|Year : 2007 | Volume
| Issue : 2 | Page : 69-75
Prostitution in India and its role in the spread of HIV infection
Devinder Mohan Thappa, Nidhi Singh, Sowmya Kaimal
Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
Devinder Mohan Thappa
Department of Dermatology and STD, JIPMER, Pondicherry - 605 006
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Prostitution describes sexual intercourse in exchange for remuneration. The legal status of prostitution varies in different countries, from punishable by death to complete legality. The great degree of social stigma associated with prostitution, of both buyers and sellers, has lead to terminology such as 'commercial sex trade', 'commercial sex worker' (CSW), female sex worker (FSW) or sex trade worker. Organisers of prostitution are typically known as pimps (if male) and madams (if female). Brothels are establishments specifically dedicated to prostitution, often confined to special red-light districts in big cities. The devadasi (handmaiden of god) system of dedicating unmarried young girls to gods in Hindu temples, which often made them objects of sexual pleasure of temple priests and pilgrims, was an established custom in India by 300 AD. An estimated 85% of all prostitutes in Calcutta and Delhi enter the sex work at an early age. The causes of prostitution include ill treatment by parents, bad company, family prostitutes, social customs, inability to arrange marriage, lack of sex education, media, prior incest and rape, early marriage and desertion, lack of recreational facilities, ignorance, and acceptance of prostitution. Truck drivers engaging in unprotected sexual intercourse with multiple partners in rural India could be major vectors of HIV transmission. The commercial sex industry is a multibillion dollar Indian and global market which now includes strip clubs, massage brothels, phone sex, adult and child pornography, street brothel, and escort prostitution. So long as men want to buy sex, prostitution is assumed to be inevitable.
Keywords: Prostitution, commercial sex workers, female sex workers, HIV infection
|How to cite this article:|
Thappa DM, Singh N, Kaimal S. Prostitution in India and its role in the spread of HIV infection. Indian J Sex Transm Dis 2007;28:69-75
|How to cite this URL:|
Thappa DM, Singh N, Kaimal S. Prostitution in India and its role in the spread of HIV infection. Indian J Sex Transm Dis [serial online] 2007 [cited 2015 Sep 4];28:69-75. Available from: http://www.ijstd.org/text.asp?2007/28/2/69/39007
| Introduction|| |
Prostitution describes sexual intercourse in exchange for remuneration.  The legal status of prostitution varies in different countries, from punishable by death to complete legality.  The great degree of social stigma associated with prostitution, of both buyers and sellers, has lead to terminology such as 'commercial sex trade', 'commercial sex worker' (CSW), female sex worker (FSW) or sex trade worker. Organisers of prostitution are typically known as pimps (if male) and madams (if female).
Brothels are establishments specifically dedicated to prostitution, often confined to special red-light areas in big cities. Sonagachi in Kolkata, Kamathipura in Mumbai, G.B. Road in New Delhi and Budhwar Peth in Pune host thousands of sex workers and they are famous red-light centres in India. In sex tourism, travellers from rich countries travel to poor countries such as Thailand in search of sexual services which may be unavailable in their own countries or simply too expensive there.
Prostitutes are stigmatised in most societies and religions; their customers are typically stigmatised to a lesser degree. , Prostitutes have more abortions and venereal diseases and become more easily sterile but still many sex workers complete their term of pregnancy and give birth to children.
| History in India|| |
Prostitution as a profession has a long history in India. A whole chapter has been devoted to it in Kautilya's Arthashastra written in circa 300 BC and Vatsayana's Kama Sutra written between the first and fourth centuries AD.  Vedic texts give account of a mythic empire builder, Bharata, and prove that people were acquainted with prostitution through references to "loose women", female "vagabonds" and sexually active unmarried girls.  The Vedic word sadbarani refers to a woman who offers sex for payment. In Vedic times, most prostitutes seem to have dressed in red, even their gold jewellery was reddened as this hue was assumed to scare away demons and give protection to those who chose to live in a moral grey zone. 
