Dr. Ritu Bala1*, Dr. Chetna Yadav2
1Asstt. Prof., Department of Social Work Punjabi University, Patiala
2Ph.D. Scholar, Department of Social Work Punjabi University, Patiala
*Corresponding Author E-mail: dr.ritusharma71@gmail.com
ABSTRACT:
Sex work is considered to be an oldest profession which has its roots in almost every society. Sex work not only fulfilled the desires of male but also generated revenue for the state and in turn got the protection from the state (Prakash, H., 2013). However, the tag of a “profession” itself does not save the sex workers, both male and female from the problems associated with the profession. The notion that sex work is a “work” is an attempt to make the harm invisible. Before becoming sex worker, the sex workers face financial, social and marital problems which force them to accept sex work as a profession. After entering into the profession, their social and economic problems continue and along with these problems they face lot of health problems as well due to the nature of the profession. Therefore, there is a need to highlight the problems which sex workers encountered during the course of their profession.
INTRODUCTION:
Women in India are involved in sex work either involuntarily, often due to economic reasons or are forced into sex work. Women who join sex work belong to a particular social, caste and class groups; illiteracy, failure of family support and lack of ability to fulfill their basic needs are the key factors for adopting sex work. Trafficking of women and children is other reason for the increasing numbers of girls and women entering the sex trade in India. Women join sex work both voluntary
and involuntarily. Women who join sex work voluntarily are due to poverty or family pressure whereas women who join sex work involuntarily are due to trafficking, coercion or traditional practices. It has been documented that sex work in India is largely involuntary. Gender-based inequities in terms of education and employment, financial constraints and cultural practices are some of the causes for entering into sex work (Saggurti, Nirjan, Sabarwal,Shagun, Verma, Ravi, Halli, Shiva, and Jain, Anirudh, 2011).
OBJECTIVE:
The objective of the study was to study the socio economic and health problems of the female sex workers registered under Targeted Intervention (TI) project of Punjab State AIDS Control Society (PSACS), Punjab.
Since the objective of the study was to explore the problems faced by female sex workers, therefore, problems were categorised into three categories i.e. social, economic and health problems and the findings of the study have been presented in the following tables:
Sex workers are equally vulnerable population as other at-risk individuals, but they are not given same amount of attention, protection, and respect. The reasons for prostituting may not be taken into account before they are judged as unworthy of attention, protection, and respect. Rather, most communities have a tendency to blame female sex workers and their circumstances. As a result the humiliation and discrimination experienced by these women is present in almost every community (Francis, Halcyon, 2015). Not only the society in general is insensitive towards their circumstances and problems, but police also ignores the complaints of female sex workers related to family and partner violence. Instead of giving them protection they advise them to stop sex work and resolve the matter ‘amicably'. Moreover, violence and discrimination against sex-workers in India is linked to the perception that sex workers are criminals and not citizens. This has led to systemic, systematic and large scale violation of human and fundamental rights such as the right to life, dignity, equality, equal protection and due processes under the law (Pai, Aarthi et al., n.d.). In the light of this background, the researchers have tried to jot down the social problems such as discrimination by the society, discrimination in access and utilisation of health services, discrimination by husband and family, harassment by the police and violence faced by the female sex workers in the state of Punjab.
i) Discrimination by the Society: Discrimination and violence are major social problems faced by the female sex workers and under the present study, boycott by the society, derogatory comments by the neighbours, denial of various memberships and denial of taking part in religious ceremonies were included to understand the discrimination faced by the female sex workers by the society. The data relating to this has been presented in the table-1.
