india - AIDS Data Hub

 Sex Work and HIV/AIDS in INDIA SEX WORK IN INDIA India is the home of 1.171 billion people (mid 2009). It is the second most populous country in the world, next to China. 1 Sex work is illegal in India. However, despite being prohibited by the law, sex work occurs in a larger scale compared to other countries. The Indian Ministry of Women and Child Development (2009) reported that there are 3 million sex workers in the country (up from 2.8 million in 2007). Moreover, 1.2 million children are estimated be commercially sexually exploited 2
children. (Table 1) Geographical Locations of Sex Workers: Figure 1. Map showing the areas wherein sex workers work, Where Do They Work? India
Sex workers are located in all parts of the country, with Mumbai and Calcutta being identified as the two largest brothel‐based sex industry centers, not only in India but in the Asian Region (Figure 1). Indeed, the city of Mumbai has about 100,000 sex workers, including caged sex workers. 3 Many female sex workers (FSWs) come from the states of Andhra Pradesh, Karnataka, Maharashtra, Uttar Pradesh, Tamil Nadu, and West Bengal. Others come from poor areas of foreign countries, such as Nepal and Bangladesh. 4 Male sex workers (MSWs) may be different types: heterosexual, homosexual and hijra. They work in different parts of India. In Delhi alone, there are as many as twenty “agencies” offering “handsome masseurs or gigolos” in the classified ads of one newspaper (the Hindustan Times), offering both in‐
house and off‐location services. They are now part of 5
Delhi's emerging gay nightlife scene. A large percentage of MSWs are eunuchs or hijras. Hijras live predominantly in the cities of North India, where they find the greatest opportunity to perform their traditional roles, but small groups of hijras are found all over India. Seven “houses,” or subgroups, comprise the hijra community; each of which has its own guru or leader, all of whom live in Mumbai. 6 1
Commercially sexually exploited girls are primarily located in low‐middle income areas and in business districts and are often known to officials. Bangalore and Mumbai have comparatively high proportions of commercially sexually exploited girls. Almost half of them are recruited from Assam, followed by Meghalaya, Manipur, Tripura, Nagaland, Mizoram and Arunachal Pradesh. 7 Categories of Sex Workers FSWs are usually categorized into three groups, as follows: (1) Brothel sex workers – working out of brothels, these individuals consider sex work as the major source of income for the family and can be seen as a hereditary profession; (2) Call girls – those who traditionally earn a living from entertaining through music and dance, supplemented by sex work or concubinage; and (3) Streetwalkers – those who were dedicated at a young age to the deities of some Hindu communities, also labeled as religious sex workers (Devdasi or Handmaidens). Gigolo service in India is growing, where males perform as dancers in nightclubs and hotels. They are usually heterosexuals providing sexual services to women. However, there are some gigolos who also service gay clients. An even larger percentage of MSWs who provide sexual services to men are the eunuchs or hijras. In addition to earning their livelihood as performers, hijras engage in sexual activity with men for money or for satisfying their own homosexual desires. Homosexuality tends not to be socially accepted in India, although male‐to‐male sex recently became legal. Currently, homosexual and hijra MSWs remain doubly stigmatized due to both their sexual orientation and their involvement in sex work. Hijras receive no legal protection, often face violence from the police and clients, and they are often subjected to extortion by police in order to carry on with their work. 8 Moreover, around 1.2 million children (both boys and girls) are believed to have been commercially sexually exploited, and their numbers are rising. An estimated 85% of all sex workers in Calcutta and Delhi entered or were forced into sex work at an early age. 9 A Guwahati‐based non‐government organization (NGO) revealed that 20% of commercially sexually exploited children in the northeast region are between 11 and 17 years old. 10 Drivers of Sex Work 11 In general, there are three major reasons for engagement in sex work: • Personal background – ill treatment by parents, family involvement in sex work, social customs, inability to arrange a marriage, lack of sex education, media influence, prior incest and rape, early marriage and desertion. • Economic causes – poverty and economic distress. Sex work is seen as a means of livelihood and survival by a large number of sex workers. Interviews with organized sex workers reveal that sex work provides them with more resources to meet their family needs than other occupations that are open to them, given their limited education and job opportunities. Trafficking reports maintain that “Every hour, four women and girls in India enter sex work, three of them against their will.” 12 Sex workers can be introduced into the sex trade by various types of agents, including: neighbors (either with or without the knowledge of the individual’s parents); older sex workers from same village or locality; unknown person/accidental meeting with a pimp; mother/sister/near relative in the profession; one giving false hope of marriage or job; a husband (legally or not legally married). Over 80% of these agents are known to the individuals – such as neighbors, relatives, and friends. 2
