs. Social Change? HIV Interventions with Sex Workers in India

Background & Significance: Scholars have pointed out that HIV interventions in countries of the global south (i.e. in South America, Africa and Asia) often originate in Europe and the U.S., and are funded by global aid agencies located in these continents (Patton, 2002). Critiquing these interventions, postcolonial scholars have questioned the managerial impulse driving these interventions, whereby the basic survival needs of statistically determined risky populations are met, while conditions for large-scale community mobilization are simultaneously blunted (Chatterjee, 2008). Drawing on works by Michel Foucault (1991), Edward Said (1978) and Gayatri Spivak (1988), these critiques emphasize the collusion between the State, global welfare agencies and local non-governmental organizations in a process that segregates risky populations and ultimately bars them from access to the institutions of civil society. While scholarship has documented the debilitating conditions resulting from such interventions, it has failed to examine the ways in which marginalized communities have found agency while responding to these efforts. This research examines the manner in which a sex workers' collective (DMSC) in Sonagachi, India has negotiated such initiatives, while operating a model community empowerment-based HIV intervention.

Methods: In-depth qualitative interviews were conducted with 80 female sex workers involved in DMSC. Interviews were conducted in Bengali. Subjects were recruited using convenience sampling methods through DMSC's membership list. In addition, we observed 15 collective actions (from 2007 to 2010) organized by DMSC and conducted a content analysis of DMSC-published documents. QSR N6 was used to analyze the data.

Results: We found that DMSC thwarts the managerial efforts of State and global HIV aid agencies by: 1) mobilizing outside the community demarcated by HIV intervention efforts, thus forging links with pimps, customers, husbands, children, merchants and local politicians in a coalition that undermines efforts to restrict the community to “risky” sex workers, 2) establishing local, peer-run healthcare, policing and banking agencies that allows the community to resist institutional monitoring, and decouple itself from State institutions, and 3) strategically aligning with external HIV aid agencies in order to access resources, while simultaneously expanding the field of negotiation beyond HIV management to incorporate the living conditions surrounding sex work. Implications: The findings illustrate how HIV interventions in the global south can unhitch themselves from managerial motivations and engage in processes of social change. First, interventions need to vacate the medical discourse that identifies “risky” and “bridge” populations as primary targets of intervention in order to include all the stakeholders in a community, even when some of them are opposed to HIV management efforts. Second, interventions need to emphasize the establishment of community-based agencies that become responsible for HIV prevention initiatives, and ultimately, the local governance of the community. Third, interventions need to expand their focus from individual-level HIV management processes and address the structural issues that comprise the larger risk environment of these communities. DMSC may serve as an exemplar for HIV interventions with marginalized communities in the global north, perhaps reversing the pathway along which these interventions have been globally transported in the past.