Appraisal of a Health Promotion Initiative: Sonagachi Project - Essay Example

Appraisal of a Health Promotion Initiative Student’s Name: University: Appraisal of a Health Promotion Initiative The Sonagachi Project: A sustainable community intervention program. Introduction The Sonagachi project was a community health promotion early intervention and prevention initiative developed in order to help in the promotion of use of STI treatment and health services amongst sex workers in India to reduce incidences of HIV. Health promotion programs are important in the mobilization of communities towards attitude and eventually behavior change. In order to influence an area as important as HIV, it is important for promotion initiatives to be guided by best practices (Campbell & Cornish, 2010). Healthcare is a multifaceted issue, and so is behavior change. Consequently, best practices cannot be determined using a linear perspective. Several aspects need to be considered in order to come up with determinants of best practices in health promotion initiatives. When it comes to health promotion involving HIV issues, behavior change through community mobilization is the most common approach (Campbell & Cornish, 2010). The cores strategy in these initiatives is community mobilization owing to the fact that the disease is spread through social means. This paper will provide an overview of the best practices expected in a community intervention program. The Sonagachi program will be summarized and an analysis of the program done as regards to the best practices. HIV HIV, in this context, will be described as an occupational health issue. Understanding the infection on its own will give insight as to the nature of its link sex workers and to the community. The most common transmission method of the HIV virus is through sexual intercourse, which happens to be the medium of exchange for sex workers. Being infected with the HIV virus does not conclusively mean that one will develop the full blown AIDS disease. However, this is dependent on how the individual manages the infection (Cornish & Ghosh, 2007). Knowledge of what to do is an important issue. AIDS is among the deadliest worldwide epidemics in the history of humanity. While most countries saw the epidemic peak in the late nineties, most in Southeast Asia were still experiencing the same increase in infection rate in the early 21st century. The number of individual living with HIV/AIDS has also increased exponentially owing to the availability of better drug treatments. Heath experts have come to terms with the fact that a cure for the infection is not plausible. They now believe that the most effective method of treating the disease is to prevent people from getting infected with HIV (Shannon & Montaner, 2012). Most of programs aimed towards educating the public on prevention target risky behavior associated with transmission. Health promotion and HIV among sex workers HIV is an important issue for sex workers. Not only does it affect their personal and social lives, but also their occupational choice. The nature of their occupation puts them at a greater risk of contracting HIV. According to UNAIDS, less than 50% sex workers have access to HIV prevention programs (Shannon & Montaner, 2012). The problems addressed by the Sonagachi project have a firm foundation on fundamental risks that sex workers expose themselves to. In addition, HIV is a disease that affects those infected for the rest of their lives. Consequently a prevention approach is bound to prove more effective. The high level prevalence of HIV infection in sex workers in India highlights the urgency to understand processes and procedures involved in developing and implementing a community intervention program that can be sustained. The Sonagachi project acknowledged HIV prevention as an important health promotion initiative with the potential to influence individual, as well as societal or community health development. An additional justification for these health promotion programs is that clients of sex workers are in the same community as the workers. Consequently, having community initiatives is important in passing knowledge to the workers and their clients. Health determinants There are numerous determinants that affect the plausibility of spreading HIV infection. These determinants occur in the capacity of protective and risk factors and, combined exposure to these factors over the course of an individual’s development contribute to the behavior they exhibit within the context of seeking information in sexual behavior (Campbell & Cornish, 2010). Approaching HIV prevention in sex workers from a protective and risk factor view demonstrates the effectiveness of using community intervention initiatives to modify exposure to these factors in the entire community thus affecting the outcome of the entire population (Krenn & Limaye, 2012). Sex workers are regarded as the most vulnerable because many risk factor determinants converge on them. In some cases risk factors such as gender and occupation combine to make sex workers vulnerable. Gender inequalities are structural risk factors embedded in the system such that they deny women opportunities and resources that are made available to males (Krenn & Limaye, 2012). Thus, there is the lack of access to means and knowledge on how they should protect themselves from HIV infection. Open discussion of sexual matters is still a taboo for most people especially those living in third world countries. Dominant ideologies of femininity also exist and they silence younger women who hold the view that knowing much about sexual matters will ruin their reputation (WHO, 2002). On the other hand, men have always believed that they should be dominant in the society. Thus, as adults, people assume that they already have adequate information about sexual matters. These dominant ideologies put off young men and boys from asking about sexual matters for fear of being considered unmanly by appearing ignorant (WHO, 2002). Other variables that affect behavior towards knowledge of sexual matters include ethnicity, gender, social status and culture (WHO, 2002). Most sex workers are young. WHO’s Department for International Development (2002) estimates that there are 11.8 