In-House Sex: The Role Brothels Play in Reducing HIV Risk Among Sex Workers in the Sonagachi Project, India

Purpose: The low prevalence of HIV (about 11%) among sex workers in Calcutta is in sharp contrast to the 50 to 90% HIV prevalence among sex workers in Indian cities like Bombay, Delhi and Chennai. The proportion of sex workers in Calcutta reporting use of condoms rose from 3% in 1992 to 90% in 1999. The significantly low rate of HIV infection and high rate of condom use among sex workers in Calcutta has been attributed to the Sonagachi Project Intervention (SPI) which utilizes sex workers engaging in HIV education, formation of community-based organizations and advocacy around sex work issues. While scholars have described the community-led structural intervention (CLSI) aspects of SPI, efforts to replicate and sustain it in other sites have met with varying degrees of success. Notably, the Gates Foundation-funded initiative to replicate the intervention with sex workers in other states in India has been unable to reproduce the collective mobilization and HIV-related behavior change that have been documented in Sonagachi. This paper argues that scholarship and replication initiatives have ignored the key role brothel housing has played in helping the intervention take root in Sonagachi. This research documents the manner in which brothels have mediated the effects of SPI.

Methods: In-depth qualitative interviews were conducted in Bengali among 45 female sex workers involved in SPI in 2005. Subjects were recruited using convenience sampling methods through the membership list of Durbar Mahila Samanwaya Committee (DMSC), the sex workers' collective that implements the intervention among its peers. Subjects included 5 madams (female brothel managers), 10 street-based sex workers and 30 brothel-based sex workers. Data were supplemented with documentation on housing and sex work from the archives of DMSC.

Results: The results indicate that brothel-based sex workers with stable housing engaged in lower levels of HIV risk behavior than street-based sex workers. Brothels helped to amplify the SPI intervention by: 1) serving as targeted sites for intervention efforts, 2) structuring the economic transactions related to sex work and thus standardizing sex-related behavior expectations, 3) creating an incentive for brothel-owners to promote the health of residents, and 4) promoting sex worker networks and community mobilization, thus enhancing the ability to negotiate condom-use. In contrast, street-based sex workers were at greater risk of infection because they 1) could not be efficiently targeted by SPI, 2) operated in social and professional isolation from other sex workers, and 3) were easily targeted by the police, customers and predatory pimps.

Implications: The results have implications for sustaining and replicating a successful CLSI such as SPI. The role played by brothels emphasizes the need for safe housing in a CLSI that seeks to reduce HIV risk among sex workers. Brothels need to be re-conceptualized as sites that have to be incorporated into structural interventions with sex workers. Moreover, street-based sex workers need to be housed in safe brothels for SPI to be successfully replicated. Current efforts to replicate SPI internationally will fail without making safe brothel housing the centerpiece of the intervention.