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Empowering Female Sex Workers for AIDS Prevention and Far Beyond: Sonagachi Shows the Way

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Empowering Female Sex Workers for AIDS Prevention and Far Beyond: Sonagachi Shows the Way Empowering Female Sex Workers for AIDS Prevention and Far Beyond: Sonagachi Shows the Way MONI NAG This paper describes the process by which the STD/HIV Intervention Programme (popularly known as Sonagachi Project) among female sex workers (FSWs) in a red-light area of Kolkata (formerly Calcutta) became a catalyst for the formation of an association of sex workers called Durbar Mahila Samanwaya Committee (DMSC) and how the DMSC, in turn, has become a powerful tool for not only the epidemio­ logical success of the Sonagachi Project, but also a vehicle for the poor and powerless FSWs to gain some control over their own lives and environment. The training and recruitment of a few selected FSWs as Peer Educators of the Project at its beginning was the first important step. The novel experience of working together with the Pro­ ject physicians and college- graduate women supervisors for the welfare of commu­ nity FSWs gave the Peer Educators a new sense of pride and self-confidence. They became increasingly convinced that in order to protect their health and fight against the injustices they suffered from, FSWs had to mobilse themselves and demand their legitimate rights through an association of their own. With the guidance and help from some dedicated Project staff, the Peer Educators took the initiative to form DMSC in 1995. The multifarious activities of the DMSC and of a few other bodies generated by it are described in this article These activities and their consequences demonstrate that active participation of sex workers in all aspects of a HIV/AIDS in­ tervention project among them as well as their united struggle for the power to protect their health and basic human rights is essential for the project's success and also con­ tributes towards an over-all betterment of their life. Prof. Moni Nag is associated with The Population Council, New York, and is Ad­ junct Professor, Department of Anthropology at the Columbia University in New York, United Slates of America. INTRODUCTION Recently, the UNAIDS published a book containing case studies of the following three HIV/AIDS intervention projects among female sex workers (FSWs) in three countries of the Asia-Pacific region: 474 Moni Nag 1. Sonagachi Project in India, 2. SHAKTI Project in Bangladesh, and 3. Transex Project in New Guinea (Jenkins 2000). The main criteria for selecting these projects out of 25 such pro­ jects in the region were their effectiveness, impact, validity and com­ pleteness of information and relevance. The primary objective of the case studies was to describe the 'experience and lessons that might clarify for others the areas of strength and weakness typical in suc­ cessful female sex worker projects'. The Sonagachi Project demon­ strates more cogently, than the other two does, the crucial role of empowerment of FSWs in the success of HIV/AIDS intervention pro­ jects among them. The article describes the process of how the Sonagachi Project was a catalyst in the emergence of an association of FSWs and how this association, in turn, has not only contributed sig­ nificantly to the Project's success in controlling the spread of diseases among the sex workers, but also towards their power for gaining some control over various aspects of their lives. STD/HIV INTERVENTION PROJECT The STD/HIV Intervention Project (SHIP), popularly known as the Sonagachi Project, started in 1992 in the red-light area of Kolkata, comprising mainly of five contiguous colonies of brothels, namely, Sonagachi, Rambagan, Sethbagan, Jorabagan and Rabindra Sarani. The area has about 370 brothels housing about 4,000-5,000 sex work­ ers. It also accommodates a further 1,500 floating FSWs daily who rent rooms in the brothels on an hourly basis, when they bring clients picked up on the streets, parks and other places. The Project was ini­ tially funded by the World Health Organisation and administered by the All India Institute of Hygiene and Public Health. The Norwegian Agency for Development funded all components of the Project for about next two years and has been funding a few developmental activ­ ities like the literacy programme for FSWs and vocational training of the children of FSWs in boarding schools. Since October 1994, the Project is being funded mainly by the Department of International De­ velopment, formerly known as the Overseas Development Agency of the United Kingdom. The Sonagachi Project has attained an international reputation for its unusual success in reducing the prevalence of STDs and in increas­ ing the prevalence of the use of condoms among sex workers. For ex­ ample, the prevalence rate of syphilis as determined by VDRL test Empowering Female Sex Workers for AIDS Prevention... 