Community-based Organisations in Policy and Practice Sex Workers, HIV/AIDS and the Social Construction of Solutions

This fascinating article offers a critical analysis of the role of sex workers community groups in HIV prevention and care in India.

'In the context of HIV/AIDS projects in India, a CBO is an organisation whose membership comprises of ‘community members’. In this case, the relevant ‘communities’ are the three social groups identified as being particularly vulnerable to HIV/AIDS, namely, female sex workers, men who have sex with men, and injecting drug users (NACO 2006; Chandrasekaran et al. 2006). And so, CBOs are organisations of these three identified social groups. In practice, CBOs often work in tandem with non-governmental organisations (NGOs). The difference is that the NGO workers are not necessarily ‘community members’, but are able to provide the CBO with the ‘technical support’ needed to run an intervention. Members of marginalised groups, such as sex workers and drug users often have been excluded from the educational, social and employment settings that would have helped them with all the cultural know-how needed to manage the bureaucratic requirements of a funded project. Hence the common need for ‘non-community-members’, in the organised form of an NGO.'

'The literature reveals that CBOs rely on far more than solidarity and ownership to function and to have their positive impacts. Supportive relationships with founders, professionals and activists on the one hand, and with local power brokers such as police, politicians and the media on the other, emerge as crucial in enabling or permitting CBOs to carry out their activities in a fruitful way. Moreover, to engage sex workers’ motivation to take part, it seems likely that projects need to offer concrete benefits, and meet sex workers’ priorities, and cannot simply rely on goodwill. Thus, there seems to be no experience to date that CBOs are ‘sustainable’ in the sense of functioning independently, as policies seem to wish for. Rather, CBOs, to be constituted as a good solution to problems of HIV/AIDS, require ongoing support (Sivaram and Celentano 2003). Given these findings, we suggest that the policy emphasis on the role of CBOs may be over-optimistic, and may lead to disappointment among funders, health professionals, and communities alike, if a more realistic and complex understanding is not found.

60435-Cornish_Banerji_Shukla_2010_CBOs_social_construction_of_solutions.pdf