Data on discrimination faced from society by female sex workers in table 1 highlighted that none of the respondents in all the three districts faced any boycott from the society ever. On being asked about the use of derogatory comments by the neighbours’ majority of the respondents i.e. 95.7 shared that they have never experienced any derogatory comments or behaviour from their neighbours whereas 4.3 percent of the respondents reported use of derogatory comments by their neighbours. Data also highlights that the respondents were never stopped from becoming a member of political group and restrained to take part in any religious function. The reason behind not facing any discrimination from society seems to be the type of sex work which is home based sex work and in the garb of family, the respondents’ status as sex worker in the society is not revealed.
|
Boycotted from society |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
- |
- |
- |
- |
|
No |
100(100) |
100(100) |
100(100) |
300(100) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
|
Use of derogatory comments by neighbours |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
- |
10(10) |
3(3) |
13(4.3) |
|
No |
100(100) |
90(90) |
97(97) |
287(95.7) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
|
Denial to take part in religious functions |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
- |
- |
- |
- |
|
No |
100(100) |
100(100) |
100(100) |
300(100) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
|
Denial to be a member of political or religious group |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
- |
- |
- |
- |
|
No |
100(100) |
100(100) |
100(100) |
300(100) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
Figures in parenthesis represents percentage.
ii) Discrimination in access and utilisation of services: Due to stigma attached to the profession, there is possibility of discrimination in access and utilisation of the basic social services such as health, education and social security by the female sex workers even if they are aware about the services (Family Health International, 2009). Table 2 highlights the data about the discrimination in access and utilization of social services if any.
From all the three districts all respondents i.e. 100 percent shared that they were never denied access to govt. schemes, were never restrained to avail their voting rights and admission to their children in schools was also never denied. Data on denial of medical facility highlighted that only eight percent of the respondents were denied health care services however majority of the respondents i.e. 92 percent were having access to medical facilities. As far as denial of health services was concerned in all the three districts only eight percent of the respondents reported denial of the health services. The reason behind this could be the moral judgment about their sexual behaviour and labelling them as a carrier of HIV virus which itself is the source of stigma for female sex workers. Studies have reported that though female sex workers have been identified as one of the key population in the spread of the HIV epidemic and need medical services on priority basis for that, yet there are stigmas attached with services available also which create a barrier to avail the services by the female sex workers. Although government hospitals and nongovernmental organisations are generally more accessible financially, yet they do not provide adequate services or drugs. Female sex workers reported that they were degraded and criticized, not examined properly, forced to undergo HIV tests, overcharged for services at private hospitals, denied medical services and delivery care, and even their identity was revealed to others in the community. While going through the stigma and discrimination, respondents also adopted some coping strategies such as leaving the place when faced with abuse, avoiding perpetrators or situations where there is possibility of getting stigmatized and abused; and not going out alone or going out with peers (Samuels, F., and Verma, R., n.d.).
|
Denial of government schemes |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
- |
- |
- |
- |
|
No |
100(100) |
100(100) |
100(100) |
300(100) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
|
Denial to children's admission in schools |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
- |
- |
- |
- |
|
No |
99(99) |
93(93) |
88(88) |
280(93) |
|
NA |
1(1) |
7(7) |
12(12) |
20(7) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
|
Denial of voting rights |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
- |
- |
- |
- |
|
No |
100(100) |
100(100) |
100(100) |
300(100) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
|
Denial of medical facility |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
6(6) |
10(10) |
7(7) |
23(8) |
|
No |
94(94) |
90(90) |
93(93) |
277(92) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
Figures in parenthesis represents percentage.
|
Criticism from husband |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
67(67) |
55(55) |
46(46) |
168(56) |
|
No |
32(32) |
38(38) |
42(42) |
112(37) |
|
NA |
1(1) |
7(7) |
12(12) |
20(7) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
|
Abandoned by husband/family |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
- |
3(3) |
10(10) |
13(4) |
|
No |
99(99) |
90(90) |
78(78) |
267(89) |
|
NA |
1(1) |
7(7) |
12(12) |
20(7) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
Figures in parenthesis represent percentage.
Data collected from those respondents who were married highlighted that majority of them i.e. 56 percent never faced any criticism from their husband in terms of their profession followed by 37 percent of respondents who faced criticism from their husband due to their profession. Seven percent of the respondents were in the category of N.A. Similarly the data on abandonment of married respondents by their husbands or families highlighted that majority of the respondents i.e. 89 percent were never abandoned by their husband whereas four percent shared that they were abandoned. Seven percent of the respondents were in the category of N.A. The reason is that home based sex workers operate mainly secretly. Therefore, there are always higher chances of their hidden identity from their family members. However, if a client is visiting again and again the sex worker, then only there are chances of her identity to be revealed in front of the family members. But mostly, home based female sex workers do not operate from home and hire different places for sex work or go with the client at the place of client’s choice. That is why in the present study covering home based female sex workers; majority never faced any discrimination from family and society.
