Action de santé communautaire avec les personnes prostituées à Lyon.

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About Cabiria

1. Short historical note

Cabiria was born out of an action-research project on the prostitution area of Lyon done by the Research Center for Anthropological Studies - in collaboration with prostitutes.

2. Context and methods

Community health projects were born during the nineties, in the context of the struggle against AIDS. Still today, prostitution is treated according to the 60’s regulations that organise the fight against prostitution, long considered "a social plague". This fight included a repressive dimension, that we won’t discuss, and a social dimension that organises the conditions that have to be set up in order to reintegrate prostitutes and to get them out of prostitution. The 60’s regulations consider prostitutes as victims who need help in raising their consciousness about their oppression and in getting them out of prostitution. This approach implies a psycho-social treatment of prostitution aimed at reintegrating prostitutes into professional lifestyle. The structures created in France at that time were based on this philosophy of social action in a context of widespread pimping. The health or prevention of STDs are not really taken into consideration - partly in reaction to the anterior regulationist system that organised a sanitary control of prostitution.

3. A rupture in the treatment of prostitution : the HIV epidemic

The development of the HIV epidemic at the end of the eighties deeply changed the outlook on prostitution. It’s also important to note that the fight between the sixties and the eighties against pimping has been successful in France.

In 1992-93, a number of projects were born in Paris, Lyon, Marseille, Nîmes, and Montpellier as well as in AIDeS committees. These projects were initially supported by associations such as the ANRS in Paris, a piloting committee in Lyon, and AIDes in Marseille. These projects progressively became autonomous and labeled themselves "Community Health Projects". There are seven projects today in France based on this same model but with slight variations.

Our work method is inspired by the communitarian approach developed by AIDeS in it’s fight against AIDS. We understood that in order to develop preventative actions against STDs, HIV and hepatitis, it was important to work on the identity issue. This work is being done in the lesbian and gay community and has been successful in the reduction of infections in this community. The research and writings of Michael Pollock have also been an important resource. The parallel with the gay community is that the 60’s regulations also considered homosexuality as a "social plague" that should be fought. This also illustrates how the perception of a social phenomenon is closely related to the social and historical context in which it exists.

The organisation of the gay community has been facilitated by it’s technical, intellectual and financial resources. The prostitution community does not possess these same resources, and few people are able to mobilise the necessary technical skills in a timely manner for the creation and organisation of projects. That is why we have chosen a strategy of alliance : health professionals in collaboration with prostitutes.

We have also been inspired by certain undertakings in Latin America and the writings of Paolo Freire and the Chicago School.

Through their alliance with the prostitution "community" (the notion is reductive because people of all different social groups and backgrounds give life to prostitution), health professionals associate with those primarily concerned in order to determine the exact needs, objectives and actions. This coalition has led us to a definition of the most important criteria ensuring both the ethics and the efficiency of our actions.

  1. The project concerns the most vulnerable groups.
  2. Those most vulnerable are primarily included and concerned in the realisation of the project. The needs of the concerned group are the basis of the whole project. Trust will allow the expression and emergence of the individual needs and desires.
  3. An innovative and experimental practice in comparison to the traditional sanitary approaches.
  4. The project expresses a need that is not met by the existing institutions.
  5. Fieldwork. Mutual information and formation instead of purely academic research.
  6. Quick and concrete health actions for those concerned. Quantitative and qualitative evaluations.
  7. Creation of a network of resource partners, chosen in function of community needs.
  8. Coordination with existing institutions and groups working in a comparable way.
  9. Efficiency of funds used.

4. Construction of an intervention method

(Largely developed in the activity reports of 97 and 98).

One of the focal points of our approach consists of focusing on the person’s needs and desires. This transformation was brought about by the associations fighting AIDS. From an institutional approach - defined by the framework and missions of the 60’s regulations - we’ve opted for more flexible proximity approaches. We’ve chosen to respect the individual, independent of her/his activities, background and/or life situation, without wanting to change her/him on any of these levels. We simply try to offer tools for health prevention and sanitary maintenance. We also try to provide tools to support social, administrative, human and civil rights issues. Initially, our work is sanitary-based, but a person’s health can’t be known without considering her/his daily social context.

Another tool and focal point of our project is proximity and mobility : we quickly organised ’mobile night accompaniment and reception units’ i.e. camping trailers during the night.

We’ve opened the reception units and accompaniment locations as close as possible to the prostitution areas. One of the strong points of our intervention method is parity : we’ve built our project on a fifty-fifty basis with persons coming from the professional health world and from the prostitution community.

Our associations do not offer common social services but function rather as a catalyst for the start of a health and prevention process for oneself and the others. The associations also function as interface and mediator with social services or associations offering services and care. The prostitution communities thus develops a large network of institutional and associative support partners.

Often when people using an association have gained confidence and/or have started a process that has been successful, they can themselves share with their ’colleagues’ the services they know. This is made possible because we develop a form of reception and accompaniment that is human and collective (not excluding individual follow up or confidentiality), where solidarity is one of the values most stressed. It’s also a way of reinforcing their own skills, and self-reliance.