The origins of a research community in the Majengo observational cohort study, Nairobi, Kenya
The origins of a research community in the Majengo observational cohort study, Nairobi, Kenya
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DOI：
10.1186/1471-2458-10-630
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发表时间：
2010-10-21
影响因子：
4.5
通讯作者：
Lavery, James V.
中科院分区：
文献类型：
--
作者：
Bandewar, Sunita V. S.;Kimani, Joshua;Lavery, James V.
背景：自20世纪80年代以来，马坚戈观察队列研究（MOCS）在肯尼亚内罗毕一个贫困的城市村庄马坚戈的一群性工作者中检查了性传播感染，特别是艾滋病毒/艾滋病。MOCS的调查人员受到了批评，因为这些女性在参与研究期间一直从事性交易，引发了对剥削的担忧。然而，尽管存在这些担忧，这一群体却存活了近30年。方法：在这一回顾性定性案例研究中，我们考察了MOCS的社区参与实践，并探讨了影响其持久性的因素。结果：在肯尼亚，从事性工作的妇女是一个高度被污名化和被剥夺权利的群体。因此，无论是在内罗毕还是在马金戈村，都没有天然的性工作者“社区”。马坚戈诊所的目的是减少妇女在STC诊所获得保健服务的障碍，使服务离她们更近，并提供一个非歧视的环境。这些妇女承认，她们曾希望参加MOCS能帮助她们找到一条脱离性交易的道路。但我们的发现也为这场辩论增加了另一个层面，因为我们采访的每一位队列成员都对MOCS对其生活产生的深刻影响表示感谢，其中大部分影响超出了通过获得优质医疗保健服务而可能改善的健康状况。参与MOCS改善和丰富了他们的生活。行政长官活动在建立一个并非独立于MOCS而存在的社区方面发挥了核心作用。结论：我们的案例研究确定了MOCS中社区参与的三个不同阶段：(1)伸出援手：动员、对话和教育；(2)通过关爱关系建立信任的基础；(3)利用现有社会资本，形成群体社区。调查结果显示了参与研究的一些不太明显的好处的重要性，即不断发展的社区经验以及随之而来的个人安全和团结方面的收益，这些都使妇女留在队列中，有些人在队列中呆了20年或更长时间。
Background: Since the 1980s the Majengo Observational Cohort Study (MOCS) has examined sexually transmitted infections, in particular HIV/AIDS, in a cohort of sex workers in Majengo, an impoverished urban village in Nairobi, Kenya. The MOCS investigators have faced criticism since the women have remained in the sex trade for the duration of their participation in the study, prompting concerns about exploitation. Yet despite these concerns, the cohort has survived for almost 30 years.Methods: In this retrospective qualitative case study, we examine the community engagement practices of the MOCS and explore the factors that account for its durability.Results: Women in sex work in Kenya were a highly stigmatized and disfranchised community. As a result, there was no natural 'community' of sex workers either in Nairobi or in the Majengo village. The Majengo clinic aimed to reduce the barriers to health care the women experienced at the STC clinic by bringing the services closer to them and by providing a non-discriminatory environment. The women acknowledged the fact they had hoped their participation in the MOCS would have helped them find a path out of the sex trade. But our findings also add another dimension to this debate, since every cohort member we interviewed expressed her gratitude for the deep impact the MOCS has had on her life, much of it beyond the improved health status made possible by access to quality healthcare services. Participation in the MOCS has improved and enriched their lives. The CE activities have played a central role in creating a community that did not exist independently of the MOCS.Conclusions: Our case study identified 3 distinct phases of community engagement in the MOCS: (1) reaching out: mobilization, dialogue and education; (2) foundations of trust through relationships of care; and (3) leveraging existing social capital to form a cohort community. The findings demonstrate the importance of some of the less obvious benefits of participation in research, namely the evolving experience of community and the accompanying gains in personal security and solidarity that have kept the women in the cohort, some for 20 years or more.