iv) Harassment by the Police:
Stigma of criminalisation has been associated with sex work in most parts of the world. Sex workers are considered as criminals and often face harassment inflicted by police officials. The police threatens sex workers to reveal their identity in the society, frighten them with raids and in turn demand money and sexual advances from the female sex workers (Samules, F.,and Verma, R.,n.d.). Since harassment by the police is a common practice in sex work, therefore it is imperative to seek information on the harassment caused by the police in the study of female sex workers and the data relating to this has been presented in table 4.
The data highlights that majority of the respondents i.e. 97.3 percent were never harassed by the police however 2.7 percent of the respondents reported to be harassed. Reason again here seems to be the hidden identity of female sex workers in the garb of family. Along with that, home based sex workers also have a strong network of pimps and other professional friends. Due to which, they also somehow manage the police.
v) Violence faced by female sex workers:
Across the globe, violence perpetrated against sex workers is common and associated with an increased risk of acquiring HIV. Sex work in itself is one of many kinds of violence against women, but it is often not clearly understood as such. The relationship between violence and sex work works both ways. The underline assumption in sex work is that sex is an involuntary right of men and it is something which can be purchased. Along with that, it treats women as an object or a commodity which can be purchased by a men and ignore the right of a woman as a person (United Nations Programme on HIV and AIDS, 2014).Violence as defined by World Health Organization (WHO) is the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that results or has a high likelihood of resulting in injury, death, sexual or psychological harm, mal-development or deprivation of liberty. World Health Organization has described various forms of violence such as physical, sexual and emotional (World Health Organization, n.d.). And the perpetrator of violence is a person who perpetrates, or commits, an illegal, criminal, or evil act. He/she is often a suspect until it has been proven that he or she carried out the offense (Perpetrator revisited, 2016). Some perpetrators specifically target sex workers to “punish” them in the name of upholding social morals, or to scapegoat them for societal problems, including HIV (World Health Organization, n.d.).Since violence and sex work go hand in hand, therefore it is imperative to jot down the data on violence faced by female sex workers. For the purpose of the present study, World Health Organisation’s classification of violence has been used for knowing the type of violence faced by female sex workers and their responses have been represented in table 5.
|
Harassment caused by police to respondents |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
1(1) |
6(6) |
1(1) |
8(2.7) |
|
No |
99(99) |
94(94) |
99(99) |
292(97.3) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
Figures in parenthesis represents percentage.
|
Type of violence faced by female sex workers |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Emotional/psychological abuse |
12(12) |
23(23) |
6(6) |
41(13.7) |
|
Physical violence |
7(7) |
2(2) |
14(14) |
23(7.7) |
|
Verbal abuse |
81(81) |
75(75) |
51(51) |
20(69)7 |
|
Sexual abuse |
- |
- |
29(29) |
29(9.7) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
|
Perpetrators of violence against female sex workers |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Clients |
22(22) |
17(17) |
34(34) |
73(24) |
|
Police |
11(11) |
9(9) |
16(16) |
36(12) |
|
Family members |
31(31) |
18(18) |
16(16) |
65(22) |
|
Pimp |
5(5) |
19(19) |
13(13) |
37(12) |
|
All of the above |
19(19) |
21(21) |
13(13) |
53(18) |
|
No response |
12(12) |
16(16) |
8(8) |
36(12) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
Figures in parenthesis represents percentage.
|
Causes of violence against female sex workers |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Asking for condom use |
25(25) |
20(20) |
19(19) |
64(21) |
|
Asking for payment after sex |
48(48) |
30(30) |
35(35) |
11(38) |
|
Unannounced accompanied clients |
11(11) |
16(16) |
11(11) |
38(13)) |
|
Alcohol consumption by client |
6(6) |
15(15) |
21(21) |
42(14) |
|
Closeness with other clients |
10(10) |
19(19) |
14(14) |
43(14) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
Figures in parenthesis represents percentage.