Devadasi (handmaiden of god) system of dedicating unmarried young girls to gods in Hindu temples, which often made them objects of sexual pleasure to temple priests and pilgrims, was an established custom in India by 300 AD.  There are reasonably good records of prostitution in large Indian cities during the 18 th and the first-half of the 19 th centuries of British rule; prostitution was not considered as a degrading profession in that period as it was from the second-half of the 19 th century. A Calcutta Corporation publication of 1806 reports highlighted that there were 2540 women in 593 brothels in 82 streets of Calcutta and they were tax-payers of about 6% of Calcutta's revenue.  During British Raj, the 75000 military prostitutes in the Lal Bazaars made up barely a couple of percent of the whole sex industry. Indian Prostitution was completely independent of the British and other foreigners.  Temple dancers, aristocratic courtesans, independent village girls and big brothels could be found in every corner of Indian subcontinent. 
Because of the clandestine nature of the sex industry and also because of the wide varieties and geographical distribution of prostitutes, it is impossible to have an accurate estimate of their number in contemporary India. Some guesses are, however, available. Gilada's  estimates of 100,000 in Bombay, 100,000 in Calcutta, 40,000 in Delhi, 40,000 in Pune and 13,000 in Nagpur are considered overestimates by some critics and underestimates by others.
Empirical data on the way of life and sexual practices of prostitutes in contemporary India are scarce.  The advent of AIDS has generated few empirical studies along with intervention programmes in red-light areas of few large cities. The findings of these studies corroborate the common knowledge that prostitutes, in general, lead a poor standard of life in dilapidated and unhygienic environments. , A major portion of what their clients pay has been shared by pimps, landlords, madams, financiers and policemen. They do not get nutritionally adequate food and they are exploited by local traders who sell them essential goods. Because of the strong prejudice against them they cannot take advantage of the government health facilities and have to depend mostly on local quacks who charge them exorbitantly for treatment and medicines. A large proportion of them suffer intermittently from various kinds of STDs. Most of them are forced to enter this occupation because of adverse circumstances. Many prostitutes send a part of their income to their families. A survey conducted in a red-light area of Calcutta in 1987 found that 59% of prostitutes were abandoned by their husbands and many of them were originating in Murshidabad district, where young women in many poor families are expected to go into prostitution, remit a substantial amount of money (Rs. 475 per month, on an average) to their families. 
Biosocial factors influencing women to become prostitutes in India
Based on the materials collected during a study on risk factors associated with cervical cancer among prostitutes in Domjur, Howrah, West Bengal, report of Sociological Research Unit, Indian Statistical Institute, Calcutta explored various biosocial factors which may lead women to prostitution.  When family and marital ties fail or disintegrate for various reasons, the life situations which a woman encounters may themselves generate a "process" of anchorlessness.
In India, interviews with 33 female prostitutes in Domjur, Howrah District, West Bengal, were conducted to understand the processes by which women become prostitutes. Of them, 84.8% were Hindus, 72.7% of whom were from lower castes. Thirty-one prostitutes were illiterate. The prostitutes tended to have most recently worked as domestic workers, casual laborers or farm labourers. The main reason for leaving their last occupation was obligation to provide sex services. Twenty-one of them were married. More than 50%, who had been married before the age of 18, became prostitutes before 25 and were older than 30. Sixty-six percent did not engage in illicit sex before becoming prostitutes. About 20% had been prostitutes for more than 15 years. Most prostitutes earned about Rs. 1000 per month. Sixty-six percent had a maximum number of five clients/day. Three prostitutes had as many as seven to eight clients/day. Life events and their reactions that led them to become prostitutes belonged to two categories: (1) women who were either widowed (17 women) or abused by husband and in-laws (4 women), leaving them with no social or economic support and (2) women who chose prostitution as an easy means to support themselves (9 women) or because they had sexual urges or were curious (3 women).
Studies of the Devadasi system in contemporary India indicate that it still prevails as an institution in some Hindu temples, mostly in Karnataka and Andhra Pradesh.  Its operations are, however, clandestine because laws against it have been passed in all states. Gilada and Thakur  reported that every year about 10,000 young girls from poor families are dedicated as devadasis to the goddess Yallama in a small temple of northern Karnataka. They speculate that most prostitutes in the border districts of Maharashtra and Karnataka are devadasis.