million young people in the world who are infected with HIV while 6,000 are infected each day. While most may have an understanding of the mechanics of sexual matters, few have the opportunity to consider and learn about consequences of having sexual relations without protection. Consequently, most are ill prepared to shield themselves from HIV and other STIs. Female sex workers are considered among the high risk groups in targeted interventions for HIV prevention interventions (Cornish & Ghosh, 2007). The sonagachi project enabled a determinants approach in planning and execution through providing a dynamic framework that allows the inclusion and modification of strategies to address any unforeseen circumstances that were encountered (Shannon & Montaner, 2012). Core strategies and concepts that steered the project evolved with the expression ad discussion of community needs. In essence, the project was not originally meant to empower the community (Campbell & Cornish, 2010). However, the project morphed into what it needed to be to achieve success. Overview of the The Sonagachi project The program was organized to encourage the utilization of STI treatment and health services to reduce the infection of HIV among sex workers. Sex workers were employed to act as peer educators and spread information about behavior change with specific reference to linking sex workers to health care centers and promoting and distributing condoms. Sex workers were involved in all areas of the project to help the project move from a health focus to empowerment, protecting human rights and improving working conditions. Several goals guided the project including reducing the risk of STI and HIV transmission amongst sex workers, advocating for HIV being treated as occupational hazards and voicing human rights for the sex workers. The core components were advocating for STD services in the community, promoting condoms, involving sex workers, demanding for better services and empowering sex workers and coaching sex workers to exercise control over their bodies. The Sonagachi project: Conceptual framework Though not in the original plan, the framework made it possible for community mobilization to be a core strategy. In addition, the project made sure to define HIV as a health problem that is occupational. Consequently, multilevel and multifaceted approaches were used in the interventions in order to address community issues like environmental barriers and resources, individual factors such as improving competencies and skills for HIV prevention and group issues such as changing social relationships. One of the prerequisites to donor funding for intervention projects is for it to be based on a theoretical framework. However, the Sonagachi project was atheoretical and largely unplanned. It was originally conceptualized as a clinic for sex workers to go to for STD issues. The original framing of the problem was to improve occupational health and safety for sex workers (Jana et al, 2004). Health promotion best practice Good health is the overall well being of an individual in terms of the physiological and mental condition especially in terms of the absence of impairments, illnesses and injuries (WHO, 2002). Health promotion is meant to empower individuals in a society to take charge of their health and control it so that they achieve the best possible result. Consequently, the most effective program would be one that gives an individual the opportunity to improve their health in proportion to health promotion best practices, values, evidence and an understanding of the context within which the health promotion goals are most likely to be achieved. Several best practices have been highlighted in literature and they apply to different areas of project planning and execution. The Interactive Domain Model posited by Kahan and Goodstadt (2001) proposes that strategies and processes involved in a health promotion program should manifest Goals, values, beliefs and theories Adequate relevant evidence A deep understanding of the context or environment The Sonagachi project: Planning, goals and needs assessment and evaluation The sonagachi project reflects most of the elements in the Interactive Domain Model. However, there are areas in the project that are deficient of the elements. Goals are meant to guide the activities of a project and their nature defines the nature of the project. The program also had the goal with a realistic expectation of being successful at different implementation stages. The goals for the project allowed for the flexibility of the program. This flexibility is reflected in an understanding of the environment and the project evolved to meet the needs. In addition, the project was framed so that it empowers and supports sex workers and others involved with them such as landlords, madams and other interested parties and stakeholders (Jana et al, 2004). Jana (2012) suggests that using community mobilization in executing HIV intervention programs is a pragmatic and logical way of fostering engagement of the community and its members in the program. Approaches targeted at marginalized sections of the population should address their vulnerabilities especially those rooted in their working, legal and social environment (Jana, 2012). The project adhered to these best practices by addressing empowerment, politics and the working environment of sex workers. According to Krenn and Limaye (2012), behavior and social change communication is an effective tool in fighting HIV and positive results are attained through empowerment resulting in behavior change triggered by social change. The sonagachi project showed this trait since one of its core components was to empower sex workers. Another important best practice in health promotion is ensuring sustainability. The most definite determinant of sustainable health promotion initiatives is a steady economic foundation. Programs should have a continuous funding stream that is within the community. The sonagachi project had various economic components embedded within it including the sale of condoms, a local lending institution and ongoing communication and networking with the media, non-governmental organizations and stakeholders. The inclusion of sex workers in the