Data on the violence experienced by the respondents highlights that majority of the respondents faced violence in one form or other. It was reported that majority of the respondents i.e. 69 percent experienced verbal abuse from their clients followed by emotional and psychological abuse (13.7 percent), sexual abuse (9.7 percent) and physical violence (7.7 percent). Similarly the data on perpetrators of violence highlights that in majority of the cases i.e. 24 percent in all the three districts, perpetrator of violence were clients followed by family members (22 percent), police and pimp (12 percent). 18 percent of the respondents shared that all the above mentioned parties perpetrated violence against them. However, 12 percent respondents did not respond to the question. Sex workers are either viewed as women “in need of rescue and rehabilitation” or as “criminals” as the laws around sex work in India is ambiguous, deeming it, neither illegal nor legal. Violence against female sex workers is common and accepted by many. Law enforcement agencies and laws on sex work often fail to protect female sex workers which often increase the risk of violence against them. Violence is also perpetrated by pimps, clients, family members and regular partners and compromises Sexual and Reproductive Health (SRH), increasing chances of unwanted pregnancies, STI and HIV (Mazumder, Nandini, 2016).
vi) Causes of violence:
Sex work is stigmatized profession due to which sex workers face lot of violence in their personal and professional relationships. Usually, violence against female sex workers is usually associated with inconsistent condom use or lack of condom use, and with increased risk of sexually transmitted infections and HIV (World Health Organization, n.d.). Therefore, it is essential to note down the reasons behind the violence against female sex workers. Keeping this in mind, the respondents were asked about the causes of violence they ever faced and the obtained information has been presented in table 6.
On being asked about the causes of violence, majority of the respondents i.e. 38 percent reported to face violence from the clients and the reason was non-payment after sex work followed by 21 percent of the respondents who asked their clients to use condom, alcohol consumption by the client in 14 percent of the cases and 14 percent of the respondents reported closeness of respondent with other clients and in case of 13 percent of the respondents, it is unannounced clients who accompanied with regular client. Female sex workers face high levels of violence, stigma, discrimination and other human-rights violations. Violence against sex workers is associated with inconsistent condom use or lack of condom use, and with increased risk of STI and HIV infection. Violence also prevents sex workers from accessing HIV information and services. They may face violence because of the stigma associated with sex work, which in most settings is criminalized, or due to discrimination based on gender, race, HIV status, drug use or other factors. Most violence against female sex workers is a manifestation of gender inequality and discrimination directed at women (World Health Organisation, n.d.).
Data on alcohol consumption by the clients during sex work highlighted that majority of the respondents i.e. 44 percent reported that their clients take alcohol occasionally during sex followed by 40 percent respondents who shared that their clients take alcohol regularly whereas 16 percent respondents shared that their clients never consume alcohol during sex. On being asked about the enforced alcohol consumption by the clients during sex majority of the respondents i.e. 66 percent reported that their clients do not ask them to take alcohol with them whereas 34 percent shared that their clients ask them for alcohol intake. The data on impact of alcohol consumption on client’s ability and willingness to use condom after alcohol intake highlighted that majority of the respondents i.e. 69 percent felt that alcohol intake affected their clients ability and willingness to use condom whereas 31 percent reported that it did not affect the situation. Various studies have shown that alcohol dependence has been associated with decreased ability to adopt safe sexual behaviour and, depending upon individual cognitive abilities and fears, it may foster risky sexual behaviours. It has also reported that clients drink to feel confident about having sex and expect to feel disinhibited, and drinking to feel disinhibited was significantly associated with non-use of condoms (Sivaram, Sudha et al., 2007).
