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Challenges in implementing targeted interventions (TIs) in female sex workers (FSW), men having sex with men (MSM) & transgender (TG) communities in Mumbai through community led structural interventions (CLSI) supported by Mumbai Districts AIDS Contro
U. Mehta1, M. Desai2, A. Kaur1, H. Pathak3, P. Yeramsetti4
1Mumbai Districts AIDS Control Society, Targeted Intervention, Mumbai, India, 2Mumbai Districts AIDS Control Society, Care and Support, Mumbai, India, 3Mumbai Districts AIDS Control Society, Mumbai, India, 4Andhra Pradesh State AIDS Control Society, Targeted Intervention, Hyderabad, India
Background: The learning's of NACP II led to paradigm shift in NACP III with aim to strengthen the Community led & community owned TIs which leads to
- Enhanced self esteem & negotiation skills
- More acceptance to services
- Up-scaling of outreach
- Sustainability due to community ownership
CLSI also involves challenges which eventually may become barrier for acceptance by the mainstream society.
MDACS is supporting 6 Community Based Organizations (CBOs) - 2 each in FSW, MSM & TG community with minimum registration of three years to implement TIs in Mumbai.
Methods: The qualitative study with open ended questionnaire was undertaken by involving CBO functionaries and community members to assess the functioning of CBO & community involvement in decision making.
Results: Community members of 5 out of 6 CBOs shared that:
- The board of trustees are selected & not elected
- The board meeting is conducted once a year
- Community involvement is negligible in decision making.
- No transparency regarding funds & expenditure
FSW & TG CBO functionaries shared that:
- Less understanding of technical & formal matters like project management, planning, account keeping leads to dependency on consultants.
- Less willingness in records & data keeping due to lack of education.
Conclusions: CBO intervention is designed to create Enabling Environment of empathy & empowerment; but more empowerment, self esteem & rights based approach with illiteracy, results in:
- Inappropriate use of powers with less understanding of roles & responsibilities
- Expectation of special treatments in mainstream services.
- Absence of sustainability plans
- Ownership leads to monarchy in governance
Recommendations:
- Change in attitude for governance.
- Setting mechanisms for capacity building, hand holding & monitoring
- De-centralization of powers by making committees
- Develop referral linkages to mainstream services.
- Showcasing best practices to motivate & adapt systems.
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