Sex Worker Leadership in Responding to HIV and Promoting Human Rights 297
structural approach, it created dangerous conditions by granting further power to authority figures such as police and venue managers, with sex workers suffering exacerbated human rights violations as a result. Greater sex worker involvement in the campaign’s approach could have generated a more appropriate approach that imparted the additional structural changes necessary, e.g., reducing stigma, for a comprehensive and sustained impact. In Brazil, the partnership between a new government and a prominent sex worker organization, whose mission extended far beyond that of addressing HIV among sex workers, catalyzed a response that explicitly sought social and economic rights for sex workers. Their collaboration generated policy changes at the national level, with significant reductions in stigma and enhancements to sex workers’ labor rights. This broad focus is considered responsible for reductions in HIV risk associated with sex work. The case of Sonagachi represents perhaps the strongest example of role sex workers can serve once a structure is established for their participation. The intervention’s initial focus was that of occupational health and safety; the broader structural changes in areas of economic and political power for sex workers, including additional intervention components such as the banking cooperative that were ultimately achieved are described as byproducts of the intervention process (Jana et al., 2004). The involvement of sex workers in this case enabled far greater structural changes than were initially envisioned. While the Brazil case illustrates the policy level change that can be achieved through sex worker and government partnership, Sonagachi illustrates the power of creating mechanisms by which sex workers can refine and expand interventions to meet the needs that individuals external to the sex work community may not readily understand. The extent of structural change achieved through each of these responses also varies significantly based on the balance of actors involved. Thailand’s early, proactive and structural response was initiated and implemented by the federal and provincial governments. While the response was a collaborative effort between several governmental sectors including public health, police, and municipal leaders that relied on national participation, it was not characterized by sex worker involvement nor was there significant sex worker initiated responses early in the Thai HIV epidemic. The intervention’s environmental focus was neither designed to nor did generate sustainable structural changes beyond the context of sex work venues. Rather, it propagated the notion of sex workers as “vectors of disease” and as a result may have actually perpetuated stigma and discrimination that impede sex workers’ ability to advocate for their rights (Center for Advocacy on and Marginalization 2008). In contrast, Brazil’s unique case of long-standing partnership between government and sex worker networks garnered arguable the most thorough level of structur-