Introduction
Any complete program on health ought to educate people on the need to take proper care of themselves by living a healthy lifestyle. An effective health program aspires to manage the health of people by ensuring quick access to affordable health care. At the same time, many ignore the fact that people infected with HIV engage in sexual activities. A strong health promotion program seeks to prevent HIV which is vital to curbing onward transmission. One of such programs, the Sonagachi Project, was implemented in the 1990s (Jana et al., 2004). The project addresses issues Indian sex workers face in their trade. The project is not concerned with promoting prevention strategies only (though it is one of issues addressed), but it aims at developing proper relationships among the stakeholders involved and fostering proper attitudes towards sex workers, health safety and the trade itself.
Taking into account the results of the case study conducted by Cornish and Ghosh, instances of people in India becoming infected with the HIV virus have increased recently, which is given as a reason for conducting the research known as the Sonagachi Project. This essay gives some background information on the HIV epidemic and the methods necessary to prevent infection. Then, the Sonagachi Project on a sustainable community intervention program (Jana et al., 2004) is compared to components of a quality health promotion.
HIV
HIV stands for Human Immunodeficiency Virus which has now become a global epidemic (Dutta & Maiga, 2011). HIV attacks the human body by lowering the body’s level of immunity therefore making it vulnerable to other diseases (National AIDS Control Organization, 2001, p.10). HIV can go undetected for a long time with the sufferer experiencing only mild symptoms such as common cold, fever and cough. After a series of attacks from other common diseases HIV builds itself to the level of Acquired Immune Deficiency syndrome (AIDS). AIDS is the last stage of HIV (Elizabeth, 2012). Statistics done in 2010 estimated the number of people in the world currently living with HIV to be 34 million, 50% of whom are women. New infections per year totaled an alarming 11.4%. In 2010, the total number of deaths was calculated to be 1.8 million per year (UNAIDS, 2010). It goes without saying that HIV remains the plague of the 21st century.
Literature review
Before dealing with the HIV prevention program and the issues involved, it is necessary to deal with the research that has been done so far on the issue. To start with, it is important to consider the paper by Cornish & Ghosh (2004) that provides a detailed account of the Sonagachi Project, its peculiarities and positive implications. The paper also reveals certain trends that have appeared in the society. Exploring HIV prevention, they offer a specific case study, i.e., the study of HIV prevention in India. It is quite important that, unlike other studies of HIV which will be mentioned below, the Cornish and Ghosh paper deals with a specific case and has practical results to offer. After successful implementation of the Sonagachi Project which was aimed at preventing instances of HIV within the sphere of social interactions, the researchers found that there are certain patterns in the cases of HIV contractions and development within the specified field. According to the results of the research, “Over the course of its 14 years, the Sonagachi Project has empowered many sex workers with new skills, confidence and legitimacy” (Cornish & Ghosh, 2004, 505). Therefore, it can be suggested that successful HIV prevention depends on people’s awareness, though the study shows how complex the issue is. Thus, apart from raising awareness about the disease, people should adopt certain behavioural patterns that contribute to HIV prevention. The use of contraception depends on adoption of basic behavioural patterns.
Analysing the research conducted by Shannon & Montaner (2012), it can be seen that there are considerable measures established for HIV prevention, especially at work, though the researchers do not go into detail while considering specific strategies. Describing the ways in which contraction of HIV can be avoided by employees and management, the authors clarify a number of issues. They consider the scale of HIV contraction among female workers all over the world, the causes of the sudden increase in HIV contractions, and ways to fight HIV. It is quite important, though, that the authors of the research focus on researching the problem rather than on searching for solutions. Shannon & Montaner (2012) also provide a detailed account of world statistics on male and female HIV contractions at work, yet the only solutions the authors offer are the promotion of good health without specifying types of the latter or methods of its implementation. The Sonagachi Project could be a very good illustration of effective strategies of HIV prevention, which could contribute to the research implemented. The strategies aimed at developing proper relationships between the stakeholders could become the major focus of the study.
However, to give credit where it belongs, Shannon & Montaner (2012) did not only provide the statistical data on male/female HIV contraction, but they also give geographical data on HIV contraction. According to the authors, HIV has taken over the greatest amount of the population in the Asian regions (Shannon & Montaner, 2012, p. 501). The information offered by Shannon & Montaner (2012) is useful for further research as the researchers briefly define major trends existing in the sphere of public health in the region. They provide data that can be further analysed to define possible reasons for the existing trends. The present research provides statistical data to be further analysed to learn more about reasons for such statistics.
