Exploring Pathways into Sex Work, Stigma, and Risk for HIV Among Female Sex Workers in India
live in India, with HIV prevalence among FSW in some major cities
estimated to be more than 50%. Previous studies have found that
coercive pathways into sex work may increase vulnerability to contract
HIV. Uncovering these pathways may have implications for the
effectiveness of HIV interventions targeted at FSW. This study aims to
understand the lived experiences of FSW, their pathways into sex work,
and subsequent risk factors.
Methods: In-depth, semi-structured qualitative interviews were
conducted with FSW (n=37) in Kolkata, India. Participants were recruited through convenience sampling from a sex workers’ collective, Durbar. Participants were asked
about their pathways to sex work, sexual behavior practices, service
utilization, experiences of violence or coercion, and stigma related
to sex work and HIV. Grounded theory was utilized in the data analysis. QSR 6 was used to analyze the qualitative data.
Results: Findings indicate that FSW entered sex work because: they
needed money (78%); to gain independence (20.5%); they were lured,
cheated or forced into the business (16.5%); to get out of family
violence (14%); they were advised by a relative/friend who was a sex
worker (11.5%); and/or to get out of hard work (6%). Pathways were not
mutually exclusive, and there was significant ambiguity between
voluntary and coercive pathways. Those that entered sex work through
coercive or forced pathways reported difficulty in condom negotiation
and access to care due to limited control or movement. Those that
entered out of choice or necessity often experienced high levels of
stigma which also created barriers to care.
Conclusions: Our findings indicate the need to better understand the
labor dynamics that influence sex workers to enter the profession. Our
analysis underscores the importance of creating HIV interventions that
address coercion and stigma in order to maximize the effectiveness of
programs to reduce HIV risk.