The new public health is compelling because it uses the discourse of empowerment and participatory methodologies to promote health citizenship, but it has also been criticized for reinforcing an individual locus of responsibility while overlooking the role of the state in providing healthy environments. Thus far, much of the discourse surrounding the new public has tended to be the purview of public health experts and professionals. This study uses the interpretive approach to health communication to understand how debates regarding rights and responsibilities inherent in the new public health are appropriated by six employees at two community-based organizations that provide support to HIV-positive (HIV+) people in South India. I ask the question: How is the term "empowerment" understood by these individuals? Three primary dimensions of power emerged from my study: power from self-acceptance and inner strength, power from family and society, and power from self-reliance. In talking about empowerment, participants implicitly and explicitly made assumptions about who was responsible for health and health care; they argued that the individual and community were responsible for health, and reframed "rights" in terms of duty and citizenship. The discussion speculates on reasons for the heightened sense of personal responsibility, as well as implications it has for community health practice.
Bibliographical noteFunding Information:
While the goal of both CBOs is to “empower” people living with HIV (PLHA), they vary in size and scope. Positive Vision (PV) is the local state chapter of a nationwide consortium of CBOs started to support people with HIV/AIDS (PLHA) in India. PV was registered under the Societies Registration Act in a high-prevalence state in India in 1998, and is operated “for, by and of the people living with HIV/AIDS.” There are approximately 10 administrative staff members who manage PV’s programs, including a president, vice-president, secretary, treasurer, and advisor. It has 2,500 members, but reaches more than 10,000 people through its services. There is a nominal membership fee that members pay to belong to the nationwide consortium of CBOs. PV remains closely affiliated to the national headquarters, receiving funding and following its agenda closely; thus when necessary, I include references to the larger organization. The AIDS Care Center (ACC) was initially established as a charitable trust more than a decade ago by two visionaries, who realized the need for a community-based care center for people with HIV/AIDS. The care center provides medical, psychological, and social support for people with HIV/AIDS and their families with a combination of in-and outpatient facilities. Residents are treated free of cost, but pay for anti-retroviral therapy (ART) if necessary. The staff consists of project coordinators, counselors, doctors, nurses, social workers, and psychiatrists, and at least half of the staff is HIV+. ACC is funded by government and private sources. In keeping with its community-based vision, patients (and their visiting families) participate in the daily running of the center; for example, the gardens are taken care of by male patients, while the women help in the kitchen.
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