The paper written by Jana, Basu, Rotherham-Borus, & Newman (2004) is another significant contribution to the means of preventing HIV with the help of health promotion practice. This paper helps to delve deeper into the peculiarities of the aforementioned Sonagachi Project. Describing its goals and showing its specifics rather graphically, the authors have managed to convey the essence of the campaign and outline its results concisely. Lastly, the paper by Evans & Lambert (2008) deals with the issues of condom use. This is research that provides a practical approach to health promotion which is quite essential for the prevention of HIV contraction,
Hence, it can be considered that the key HIV/AIDS determinants are poverty and lack of sexual education among the population of the state. Therefore, it can be suggested that at present, there are three basic health promotion practices concerned with HIV issues which are the Sonagachi Project, informing people directly about ways to prevent HIV, and informing people on the proper use of various protectants like condoms. Learning the common HIV determinants will help define the key strategy for making HIV contraction rates lower and also check if providing information about HIV/AIDS can possibly help solve the issue among sex workers in India. The Sonagachi Project can be regarded as certain evidence that promotion of certain behavioural patterns leads to considerable improvement of the situation. The implications of the project also suggest that sex workers do change their ways which contributes to development of proper relationships between sex workers and their clients, sex workers and their management.
HIV determinants and strategies for HIV prevention
On the one hand, the key determinants for HIV were outlined quite a long time ago, and nowadays every single person knows that sharing needles and promiscuous sexual relationships are the surest ways to get HIV/AIDS. However, it is still worth keeping in mind that, with the development of civilization, new determinants of HIV appear, which means that new measures of precaution must be applied to ensure good health.
For instance, according to Gerbi, Habtemariam, Robnett, Ngwana, & Tameru (2012), for quite a long time religion used to be the shield that protected people from HIV/AIDS. Indeed, it seemed absurd that a person who had devoted his/her life to serving God and following His Commandments and the key principles of the teachings of Christ as they are explained in the Bible could possibly choose a track of life that would lead him/her to contract HIV/AIDS. However, as Gerbi, Habtemariam, Robnett, Ngwana, & Tameru (2012) claim, religious beliefs no longer mean that one is completely safe from getting HIV/AIDS. “Studies mentioned previously have identified religion as a possible protective factor against HIV infection. However, religious affiliation and [church] attendance…do not always correlate with HIV protective behaviors” (Gerbi, Habtemariam, Robnett, Ngwana, & Tameru, 2012, p. 137). Therefore, it is impossible to rely on religious beliefs of people when developing prevention strategies. Admittedly, certain Christian postulates tend to make sex workers feel guilty and careless and these people do not care about their health seeing themselves as sinful and unworthy beings that can be punished by the divine force for their trade. Though, they do not stop working as they still need money to support their families. On the contrary, the Sonagachi Project is effective as it addresses the most vulnerable group. The project involves people irrespective of their religious beliefs. Importantly, the project promotes ideas that help sex workers develop self-esteem, self-respect, and these qualities, in their turn, make people care about their health and follow basic precautions.
However, according to the research conducted by Kownaklai, Rujkorakarn, Tanwattananon, & Williams (2012), drugs and promiscuous sexual relations still remain the key determinants in HIV contraction
The study findings are consistent with the UNAIDS report that AIDS infected persons are in the working/reproductive age group, and the risk of infection from sexual intercourse is most common (UNAIDS and WHO, 2009). Most persons in this study also had low incomes, and needed money for daily needs and for health care. (Kownaklai, Rujkorakarn, Tanwattananon, & Williams, 2012, p. 117)
In addition, it is essential that people should know as much as possible about the threats of HIV/AIDS and the means to avoid it, which is, unfortunately, a huge problem in some communities. According to the research conducted by Fawole, Ogunkan, & Adegoke (2011, p. 65), “lack of communication between parents and children about sex; high level of illicit sexual activity; high incidence of campus prostitution, poverty or hash economic conditions among other factors” predetermine the considerable increase in the number of HIV contractions. Even though some of the issues, like communication between children and parents, seem to be quite delayed assistance for sex workers, it is still obvious that offering the latter more information about sexual intercourse and protection from HIV/AIDS is an obvious solution. Besides, sex workers also have children so they should know how to articulate important ideas to their children and how to make their children aware of hazards of sexual intercourse.
