Exploring Sexual Health Seeking Behavior of Male and Transgender Sex Workers in Red Light Districts of Eastern India

Background and Purpose:

The purpose of this study is to examine the sexual health belief, risk perception, and decision-making behavior of male and transgender commercial sex workers in India in order to reduce HIV/STI transmission and improve healthcare seeking behavior among this population. Male and transgender sex workers comprise 15% of the sex workers’ populace in India. While a significant body of research exists on commercial female sex workers in the field of HIV/STI intervention, scant information is available on male and transgender sex workers. It is anticipated that the study will help to formulate future programmatic interventions that can cater more effectively to the health needs of the Indian male and transgender commercial sex worker population, contribute to HIV/STI risk reduction among this group and increase positive health practices. The study is expected to serve as a pilot study for future funded research of an understudied population.

Methods:

The methodology used for this project was structured and semi-structured interviewing of 38 male and transgender sex workers. Administration of an interviewer led questionnaire enabled data collection on several of the research questions. The sex work sites that were visited included a red light district in Kolkata and three red light districts located in rural areas of West Bengal, India. All communication took place in Bengali, the native language of the interviewees. No videotaping or audiotaping was performed. The interview transcripts were translated into English, transcribed and analyzed. The transcripts amounted to 187 pages of translated text. Twenty seven pages of field notes were also recorded.

Results:

The sexual identity of male sex workers in India is fluid, subject to personal interpretation and affects risk perception and sexual health behavior. The interviewed sex workers were aware of the risks of infection HIV and STI from unprotected sex. Yet condom compliance among the interviewees was significantly poor. The slippage and breakage of condoms and non-availability of condoms were the primary reasons rendering condom compliance was poor. This in addition to contextual factors like criminalization, unchecked violence against sex workers and stigmatization significantly hindered safe sex practices. Stigmatization also hindered positive health behavior like testing and screening.

Conclusions and Implications:

The results of the study hold the potential for future interventions among the male and transgender populace in India. A community based health communication intervention for increasing condom compliance by reducing the barriers is feasible in future. Interventions---for promoting condom usage, increasing their availability and providing a supply of good quality condoms that offer protection during anal sex can be designed in a future study. The adoption and usage of water based and silicone based lubricants appear to be an important factor in reducing breakage of condoms. A health communication intervention popularizing and supplying lubricants to male and transgender sex workers can be designed in a future study. The study results also show the need to design future intervention to minimize the impact of contextual barriers like criminalization, violence and stigmatization to increase positive health practices like regular screening and testing.