Clients FSWs have relatively high numbers of sexual Figure 2: Percentage of men aged 15‐49 who had commercial sex, partners. In one night, a sex worker could have 1 by occupation, 2005‐2006 to 6 clients, which means 7 to 42 clients a week, or 21 to 120 clients a month. Figure 2 shows that 1.1
men aged 15‐49, regardless of work status, had P ro ductio n Wo rker
0.9
Sales Wo rker
engaged in commercial sex. This practice was most 0.7
Emplo yed
evident amongst production workers and sales 13
0.7
Service Wo rker
workers. Other Wo rker
0.6
Gigolos’ services are usually availed of by women A gricultural Wo rker
0.3
from other countries, usually tourists. These P ro fessio nal
0.2
clients are visited and given services at their 0.2 Unemplo yed
hotels. 0
0.2
0.4
0.6
0.8
1
1.2
Local middle‐class Indians are increasingly using Source: IIPS, National Family Health Survey round III, 2005 – 2006
the services of MSWs and hijras. Fees/Income FSWs are stratified, with call girls imposing higher prices since they come from more privileged backgrounds, followed by brothel sex workers who are at the middle stratum. Streetwalkers, on the other hand, occupy the lowest stratum, thus earning the least, and are more vulnerable to abusive customers and officials. As a result, income varies widely with type of sex work. Sex workers operating on the street and in brothels earn between 2,000 to 24,000 rupees (US$ 43‐522) per month, whereas call girls make 40,000‐800,000 rupees (US$ 870‐
14 & 15
17,300). Fees for gigolos or MSWs are typically negotiated over the phone, and typically range from 1,000 to 3,000 rupees (US$ 21‐64). 16 Commercially sexually exploited children are usually given 150 to 300 Indian rupees (US$ 3‐7) for half an hour and 1,000 to 2,000 rupees (US$ 21‐43) for a full night. 17 SEX WORK and HIV/AIDS HIV Prevalence – Sex Workers and Clients India accounts for around 13% of global HIV infections. Nationwide, there are about 2.4 million people living with 18
HIV (2007), with an adult prevalence rate of 0.36. The country’s first cases of HIV were diagnosed among sex workers in 1986 at Chennai, Tamil Nadu. HIV prevalence among sex workers was 4.9%, in 2007, down from 9.4% in 2000. 19 One study has found that HIV prevalence ranged between 22‐38% (averaging at 14.5%) among districts in the four high‐prevalence southern states of Andhra Pradesh, Maharashtra, Tamil Nadu and Karnataka. 20 In the city of Mysore, for instance, around a quarter of sex workers are infected with HIV. 21 Figure 3 present a comparison of the HIV prevalence rates among sex workers based in major urban areas and outside major urban areas. HIV prevalence rates in major urban areas were higher from 1998 to 2001, but declined 3
from 2003 to 2005, and then increased again in 2006 (36.8%) while the HIV prevalence rates in rural areas were higher in 1992, 1993, 1994, 1997, and 2002. Figure 3: HIV Prevalence (%) among Sex Workers Inside and Outside Major Urban Areas, 1990‐2006 22 80
60
40
20
0
1990
1991
1992
1993
1994
1995
1996
1997
Major Urban Areas
1998
1999
2000
2001
2002
2003
2004
2005
2006
Outside Major Urban Areas
The 2006 Sentinel Surveillance Country Report reveals some variations in HIV prevalence over time across states (Figure 4). For instance, from 2003 to 2006, HIV prevalence among female sex workers (FSWs) had decreased in Manipur but increased in Nagaland. In southern states, HIV prevalence reduced by about one‐third from 2003 to 2006. In West Bengal, an increasing trend in HIV prevalence among FSWs in Bardhman, and Medinipur could be observed. On the other hand, the HIV prevalence at other sentinel sites in West Bengal (Kolkata and Jalpaiguri) fluctuated from 2003 to 2006. Overall, HIV prevalence among FSWs was >5% in 39 of the 123 valid sentinel sites. 23
Mizoram, Manipur, Nagaland and Maharashtra have HIV prevalence rates of >10% among FSWs . Figure 4: Trends in HIV prevalence among female sex workers in high prevalence states, 2003‐2006 Source: National Institute of Health and Family Welfare and National AIDS Control Organization, Annual HIV Sentinel Surveillance Country Report, 2006 In the 2006 Behavioural Sentinel Survey (BSS), HIV prevalence was found to be 4.4% among truck drivers – one of the most common groups of clients had by sex workers. Figure 5: HIV Knowledge and Condom Use among Female HIV Knowledge Sex Workers in India
2006 BSS findings reveal a significant improvement in HIV 88
2006
38
knowledge of sex workers. Figure 5 shows an increase in the percentage of sex workers who both correctly 2001
76
22
identified ways of preventing the sexual transmission of HIV and rejected major misconceptions about HIV from 22% in 0
20
40
60
80
100
24
2001 to 38% in 2006. Knowledge
Condom Use
Source: BSS 2001 ‐ 2006
4