Poverty is one of the main causes which push woman towards sex work. Economically depressed woman with low education level become victims of sex work (Gadekar, Umesh, 2015). Various studies carried out on female sex workers reveal that poverty is the one of the major reasons for women’s entry into sex work. They face economic problems both before and after entering in to the profession. They enter into sex work thinking that life will change after that. However due to hidden and illegal status most of the sex workers live the same life and some times worse than before. But after getting in to sex work, they do not have option to go back because of stigmatisation and immorality attached to it. Their economic problems continue to be more or less the same because they have to give share to various people involved in or associated with sex work like pimps, police, family members, and influential out of their earnings. As far as earning of the respondents was concerned, it was reported to be between Rs. 5000/- to Rs. 10,000/- p.m. depending upon the client volume but their expenses were also in proportion with their earnings and they were left out with very small amount for their personal use and to save for their future. Since economics play an important role therefore it is important to note the economic problems of the respondents. For the purpose of the present study, economic problems such as poverty, less payment, household expenses, debt, and rent for sex work place were taken into account and the data relating to this has been presented in table 8.
|
Alcohol consumption during sex work by the client |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Regularly |
34(34) |
56(56) |
30(30) |
120(40) |
|
Never |
15(15) |
9(9) |
24(24) |
48(16) |
|
Occasionally |
51(51) |
35(35) |
26(26) |
132(44) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
|
Enforced alcohol consumption by the clients |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
35(41) |
21(23) |
30(39) |
86(34) |
|
No |
50(59) |
70(77) |
46(61) |
166(66) |
|
Total |
85(100) |
91(100) |
76(100) |
252(100) |
|
Impact of alcohol on client’s ability and willingness to use condom |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
65(76) |
71(78) |
50(66) |
175(69) |
|
No |
20(24) |
20(22) |
26(34) |
77 (31) |
|
Total |
85(100) |
91(100) |
76(100) |
252(100) |
Figures in parenthesis represents percentage.
|
Economic problems |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Poverty |
25(25) |
20(20) |
26(26) |
71(24) |
|
Less payment |
30(30) |
18(18) |
21(21) |
69(23) |
|
Household expense |
20(20) |
13(13) |
18(18) |
51(17) |
|
Debt |
12(12) |
21(21) |
16(16) |
49(16) |
|
Rent for sex work places |
13(13) |
28(28) |
19(19) |
60(20) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
Figures in parenthesis represents percentage.
|
Are you suffering from any disease? |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
74(74) |
64(64) |
53(53) |
191(64) |
|
No |
26(26) |
36(36) |
47(47) |
109(36) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
|
If yes, what type of disease |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
General medical ailments |
55 (74) |
46(72) |
44(83) |
145(76) |
|
Psychiatry ailments |
6(8) |
8(13) |
5(9) |
19(10) |
|
Sexually Transmitted Infection and HIV/AIDS |
13(18) |
10(16) |
4(8) |
27(14) |
|
Total |
74(100) |
64(100) |
53(100) |
191(100) |
|
Place of treatment |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Govt. hospital/dispensaries |
97(97) |
79(79) |
33(33) |
209(69.7) |
|
Homeopathy/Aurvedic/Unani |
- |
1(1) |
- |
1(.3) |
|
Private allopathic doctor |
3(3) |
18(18) |
63(63) |
84(28) |
|
Home remedy |
- |
2(2) |
4(4) |
6(2) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
Figures in parenthesis represents percentage.
Data on economic problems faced by the respondents highlighted that in all the three districts majority of the respondents i.e. 24 percent cited poverty as their major economic problem followed by less payment from sex work (23 percent), rent for the place for sex (20 percent),household expenses (17 percent), and debt (16 percent). District wise data highlighted that in district Amritsar majority of the respondents i.e. 30 percent cited less payment, in district Ludhiana majority of the respondents i.e. 28 percent mentioned rent for sex work place whereas in district Jalandhar 26 percent of the respondents shared poverty as their major economic problems. Other economic problems faced by the respondents in district Amritsar were poverty (25 percent) household expenses (20 percent), rent for sex work place (13 percent) and debt (12 percent). Whereas in district Ludhiana economic problems faced by the respondents were debt (21 percent), poverty (20 percent), less payment (18 percent) and household expenses (13 percent). Females enter into sex work due to various reasons – for example to support the family financially, building the house, meeting the household expenses for themselves, children, to maintain the social status, to pay debt. It is considered as a strategy where marginal people can earn more money than they would be otherwise. However, there is a cost involved in maintaining the profession as well. They spend their money in meeting the household expenses, maintaining their beauty, transportation, communication with clients and other networks, bribe to police and many more. Therefore, the significant proportion of their income goes into expenses than in saving (Katsulis, Yasmina, 2006).