Thus, at present, it can be seen that the key determinants of HIV/AIDS are still promiscuous sexual relations and drugs. However, the aspect of low income has been added; moreover, according to the research, most of the people who are contracting HIV are those working in offices and having families. Hence, it is no longer instability that determines the desire to do drugs or to have promiscuous sexual relations which may lead to HIV contraction, but social status and, probably, insecurity which can be either the result of immigration (Ramsden & Hopkins, 2012) or any other change in one’s personal life. In addition, the aspect of learning about the basic ways to avoid contracting HIV/AIDS have also been highlighted; as it turns out one of the most significant HIV determinants in the present-day world is lack of information about HIV/AIDS among under age people. Thus, it is crucial that people should understand that the more they know about HIV/AIDS and the more preventive measures they take to make the threat as little as possible, the less chance they have of getting HIV/AIDS. Therefore, it seems that the key strategy in health promotion will be offering the necessary information about the threats of HIV/AIDS; about the ways people contract it, and about ways to avoid contracting the disease.
Health promotion practices
It is worth mentioning that there are certain serious flaws in current HIV prevention strategies. It seems that the problem remains unresolved because the current strategy focuses on the wrong issues. Indeed, according to what Mongkuo, Mushi & Thompson (2010) claim, the tendency to blame contraction of HIV mainly on sexual relationships between men is no longer true: “prevention messages tailored only to MSM or non-MSM individuals may not reflect the current state of sexual behaviors” (Mongkuo, Mushi & Thompson, 2010, 33). Therefore, it is obvious that a new strategy of health promotion must be adopted. The Sonagachi Project is in tune with the latest trends as it focuses on female sex workers (though, male sex workers are also involved) which does positively affect the situation in the region. Notably, the project can be launched in other parts of the country. Sex workers (irrespective of gender) should be aware of proper behavioural patterns. It is important to add that the new health promotion strategy must focus on keeping Indian sex workers informed about the threat of HIV/AIDS. Indian sex workers should develop self-respect and they should pay specific attention to their (and their clients’) health. The Sonagachi Project has contributed greatly to HIV prevention in the region and it has also shown that the problem is complex and needs a complex approach.
Alemayehu & Aregya (2012) offer another unusual approach worth considering. According to the authors, it is essential not only to increase awareness of HIV/AIDS contraction among the healthy population, but also offer all the required information both on how to prevent HIV infection from spreading further and how to sustain life in a person who has already contracted the virus and has AIDS. Also, the search for a medicine that can possibly defeat AIDS will go considerably faster once the researchers are able to see how the medicine affects patients.
Another possible idea for health promotion practice, according to the innovative research by Ali, Wassie & Greblo (2012), is to use human resources more efficiently. Considering the number of instances of HIV/AIDS contraction among the workforce of Asian countries, the authors offer a health promotion program that can possibly change people’s perception of HIV/AIDS and the people carrying the virus. As the authors claim, “The human resource is the first and foremost important aspect of any disease control programme and thus for HIV/AIDS and other disease control initiatives” (Ali, Wassie, & Greblo, 2012, p. 122). Therefore, according to the authors, one of the most obvious solutions to increase people’s awareness of the dangers and threats of HIV infection, as well as to help those who have already been infected, is better trained staff. Indeed, it seems that in the sphere of HIV/AIDS prevention and treatment, there is an increasing need for professionals who can offer people decent help and verified information. Last, the idea of promoting health is giving enough information on all sorts of barrier devices for preventing sexually transmitted diseases, starting with condoms, as Dutta & Maiga (2011) stress.
Conclusion
Therefore, it is clear that, at present, there is no panacea for HIV. Despite all attempts to cure the disease, the virus is still uncontrollable and it can turn into AIDS at any point, which means that there is still a lot of work to be done. Nevertheless, it seems that with the help[ of the research mentioned above, certain strategies concerning HIV treatment can be worked out, which will bring people one step closer to providing a solution to the problem.
Hence, it can be considered that good health promotion includes a number of various elements such as providing necessary information on current health issues. Moreover, good health promotion goes beyond advising people to exercise and eat a specific diet. In addition to good nutrition rules and a healthy lifestyle, good health promotion also involves instruction on most typical health problems as well as recommendations on how to avoid the most dangerous diseases, and, in case a disease is contracted, the most up-to-date means of curing these diseases.
Even in the case of HIV, one of the most terrifying diseases, there are certain procedures that can be done, and HIV does not mean that a person’s life is over. Thus, good health promotion is not only about keeping fit – it is about being warned and therefore being armed.
References
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Ali, F, Wassie, B, & Greblo, A, 2012, ‘HIV/AIDS control programmes in developing countries: the role of human resource’, Journal of AIDS and HIV Research, vol. 4 no. 5, pp.121-127.
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