BSS 2006 data also shows that 81% of FSWs (up from 66% in 2001) knew that consistent condom use, as well as having faithful and uninfected sexual partner, will help prevent HIV infection. 25 Condom Use Figure 6 reveals that the percentage of FSWs reporting the Figure 6: Percentage of brothel based vs. non-brothel
use of a condom with their most recent client is about 88% based sex workers using a condom the last time they had
(up from 76% in 2000). 26 In comparison, 94% of brothel sex with a paying client, 2006
based FSWs against 85% of non‐brothel based FSWs reported condom usage in the last occasion when they had 85
2006
sex with a paying client. 27 94
The 2000 BSS findings confirm that the FSWs’ use of a 80
85
90
95
condom with their most recent client vary per region. The Brothel Based
Non‐Brothel Based
southern region has the highest percentage with 96%, followed by the northern region with 94%, and the north‐ Source: BSS 2006
eastern region with 77%. 28 On the other hand, the proportion of MSWs who used a condom the last time they had sex with a commercial partner within the last month was highest in Calcutta (64%) and lowest in Delhi (41%). In all states, the highest proportion of respondents who used condom the last time with commercial partner was reported in Goa (87%t) and lowest in Uttar Pradesh (13%). 29 NATIONAL RESPONSE TO SEX WORK AND HIV 30 Figure 7: Percentage of sex workers reached by HIV
HIV Prevention Programs – Coverage and Impacts prevention program, 2001-2006
56
In 2006, 56% of FSWs reported that, in the past one year, 2006
47
someone had approached them to educate them on 2001
STI/HIV/AIDS. In addition, nearly one‐third of the FSWs 40
45
50
55
60
(against one‐fourth in 2001) reported Reached by the Program
attendance/participation in some campaign meetings on 31
STI/HIV/AIDS in the past one year. Figure 7 shows that more sex workers were reached by the HIV prevention programs in 2006 than in 2001 (56% versus 47%). 32 Brothel based FSWs are better reached than their street based counterparts and have higher levels of reported awareness about HIV, testing, and condom use. 33 In Mumbai in 2006, 38% of FSWs (up from 28% in 2001) have been tested for HIV, among whom 91‐99% received their results. 34 Partner Agencies 35 India’s partners working closely in responding to the HIV epidemic include multilaterals (UNICEF, UNAIDS, UNFPA, UNODC, ILO, UNDP, WHO, World Bank, GFATM), bi‐laterals (DFID, EC, USAID, AusAid, etc.), International NGOs (e.g. Catholic Relief Services, Population Services International, Family Health International, etc.), foundations (e.g. Clinton Foundation, Gates Foundation) and private players including industry.36 India needs coherent support to meet both national and international targets. HIV‐AIDS Expenditures 37 5
India is spending increasing amounts of funds on HIV, with an upward trend in domestic spending from 2004‐2005 to 2006‐2007 (by 61%). Prevention received more than half (54%) of the USD 171 million total expenditure for 2006‐2007. HIV spending in India has seen a growth of 26% and 28% in 2005‐2006 and 2006‐2007, respectively. Obstacles a nd Challenges S ex work is illegal in India, and yet brothels are widespread. HIV prevention programs target sex workers but the context of sex work is complex, and the enforcement of outdated laws often acts as a barrier against effective HIV prevention and treatment efforts. In addition, while educating people about HIV/AIDS and prevention has been effected at the national level, state and local levels are lacking in this area. Stigma and discrimination against people living with HIV/AIDS and those considered to be at high risk prevail. In fact, stigma and denial undermine efforts to increase the coverage of effective interventions among high‐risk groups, including sex workers. Capacity building should be done to avoid harassment by police and ostracism by family. Directly involving the sex workers would allow communities to address the epidemic, as well as increase the reach and effectiveness of prevention efforts. New approaches are needed in order to reach the high‐risk groups, in particular sex workers and their clients, with information about HIV/AIDS, safe sex, and how to prevent and treat HIV/AIDS. Expanding access to effective prevention programs must be undertaken in the states where infection rates are highest, and along the nation’s .38
major trucking routes Continuous researches should be done. Networking and better management of data are required for effective monitoring of the HIV prevention programs in India. 6
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14
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21
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24
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25
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26
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29
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30
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31
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34
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35
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36
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37
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38
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