ix) HEALTH PROBLEMS:
Female sex workers face considerable vulnerability to Sexually Transmitted Infections (STIs) and HIV infection due to their occupation, social marginalization, and lack of control over condom use. They also lack access to information and services due to actual or perceived fear of rejection, stigma and discrimination by health care providers. The same factors also make them vulnerable to unintended/unwanted pregnancies, resulting in high rates of abortion (India HIV/AIDS Alliance, 2012). Even in United Nations Programme on HIV and AIDS, 2012, it was reported that there is great impact on the health of women having sex work as a profession. Majority of them suffer from diseases such as sexually transmitted diseases and HIV/AIDS. Before highlighting the status of female sex workers in terms of HIV/AIDS and STI, it is very important to discuss about the general health ailments of the respondents. Table 12 highlights the data on health status of female sex workers.
Data on health status of the respondents represented in table 9 highlights that majority of the respondents i.e. 64 percent were having health problems such as fever, joint pain, headache, low blood pressure whereas 36 percent respondents were not suffering from any kind of diseases. On being asked about type of disease from those respondents who were suffering from any disease, 76 percent of the respondents reported general medical ailments such as fever, joint pain, headache, low blood pressure, followed by 14 percent who reported to have sexually transmitted infections including HIV and 10 percent reported to have psychiatry ailments such as depression, mood disorder, anger and so on. As far as place of treatment was concerned, majority of the respondents i.e. 69.7 were taking treatment in government hospitals/dispensaries followed by private allopathic doctor (28 percent). Only two percent of the respondents were depending upon home remedies for treatment and 0.3 percent of the respondents reported of taking Homeopathy/Aurvedic/ Unani treatment.
Mental health is a major challenge in India. At least 13.7 per cent of India’s general population has various mental disorders out of which 10.6 per cent of them require immediate interventions. Despite three out of four persons experiencing severe mental disorders, there are huge gaps in treatment which is more than 60 per cent. In fact, the economic burden of mental disorders is so huge that affected families have to spend nearly Rs.1,000-Rs.1,500 a month mainly for treatment and to access care. Due to the stigma associated with mental disorders, nearly 80 per cent of those with mental disorders had not received any treatment despite being ill (Yasmeen, Afshan, 2016). As compared to the general population, female sex workers are a much marginalized population, especially in the India where awareness for mental health is low and the availability of mental health services is insufficient. There is a need for interventions to promote the health of female sex workers and must prioritize mental health and suicide prevention along with the existing HIV prevention programmes. Government should adopt multipronged approach to reduce self- harm and includes community mobilisation that organizes, empowers, and provides the means for women to collectively confront violence and improves their access to mental health interventions (Shahmanesh, Maryam et al., 2009).
There has been focus on physical health problems such as STIs/HIV of female sex workers, however, mental health issues of this population have largely been neglected. Female sex workers often struggle with trauma, anxiety, phobia, depression, anger issues, and mental illness arising out of the profession. Stigma and disapproval of sex work from society at large may limit sex workers willingness to access and avail mental health services. In Indian context situation is alarming. There is no much attention given on mental health of female sex workers. Due to their profession, often face many problems like social exclusion, financially dependency, fear of infection , leading a double life , problems with intimate relationships , customers‘ demands , sexual problems, sex work per se, shame and feelings of guilt, or adverse working conditions which leads to the unhealthy mental state of the female sex workers. As a result, they face anxiety disorders, depression, suicidal tendency, stress and other issues. There is no doubt that the work conditions of sex work have a significant impact on the mental health of the involved women. Higher rates of mental disorders, however, are related to the subjectively perceived burden associated with that kind of work. Objectively, it is open violence in and apart from the work setting, which also significantly impacts on these women‘s mental health (Rossler, W. et al. ,2010).In order to overcome psychological pressure, a female sex worker adopts several strategies like body exclusion zones, the condom as a psychological barrier, domination services, and meaning attached to sex as work, not performing certain sex acts with clients in order to reserve them for personal activities and so on (Wong, Serena, 2009).
