Contextualization of Sexual Health Behavior Among Commercial Female Sex Workers: A Study in India on the Impact of Violence

Background and Purpose:

Sexual health behavior cannot be construed as a singularly individual attribute unaffected by surrounding contextual factors. In HIV/STI intervention programs among commercial sex workers the lack of correlation between sexual knowledge and sexual behavior has been noted repeatedly. A thorough understanding of the environmental and structural factors, such as economic deprivation, violence and stigmatization, is necessary for a successful implementation of a HIV/STI prevention program among commercial sex workers. Violence is one of the primary contextual factors that significantly raise sex workers’ HIV/STI risk through being pressured by a client into unprotected sexual intercourse. The current study examines how violence affects sexual health behavior including condom compliance among commercial female sex workers in a red light district called Sonagachi in Kolkata, India. The study also discusses an innovative multilayered strategy devised by the sex workers to combat violence and successfully maintain safe sex practices.

Methods:

Ethnographic research was used for this project along with structured and unstructured interviews and participant observation. The researcher spent a total of four months over a period of three years among commercial female sex workers in Sonagachi. Data was collected from 42 subjects. Prior permission was obtained from the central governing committee of the sex workers’ union in Sonagachi before the commencement of any research work and interviewing. Institutional Review Board (IRB) research approval was also received.

Results:

Violence serves as a contextual factor that impedes condom compliance and positive health behavior on part of sex workers. The current study results indicate that the women at Sonagachi have been subject to violence perpetrated by different sources including pimps, brothel owners, law enforcement agencies, local criminals and intimate partners. But the unionization of the sex workers resulted in a drastic reduction of violence perpetrated against the sex workers. An identification of stakeholders within and outside the realm of sex work, and engaging the stakeholders in dialogue, helped in generating empathy and significantly diminishing the incidence of violence. Unionization and stakeholder negotiation thus comprise a multilayered strategy to combat violence perpetrated against sex workers and resulted in a significantly increased condom compliance rate.

Conclusions and Implications:

The findings of the study indicate a need to reassess dominant theoretical and praxis-related notions on HIV/STI intervention research among sex workers and emphasize the need to include local cultural constructions in the sex worker community. There needs to be a focus on the contextualization of health behavior by structural determinants of health like violence. Violence is often interwoven in commercial sex trade, especially when sex work is rendered illegal by a country’s legislative system. Ceaseless violence against sex workers, perpetrated by multiple sources, often precipitates condom failure, lack of condom compliance, mental morbidity, unwillingness to access health resources and a general deterioration of overall health of the sex workers. The current research contrarily shows that the sex workers can confront the system that delegitimizes, disempowers and victimizes them, and actively engage with it, in order to change their marginalized status and attain empowerment.