selling and distribution of condoms is an adherence to best practices outlined by Comish and Ghosh (2007) who suggest that health promotion initiatives should display genuine participation of the community in their design. In addition, interventions should adopt a structurally oriented and integrated approach to promote safer sex practices in the context of sex work (Evans & Lambert, 2008). The sonagach project demonstrated integration by targeting sex workers, the community and other with economic and social associations with sex workers. Structural and multi-component interventions are advised since changes focusing only on behavior change are not as effective (Shannon & Montaner, 2012). Structural interventions include sex work collectivization and policy change. Advancing human rights among sex workers and improving working conditions address structural interventions making the project adhere to multi-component interventions. The project was deficient because no theoretical perspectives were used in the initiative. According to Lytle and Perry (2001), effective interventions in health promotion should not only draw from practice but also be theory-based (Evans & Lambert, 2008). The sonagachi project was a theoretical and unplanned. However, this deficiency is what enabled the program’s framework to be dynamic enough so that it could evolve to meet the needs of different actors as the project was implemented. Regardless, the goals were based upon available evidence. Research shows that more than 90% of the transmissions in India are related to individuals not having safe sexual intercourse (Cornish & Ghosh, 2007). Being that the same research also found that sex workers are among the most at risk group, the goal of STI and HIV transmission among sex workers is evidence based. The strategies were also based on evidence (Krenn & Limaye, 2012). For instance, evidence shows that some of the sex workers do not practice safe sex owing to their freelance like working condition. Thus, one of the strategies was for sex workers to work under a single institution that will help with their empowerment. Evidence also shows that increased circulation of condoms among sex workers decreases the rate of infection significantly (Krenn & Limaye, 2012). Having sex workers work as vendors of condoms ensures that they were kept in circulation. Different actors in the project were focused on different matters. Project donors were mainly focused on the health outcomes while the sex workers had more interest in community development. Attitudes of people in the community affect the nature of work that sex workers do. The project focused on HIV prevention derived from the public health concern that commercial sex work provides a riskier context for HIV transmission. This is not equivalent to the interest that sex workers have in making their working environment stable and secure. Despite this, the results were applicable to both parties. Although it was promoted as a community based initiative, it was a multidimensional project that involved negotiations between professionals, sex workers, funding agencies, local powerbrokers, madams and other interested parties who all had to be accommodated for the project to endure effectively. Conclusion The sonangachi project has made an enormous contribution to HIV intervention programs focused on sex workers. The success of the program shows that sex workers as well as the communities they work within want to ensure that the spread of HIV infection is curbed. Promotion of health is a vital factor in HIV prevention interventions. The effectiveness of these programs is higher if the intervention is based on best practices from evidence. In addition, knowledge of the implementation context as well as health determinants is vital to getting positive project outcomes. Most of the best practices in HIV intervention programs were incorporated in the sonagachi project. Viewing the project from the perspective on the Interactive Domain Model, the sonagachi project placed great focus on empowering sex workers, creating a safer working environment, advocating for HIV and STDs to be considered as occupational health risks, articulating human rights and promoting condom use. References Campbell, C., & Cornish, F. (2010). How can community health programmes build enabling environments for transformative communication?: Experiences from India and South Africa. HCD Working Papers, 1. London School of Economics and Political Science, London, UK. (Unpublished). Cornish, F. & Ghosh, R. (2007). The necessary contradictions of'community-led' health promotion: A case study of HIV prevention in an Indian red light district. Social Science & Medicine, 64(2), 496-507. Evans, C., & Lambert, H. (2008). The limits of behaviour change theory: Condom use and contexts of HIV risk in the Kolkata sex industry. Culture, Health & Sexuality, 10(1), 27 – 41. Jana, S., Basu, I., RotheramBorus, M. J., & Newman, P. A. (2004). The Sonagachi Project: A sustainable community intervention program. AIDS Education & Prevention, 16(5), 405-414. Jana, S. (2012). Community mobilisation: myths and challenges. Journal of epidemiol community health. Retrieved from http://jech.bmj.com/content/early/2012/06/27/jech-2012-201573.full Kahan, B., & Goodstadt, M. (2001). The Interactive Domain Model of Best Practices in Health Promotion: Developing and Implementing a Best Practices Approach to Health Promotion. Health Promotion Practice, 2(1), 43-67. Retrieved from http://www.idmbestpractices.ca/pdf/IDM-HPP.pdf Krenn, S., & Limaye, R. (2012). The role of social and behavior change communication in combating HIV/AIDS. Johns Hopkins. Retrieved from http://ftguonline.org/ftgu-232/index.php/ftgu/article/view/2037/4070 Lytle, L.A., & Perry, C.L. (2001). Applying research and theory in program planning: An example from a nutrition education intervention. Health Promotion Practice, 2(1), 68-80. Shannon, K., & Montaner, J. S. G. (2012). The politics and policies of HIV prevention in sex work. The Lancet Infectious Diseases. WHO. (2002). Preventing HIV/AIDS and promoting sexual health: among especially vulnerable young people. Department for international development. Retrieved from http://whqlibdoc.who.int/hq/2002/WHO_HIV_2002.23.pdf Read More