Going beyond the clinic: confronting stigma and discrimination among men who have sex with men in Mysore through community-based participatory research

Abstract

Community-based participatory research (CBPR) has gained considerable popularity in recent decades given its ability to address social inequities, improve health outcomes and enhance community participation and ownership with respect to various health-related interventions. This paper describes the engagements of a community of self-identified men who have sex with men, most of whom also identified as male sex workers, in a long-term iterative and systematic process of knowledge production, reflection, and action. The project took place in 2006 in Mysore, South India, under the larger umbrella of an HIV intervention formed by the University of Manitoba and the sex workers collective known as Ashodaya Samithi, funded by the Bill & Melinda Gates Foundation (Avahan). CBPR is revealed as uniquely suited for tackling stigma and discrimination as subjects of scientific inquiry and as key methodological obstacles. As the community cultivated their own analysis around stigma, the concept became a key rallying point for increasing equity with respect to access to health services for this community. CBPR proved highly effective in mobilizing community participation and increasing access to sexual health services, over the long-term, because it was supported by and was able to feed community insights into a much larger infrastructure that sought to mobilize sexual minorities. More broadly, by highlighting various positive effects arising from CBPR, we have sought to further emphasize the greater possibilities of public health practitioners working more democratically with disenfranchised and highly stigmatized communities.

Keywords:

• MSM
• India
• HIV prevention
• CBPR

Acknowledgements

The authors would like to thank the University of Manitoba and the Bill & Melinda Gates Foundation (Grant #43136, Avahan, India AIDS initiative) for providing funding support. The views expressed in this paper are those of the authors and do not necessarily reflect the official policy or position of the Bill & Melinda Gates Foundation. We are most grateful to the community participants who generously supported this project by offering their time and insight.