In Karnataka, the most common form of traditional sex work is associated with the Devadasi system.  The Devadasi tradition in India extends back several centuries: the term has been found in written records from as far back as the 12th century. In brief, the Devadasi tradition involves a religious rite in which girls and women are dedicated, through marriage, to different gods and goddesses, after which they become the wives or servants of the deities and perform various temple duties. Over time, these duties have come to include provision of sexual services to priests and patrons of the temples and, owing to the sacred setting and the view that Devadasi women embody a form of divinity; this activity has been referred to by some as "sacred prostitution".
A recently published study gives the extent of Devadasi tradition in Karnataka sex industry.  Of 1588 FSWs interviewed in Karnataka state in India, 414 (26%) reported that they entered sex work through the Devadasi tradition. Devadasi FSWs had initiated sex work at a much younger age (mean, 15.7 vs. 21.8 years), were more likely to be home based (68.6% vs. 14.9%), had more clients in the past week (average, 9.0 vs. 6.4) and were less likely to migrate for work within the state (4.6% vs. 18.6%) but more likely to have worked outside the state (19.6% vs. 13.1%).
An estimated 85% of all prostitutes in Calcutta and Delhi enter the sex work at an early age.  Their numbers are rising. The promotion of tourism has given impetus and thrust to this. These girl prostitutes are primarily located in low-middle income areas and business districts and are known by government officials. Brothel keepers regularly recruit young girls. An estimated 33% of prostitutes are young girls. In Bangalore, Calcutta, Delhi and Hyderabad, there are an estimated 10,000 girl prostitutes. UNICEF estimates about 300,000 child prostitutes. Girl prostitutes are grouped as common prostitutes, singers and dancers, call girls, religious prostitutes or devadasis and caged brothel prostitutes. Religious prostitutes are mainly found in the South. Caged ones are found in Bombay. A little over 50% of prostitutes come from other countries, such as Nepal and Bangladesh. The girls tend to come from urban slums and poor rural areas. High prostitute supply regions include Andhra Pradesh, Karnataka, Maharashtra, Uttar Pradesh, Tamil Nadu and West Bengal states. About 85% are Hindus and about 66% are from scheduled castes and tribes. Bangalore and Bombay have a higher proportion of girl prostitutes. The causes of prostitution include ill treatment by parents, bad company, family prostitutes, social customs, inability to arrange marriage, lack of sex education, media, prior incest and rape, early marriage and desertion, lack of recreational facilities, ignorance and acceptance of prostitution. Most of them enter involuntarily and then become a part of the system of exploitation.
Call-girls and high-class escort girls
Prostitutes who are known as call-girls are usually more educated and attractive than those living in brothels and are often engaged in some other occupation.  They earn higher incomes and have some freedom in choosing their clients who mostly belong to the middle and upper classes. In a study of 150 call-girls, 20 clients and ten madams in Delhi, Bombay and Calcutta in the 1970s, Kapur  found that the earning of call-girls ranged from Rs. 50 to 100 per hour and Rs. 400 to 10,000 per night. Eighty percent of their clients were married. Many of them had suffered from sexually transmitted diseases (STDs) at one time or other and had experience of induced abortion but in general, they tried to take good care of their health by visiting physicians whenever necessary. Many of them wanted their clients to use condoms but most clients did not comply. A high proportion of their clients preferred oral sex to vaginal intercourse. In a subsequent study of nine call-girls in Delhi in 1993, Kapur  found that some of them belonging to the upper-middle class were aware of AIDS and rejected clients who refused to use condoms.
At the other end of the spectrum which operates high-class escort girls recruited from women's colleges and the vast cadres of India's fashion and film industries.  They can command large sums of money. These services usually operate by way of introduction. However, a recent trend has seen the emergence of several snazzy websites, openly advertising their services.
Clients of prostitutes
Prostitutes or so called FSWs appear to be on call round the clock because of their poverty , and cater on an average 1.6-13 clients per day per FSW in various parts of the country. Marriage seasons, festivals and fairs are considered 'peak' seasons, while winter, summer and rainy seasons are considered 'lean'.  Brothels close down for festivals such as Holi and Dusserah for Hindu and Ramzan and Muharram for Muslim FSWs in some cities. 
