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Structural stigma, sex work and HIV: contradictions and lessons learnt from a community-led structural intervention in southern India
  1. Monica Rao Biradavolu1,
  2. Kim M Blankenship1,
  3. Asima Jena2,
  4. Nimesh Dhungana3
  1. 1Department of Sociology, Center on Health Risk and Society, American University, Washington, DC, USA
  2. 2Center for Studies in Society and Development, School of Social Sciences, Central University, Gandhinagar, Gujarat, India
  3. 3Center on Health Risk and Society, American University, Washington, DC, USA
  1. Correspondence to Dr Monica Rao Biradavolu, Department of Sociology, Battelle-Tompkins Hall, American University, 4400 Massachusetts Avenue NW, Washington, DC 20016-8072, USA; monica.biradavolu{at}


Background Recent theorisation has pushed stigma research in new directions, arguing for a need to challenge the unequal power relations that impact groups most at risk for HIV-related stigma rather than locate stigma in the individual. Such a conceptualisation resonates with the growing emphasis on structural interventions for HIV prevention that attempt to alter the social context of risk.

Methods The paper predominantly relies on longitudinal interviews conducted three times over a 2-year period with sex workers with varying degrees of involvement with the non-governmental organisation (NGO) and community-based organisation.

Results Recognising that stigma is socially constructed and structurally reproduced, the NGO helped mobilise marginalised and hitherto scattered female sex workers to form community-based organisations to challenge their disadvantaged status in society. The authors show how stigma alleviation strategies presented a contradiction: emboldening one group of female sex workers to self-identify as sex workers while making others reluctant to access the intervention-run clinic.

Conclusion The paper builds on a growing body of research that acknowledges the struggles in implementing structural interventions, particularly for NGOs working in regions with a diverse population of sex workers with varying needs. The authors argue that intervention goals of reducing stigma and increasing the use of sexually transmitted infection services do not have to conflict and, in fact, must go hand-in-hand for an implementation to be considered a structural intervention.

  • Stigma
  • structural Interventions
  • female sex workers
  • India
  • HIV
  • sociology FQ
  • qualitat res meth FQ
  • developing country
  • ethnography
  • AIDS
  • anthropology
  • medical sociology FQ

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  • Funding Support for this research was provided by the Bill & Melinda Gates Foundation's Avahan India AIDS Initiative through Grant No. 30183. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Bill & Melinda Gates Foundation and Avahan.

  • Competing interests None.

  • Patient consent There are no patients in this study. Consent was obtained from interview respondents.

  • Ethics approval The ethics approval was provided by Yale University, Duke University and American University (in the US) and YRG-Care (Chennai, India).

  • Provenance and peer review Commissioned; externally peer reviewed.

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