Study Says Addressing Vulnerabilities Of Female Sex Workers Key To HIV-Prevention
Vulnerabilities of female sex workers (FSWs) should not be seen from the context of sex work alone, rather their structural, social and financial vulnerabilities need to be addressed to provide them with a safe and enabling environment.
This was the among the key conclusions of a landmark study undertaken by researchers from the National Institute of Rural Development and Panchayati Raj, Hyderabad, and Population Council, an international nonprofit that conducts research in public health and biomedicine. The research found that 55% of sex workers surveyed were vulnerable. The study was published in the prestigious journal of PLoS ONE and the findings have important policy implications for programs working with sex workers.
Titled ‘Measuring vulnerability among female sex workers in India using a multidimensional framework,’ the study was conducted in four Southern States (Andhra Pradesh, Telangana, Karnataka, Tamil Nadu) and a Western (Maharashtra) State.
The four Southern States were chosen as they are historically known for high HIV prevalence, and large number of FSWs. The HIV prevalence among FSWs in Andhra Pradesh/Telangana and Karnataka is around 6% each, 7% in Maharashtra, 1% in Tamil Nadu. The living condition of FSWs in these areas was one of the poorest with a large proportion of FSWs being exposed to harsh socio-environmental stress such as lack of proper health care and security. Nearly half the FSWs in Maharashtra, two-thirds in Andhra Pradesh and Telangana, one-fifth in Karnataka and two-fifth in Tamil Nadu depended solely on earnings from sex work to make a living.
Measurement of vulnerability and identifying the context leading to vulnerability is important for strategic planning for any intervention. FSWs in India face multiple vulnerabilities by nature of their profession.
Speaking about the importance of this study, Dr. Ruchira Bhattacharya, Assistant Professor, Centre for Gender Studies and Development, NIRDPR, said, “this study is of profound importance to a range of development enthusiasts, starting from research scholars who are looking for an appropriate methodology to measure multidimensional vulnerability, to the policy makers who are designing solutions for public health and need appropriate, comparable and yet simple measures to monitor the situations of extremely marginalized communities.”
The study found that not having insurance, in particular, was a key factor in defining the financial vulnerability of the sex workers. Given the increasing emphasis on ensuring access to insurance for all individuals by the Government of India, this is yet another opportunity for the policymakers to leverage and provide this vulnerable group with financial security.
It was found that lack of insurance contributed most (32%) to financial vulnerabilities, followed by lack of savings or investment in gold, land or property (26%),lack of alternative income other than sex work (20%) and not having saving accounts in bank orpost office (16%). Loan from an informal source contributed only 6% to the overall vulnerabilities.
Lack of awareness of their legal rights is another area which needs to be addressed, which will enable them to become more resilient to exploitation.
The study revealed that the absence of social support and network contributed about one quarter to the overall vulnerability level. The absence of social coherence – as indicated by the reluctance of community members to come together to offer aid to the FSW in times of crises – alludes to the need for concerted efforts to building community collectivization.
In addition, the findings suggested that 23% of the vulnerabilities among FSWs were due to their personal attributes, with their degree of dependency and being mobile/migrant for sex work contributing to 42% and 34% of the vulnerabilities respectively. Street based solicitation contributed to only 4% of the overall vulnerability, claimed the study.
The study also showed positive associations between vulnerability and HIV-related sexual risk factors suggesting that addressing vulnerabilities of FSWs would eventually lead to better HIV risk behavior among them.
The highest vulnerability was among sex workers surveyed in Maharashtra. The study also found that vulnerable FSWs were more likely to engage in risky sexual behaviors. The research is of profound importance for health policy enthusiasts, as higher vulnerability means a greater chance to engage in behaviors that put them at risk of sexually transmitted infections.
Intervention programs need to adopt a multi-pronged strategy to address multidimensional vulnerabilities and should be specifically designed to address financial vulnerabilities. This can be achieved by facilitating access to formal financial services and helping them to increase their saving habits and make investments in different movable and immovable assets. This study demonstrated that a multidimensional approach to measuring vulnerabilities among FSWs may help in identifying a range of factors that can be prioritized by interventions.
In light of the fact that India has been dealing with an HIV epidemic and FSWs continue to be one of the core sources of transmission, the existing interventions aimed at HIV-prevention among this group must continue uninhibited. Further strengthening of these efforts will require the system to address some of the vulnerabilities as mentioned in this study. This will enable and empower the FSWs to adopt safe and free behavior without any compulsion or fear. The first step in this direction is identifying vulnerable FSWs and measuring the degree of vulnerability faced by them.