Community engagement in HIV prevention in Asia: going from ‘for the community’ to ‘by the community’—must we wait for more evidence?
- Asia Unit, The Global Fund on AIDS TB and Malaria, The Gobal Fund, Geneva, Switzerland
- Correspondence to Dr Swarup Sarkar, Asia Unit, The Global Fund on AIDS TB and Malaria, The Gobal Fund, Geneva, Switzerland;
- Accepted 7 December 2009
The HIV epidemic in Asia is predominantly defined within the marginalised communities and their partners. The term ‘communities’ here refers to people who are living with HIV or injecting-drug users (IDUs), sex workers and clients, men who have sex with men (MSM), transgender population and intimate sexual partners, essentially population groups predisposed to higher risks of HIV.1 2 The prevention of HIV among these communities is considered crucial to a successful HIV intervention response in Asia. Although any behaviour change programme must be addressed and tailored to these communities, the rationale, purpose, extent and means of engagement of these communities have often been debated.2–5 However, despite recent rhetoric about the role of the affected communities in the response to HIV, significant involvement of the community has rarely been the mainstream practice. Instead, community involvement has been described as minimalistic, tokenistic and incomplete.2 3 6
One of the most common characteristics of these communities is that they are socially marginalised and often criminalised, even if their behaviour or actions are not illegal by law or immoral by belief. This makes it difficult to reach out to such high-risk population groups through existing health or social services, either because the services are not available or accessible to the marginalised community members, or because of the perceived or actual judgemental attitude, stigma and discrimination by healthcare workers and those associated with the field.7 For example, STI clinics are not open in the evening time when sex workers actually work. Similarly, physicians do not examine for anal STIs.3 This has led to the concept of …