|
Psychological problems faced by female sex workers |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Mood disorders/depression |
3(3) |
56(56) |
15(15) |
74(24.7) |
|
Trauma |
- |
3(3) |
1(1) |
4(1.3) |
|
Alcohol/drugs dependency |
2(2) |
2(2) |
- |
4(1.3) |
|
Stress/Tension |
39(39) |
4(4) |
57(57) |
100(33.3) |
|
Suicidal tendency |
- |
- |
- |
- |
|
Anxiety disorder |
1(1) |
4(4) |
17(17) |
22(7.3) |
|
Anger issues |
43(43) |
30(30) |
6(6) |
79(26.3) |
|
Social phobia |
12(12) |
1(1) |
1(1) |
14(4.7) |
|
Seeking emotional support |
- |
- |
3(3) |
3(1) |
|
Total |
100(100) |
100(100) |
100(100) |
300(100) |
|
Reasons for psychological problems |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Job pressure |
5(5) |
50(50) |
10(10) |
65(21.7) |
|
Family problems |
50(50) |
47(47) |
80(80) |
177(59) |
|
Physical problem |
1(1) |
3(3) |
6(6) |
10(3.3) |
|
Societal pressure |
2(2) |
- |
2(2) |
4(1.3) |
|
Identity crisis |
6(6) |
- |
- |
6(2) |
|
Emotional distress |
36(36) |
- |
2(2) |
38(12.7) |
|
Total |
100(100) |
100(100) |
100(100) |
100(100) |
|
Treatment of psychological Problems |
Amritsar |
Ludhiana |
Jalandhar |
Total |
|
Yes |
- |
- |
- |
- |
|
No |
100(100) |
100(100) |
100(100) |
100(100) |
|
Total |
100(100) |
100(100) |
100(100) |
100(100) |
Figures in parenthesis represents percentage.
Data presented in table 10 on mental health of female sex workers highlighted that majority of the respondents suffered from stress/tension (33.3 percent), followed by anger (26.3 percent), mood disorders/depression (24.7 percent), anxiety disorder (7.3 percent), social phobia (4.7 percent), alcohol/drug dependency and trauma (1.3 percent each) and were feeling emotionally unstable (one percent). None of the respondent reported to have suicidal tendencies.
Under the current study, the possible reasons behind their above mentioned problems were also explored and the obtained information was presented in table 11. Data on reasons behind mental health issues of the female sex workers highlighted that majority of the respondents i.e. 59 percent cited family problems behind their mental health issues followed by job/work pressure (21.7 percent), emotional distress (12.7), physical problem (3.3 percent), identity crisis (two percent) and societal pressure (1.3 percent). Information was also obtained whether the respondents took any medical consultation for their psychological problem. Majority of the respondents 100 percent from all three districts shared that they never contacted any doctor for mental health problems as they were not aware about these mental health issues.
Women in sex work whether enter voluntarily or involuntarily, face many problems due to their association with their profession. Even if, female sex workers choose to leave the profession, there are still problems which hovers around them such as fear of being exposed, threats from madam/pimps or someone known from the previous profession, threat from the clients and many more along with social stigma attached to their profession. Sex workers also face challenges in terms of health, emotional, social, financial, and social because of their profession. Most of the challenges are interrelated. Due to financial challenges, a sex worker also faces social challenges of being discriminated or stigmatised; due to health challenges, she might experience financial and psychological challenges. Therefore one challenge always leads to another one and impact the life of a sex worker. Therefore, there is need to have comprehensive plan for women in sex work which not only focuses on their financial aspect but also takes care of their social, health and emotional part. In addition to that, women in sex work should be made self-reliant and should provide alternate for the livelihood when they leave sex work either voluntarily or due to their age. To provide such opportunities to the female sex workers, Government and Non- government organisations can play a vital role which would help in improving the social and economic status of the women in the sex work. Also, there is a need to focus on the psychological health along with physical health of female sex workers. Strong emphasis should be given to these services under NACO and should be rendered only through qualified and trained staff.
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Received on 04.02.2019 Modified on 11.02.2019
Accepted on 15.03.2019 © A&V Publications All right reserved
Int. J. Rev. and Res. Social Sci. 2019; 7(1):211-220.
DOI: 10.5958/2454-2687.2019.00014.5