Sex workers on the frontline of the AIDS response in India
07 July 2011
In a densely packed sub-urban township far away from Lutyen’s Delhi, at a small house encased in a cacophony of concrete flats, about 20 women engaged in sex work got together to share their experiences of the AIDS response. “How do we appear to you,” asked Ms Munni to the visiting UNAIDS Executive Director Michel Sidibé. “Like me, like any one of us,” he replied, in turn getting wide beaming smiles from all the women, for being accepted as part of society.
Mr Sidibé’s was interacting with sex workers on 6 July, just weeks after United Nations Member states adopted an historic political declaration on AIDS in which they recognized explicitly for the first time that prevention strategies inadequately focus on populations at higher risk—specifically men who have sex with men, people who inject drugs and sex workers. Much of the sex work in East Delhi is not run through organized brothels but operates on the streets and in homes. This nature of sex work is not unique to Delhi, but a regular feature in most cities and towns of India, making it difficult to reach men and women engaged in sex work with HIV prevention and treatment services.
Outreach programme supports sex workers
With no support structure, women sex workers often face violence at the hands of their male clients. “Sometimes our clients take us to their rooms and invite their other friends over. We are forced to have sex with them and drink alcohol. When we resist we are beaten up,” said Ms Reshma. She has been a sex worker for the past three years and now also works as a peer educator at the sex work outreach programme run by the Society for Service to Voluntary Agencies (SOSVA). Ms Reshma’s role as a peer educator involves providing health education and counselling as well as promoting condom use and facilitating health referrals to her fellow sex workers. The organization provides HIV prevention and treatment services for nearly 1 000 sex workers.
I am nineteen and just passed out of school. I sell sex, because I have to take care of my three younger sisters. My job in a call centre did not fetch me enough.
Ms Reenu, who works as a sex worker in East Delhi
Condom use in the project area has risen, and rates of sexually transmitted infection have fallen in the last two years. “Most of our clients ask to use condoms. Those who don’t, we convince them to do so,” said Ms Reshma. What if the clients offer more money for sex without use of condoms? “We cannot risk our future lives for the sake of a thousand rupees [approx. US$ 20] more,” Ms Munni states emphatically.
The sex workers have about ten clients a week, and often use a network of brokers to obtain their clientele. These brokers retain about 50%-60% of the fees charged to the client. “Sex workers find it safe to operate in my house as I am able to protect their identity and also provide a safe space to have sex for the women—as well as the clients,” said Ms Lali, a broker who also sells sex herself out of her residence.
You are at the frontline of the AIDS response and with your support we will reach our vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.
Michel Sidibé, UNAIDS Executive Director
Most of the sex workers are married and many of their partners either do not know about their wives involvement in sex work, or remain silent. “I am sure he knows about, but to keep the family peace he is quiet about it,” said Ms Shahana. “I am nineteen and just passed out of school. I sell sex, because I have to take care of my three younger sisters. My job in a call centre did not fetch me enough,” said Ms Reenu to Mr Sidibé.
Changing nature of sex work
The nature of sex work has changed rapidly in the area with the increased use of mobile phones by women and brokers to sell sex. “Providing prevention and treatment services have become difficult as we cannot easily identify the women anymore,” said Ms Nazish Musthafa, the Progamme Manager of the outreach project. “Even when we make contact, we often lose them to follow up as they keep changing their mobile phones to avoid harassment and violence from past clients.”
Another evolving trend is the entry of school girls into sex work. Most of the peer educators in this project counsel girls, but are often helpless to stop them from being exploited. “There is now a new trend—sex work for lifestyle,” said Mr Shalabh Mittal, from an agency that provides technical support to organizations involved in AIDS programmes in Delhi State. “Many young women are entering into sex work as choice and reaching them with HIV prevention services is proving to be a challenge.”
Commending SOSVA and the sex workers for their contribution to the AIDS response Mr Sidibé said, “You have given dignity and respect to women. You are at the frontline of the AIDS response and with your support we will reach our vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.”
Civil society role
Later in the day Mr Sidibé held meetings with representatives of civil society and the pharmaceutical industry. At the meeting with civil society organizations, they called for UNAIDS support in ensuring that the next national AIDS plan is evidence-informed and inclusive of the needs of communities. Recognizing that the next plan will determine the course of the epidemic in India, Mr Sidibé promised to provide necessary technical support and high level advocacy support.
Future of pharmaceutical industry
At an interactive forum organized by Federation of Indian Chambers of Commerce and Industry (FICCI), members from pharmaceutical industry, government and civil society highlighted the need to ensure that India remains a reliable supplier of quality generic drugs. Mr Sidibé urged for innovation in development of new drugs. He emphasized that the demand for HIV treatment will grow as more people become eligible for treatment and choose to use Treatment for Prevention.
India’s policies will determine, not just the course of the epidemic in India, but also in Africa
Michel Sidibé, UNAIDS Executive Director
Commenting on the changing landscape of the Indian pharmaceutical industry Mr D.G. Shah, President of the Indian Pharma Alliance and Co-Chairman, FICCI Pharma Committee said, “We need holistic approach to understand the threats to Indian Pharmaceutical Industry comprising global forces, political pressures, MNC’s acquisitions and blind imitation of regulatory requirements of developed nations.” He called for trade agreements to be balanced and for technical support in helping developing countries in using TRIPS flexibilities and negotiating fair trade agreements. “Most of the developing countries face constrains of institutional framework to operationalize the policies e.g. lack of operational guidelines for practicing compulsory license. Apart from Free Trade Agreements, there are many other non-tariff barriers for generic drugs such as pressures for adoption of ISE guidelines for drug regulatory approval,” Mr Shah added.
“The Competition Commission of India will closely watch the domestic pharma industry and we will not allow anyone to create dominance and exclusivity in Indian markets, including pharmaceuticals,” said Ms. Renuka Jain Gupta, the Director of the Competition Commission of India.
Wrapping his trip to India Mr Sidibé said, “India is now poised to be a major player in the global AIDS response. India’s policies will determine, not just the course of the epidemic in India, but also in Africa.”