Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review

Globalization and Health

Fiona Scorgie²  Yves Lafort⁴  Bea Vuylsteke³  Ashar Dhana¹  Sushena Reza-Paul⁶  Richard Steen⁷  Matthew F Chersich²  Lizzie Moore⁵ 

[1] Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa;Wits Reproductive Health and HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa;Institute of Tropical Medicine, Antwerp, Belgium;International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium;MatCH (Maternal, Adolescent and Child Health), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa;Community Health Sciences, University of Manitoba, Manitoba, Canada;Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands

关键词: Africa;    Structural interventions;    Community mobilisation;    Female sex workers;   

Others  :  824084
DOI  :  10.1186/1744-8603-10-47

 received in 2013-10-31, accepted in 2014-03-25,  发布年份 2014

【 摘 要 】

Background

Female sex workers (FSWs) experience high levels of sexual and reproductive health (SRH) morbidity, violence and discrimination. Successful SRH interventions for FSWs in India and elsewhere have long prioritised community mobilisation and structural interventions, yet little is known about similar approaches in African settings. We systematically reviewed community empowerment processes within FSW SRH projects in Africa, and assessed them using a framework developed by Ashodaya, an Indian sex worker organisation.

Methods

In November 2012 we searched Medline and Web of Science for studies of FSW health services in Africa, and consulted experts and websites of international organisations. Titles and abstracts were screened to identify studies describing relevant services, using a broad definition of empowerment. Data were extracted on service-delivery models and degree of FSW involvement, and analysed with reference to a four-stage framework developed by Ashodaya. This conceptualises community empowerment as progressing from (1) initial engagement with the sex worker community, to (2) community involvement in targeted activities, to (3) ownership, and finally, (4) sustainability of action beyond the community.

Results

Of 5413 articles screened, 129 were included, describing 42 projects. Targeted services in FSW ‘hotspots’ were generally isolated and limited in coverage and scope, mostly offering only free condoms and STI treatment. Many services were provided as part of research activities and offered via a clinic with associated community outreach. Empowerment processes were usually limited to peer-education (stage 2 of framework). Community mobilisation as an activity in its own right was rarely documented and while most projects successfully engaged communities, few progressed to involvement, community ownership or sustainability. Only a few interventions had evolved to facilitate collective action through formal democratic structures (stage 3). These reported improved sexual negotiating power and community solidarity, and positive behavioural and clinical outcomes. Sustainability of many projects was weakened by disunity within transient communities, variable commitment of programmers, low human resource capacity and general resource limitations.

Conclusions

Most FSW SRH projects in Africa implemented participatory processes consistent with only the earliest stages of community empowerment, although isolated projects demonstrate proof of concept for successful empowerment interventions in African settings.

【 授权许可】

   
2014 Moore et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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