475 declined from 25.4 per cent in 1992 to 11.9 per cent in 1998 (Jana and Banerjee, 1999: 19). The prevalence of using condoms 'always' in­ creased from 1.1 per cent in 1992 to 50.4 per cent in 1998, and the prevalence of using them 'often' increased from l.6 per cent in 1992 to 40.1 per cent in 1998. A few clinics attended by physicians have been set up in the Project area for treating STDs and other minor illnesses of sex workers free of any charge. The prevalence of HIV infection has not shown any decline in Sonagachi, but has always remained much lower than that in other large Indian cities. For example, HIV prevalence among FSWs in a Mumbai red-light area was over 70 per­ cent in 1997 compared to 5.5 per cent among FSWs in Sonagachi in 1998 (Jenkins, 2000:79; UNAIDS, 2000:13). The Government of In­ dia's National AIDS Control Organisation (NACO) considers the Sonagachi Project as the most successful HIV/AIDS intervention pro­ jects among FSWs in India (NACO, 2001). The remarkable epidemiological success of Sonagachi Project can be attributed, to a great extent, to the active participation of FSWs in all its phases. It was decided, at the initial stage of the Project, to re­ cruit a few sex workers who would be the primary channel of commu­ nication between the Project staff and the community of FSWs. They were called the Peer Educators (PEs) who later on took the initiative in the formation, in 1995, an organisation of FSWs called Durbar Mahila Samanwaya Committee (DMSC). Subsequently, a few other organised bodies of FSWs grew out of the DMSC. All these bodies contributed significantly to the Project's success. PEER EDUCATORS: AGENTS OF CHANGE The basic approach of the Sonagachi Project is expressed in terms of three 'R's: 'Respect' for FSWs, 'Recognition' of their profession and rights, and 'Reliance' on their understanding and capacity. This was translated into action by making efforts to actively involve FSWs in all components of the Project and to build a relationship of trust and partnership between the Project staff members and FSWs in the Pro­ ject area. The Project staff realised at an early stage that the Project's main activity of educating FSWs regarding STD/HIV/AIDS and mo­ tivating them to use condoms can be performed best by their own peers, if the latter are adequately trained for the purpose. Initially, 12 FSWs were selected to work as PEs from the community on the basis of their interest in the Project, capacity for grasping, and leadership quality. They would be paid a nominal salary from the Project to work 476 Moni Nag for it in the morning hours and were allowed to ply their profession at other times. The six-week training module for PEs consisted of classroom teaching as well as field-based orientation. In addition to the nature, modes of transmission, and symptoms of STD/HIV/AIDS, the subject matter of teaching included how to prevent these diseases with special emphasis on the use of condoms. The PEs were taught how to demon­ strate to FSWs the correct use of condoms and how to negotiate with their clients effectively regarding condom use. They were also en­ couraged to explore with the FSWs in the community the ways by which the Project could fulfill its objectives more effectively The PEs were required to visit a specific number of FSWs daily, talk with them about STD/HIV/AIDS, inquire about their problems regarding use of condoms, supply condoms as needed, and encourage them to go to the clinics set up by the Project, particularly, if they felt sick. Personal communication between PEs and the community FSWs, based on mutual trust, is a source of the Project's strength. The blue uniform jacket with a printed red-cross symbol on it, worn by a Peer Educator while on duty, gives her a sense of pride and is a source of prestige to her children and to others in the red-light area. The PEs have regular periodical meetings with the Project's supervisors (mostly women college graduates) and physicians. The experience of working together with the latter for the welfare of FSWs in the com­ munity enhances a Peer Educator's self-confidence and instills in her a sense of identity other than being a mere sex object. In the course of their work, the PEs soon realised that educating and motivating FSWs to have safe sex was not of much use unless their clients cooperated with them in using condoms. Despite wide publicity through mass media regarding the danger of AIDS and the need to use condoms for preventing it, most clients were reluctant to use them on the ground that condoms reduced the pleasure of sexual intercourse. Most clients strongly resisted all attempts of the FSWs to use condoms. At the initial stage of the Project, until FSWs mobilised themselves to some extent, if any FSW turned down a client for his re­ fusal to use condom, he would not have difficulty at all in finding a FSW in the neighbourhood, who would be willing to entertain him sexually without the use of condom, but most probably at a higher price.
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