A few hundred thousand men have sexual relations with prostitutes every day in India.  Insights derived by health practitioners and social workers from the experience of working in red-light areas suggest that the following categories of men are frequent visitors to prostitutes: low-level workers in the manufacturing and transport industries; other workers living away from their families for a length of time; traders and customers in transitory markets; visitors to fairs, festivals and pilgrim centres; defence personnel living away from families; students; pimps and others who have some control over prostitutes; traders and service providers in red-light areas; and professional blood donors. 
Joardar  reported that married men comprised two-thirds to three-quarters of clients. Employees and white-collar workers constituted 29% of the clientele. A multistate Indian study conducted in 1996  found that 0.9-3.2% of the urban and 0.7-4.2% of the rural population had high-risk sexual behaviour. A study in Delhi indicated that 30% of urban men had premarital sex, while in Tirupati, South India it was 37%. 
As in many other countries, Indian truck drivers and their helpers who spend the major part of the year on or near highways are generally known to visit many prostitutes during their stopovers. In-depth interviews with 79 truck drivers and 21 helpers in a check-post near Calcutta in 1993 showed that a majority of them reported visits to between three and seven prostitutes in a week and that the number visited by each trucker ranged from 50 to 100 in a year.  Also, most of them reported never having used any condoms. Blood tests in a sample of truckers in the same place in 1993-1994 showed that 5.6% of them were already HIV-positive.
Role of long-distance truck drivers-clients of prostitutes in the spread of HIV infection
Large numbers of truck drivers have been found to be having sex with the prostitutes in rural areas along the highways of India. Some have sex with men also. HIV/AIDS awareness and condom use has been found to be poor among them. These truck drivers play an important role in the spread of the infection in rural India. To investigate the above hypothesis, data on HIV risk behaviour, condom use and HIV/AIDS awareness were obtained through a survey and interviews with 200 randomly selected truck drivers, 21 highway prostitutes and 27 male prostitutes in Delhi and nearby areas during October 1990-December 1990.  Three hundred and two randomly selected truck drivers were tested for HIV infection; none of the highway prostitutes consented to the HIV antibody test. A survey was again conducted among 100 randomly selected truck drivers in November 1991 and November 1992 to assess the levels of current HIV awareness and risk behaviour. The drivers were aged 20-40 years, wayside prostitutes aged 32-40 years and part-time male prostitutes aged 16-34 years. Sixty percent of the drivers were married with families, as were all of the wayside prostitutes and none of the male prostitutes. Seventy-eight percent of drivers admitted having multiple heterosexual partners, including prostitutes and 5% admitted to regular homosexual encounters. Three of 302 men tested were found to be infected with HIV. None of the 21 highway prostitutes had heard about AIDS, although 21 of 27 male prostitutes had. All highway prostitutes admitted having at least one episode of unprotected sex with their sex partners in the previous fortnight, while all of the male sex workers would allow unprotected sex if their partners desired. Some male prostitutes were also paid blood donors. Truck drivers engaging in unprotected sexual intercourse with multiple partners in rural India could be a major vector of HIV infection.
In a study to determine the prevalence and pattern of STDs and to study sexual lifestyles of long-distance truck drivers and their assistants in south India, a total of 263 truck drivers/assistants were recruited from the highway clinic from October 1999 to March 2001 at Pondicherry, India.  All of them were sexually active and heterosexual contact was the predominant mode (99.2%). Two-third of them had contact with CSWs and roughly 60% admitted alcohol consumption. One hundred and two participants (38.7%) had various STDs; syphilis was the most common STD. The positivity rates of HIV, VDRL and HBsAg were 15.9%, 13.3% and 21.2% respectively.
Extent and speed of spread of HIV infection in India through the commercial sex networks
There is a widespread belief in India that prostitutes are primarily responsible for the origin and spread of AIDS and it can be mostly controlled by testing all of them for HIV and isolating those who are found positive.  This belief is partly based on the highly publicised initial detection of HIV infection among a few prostitutes in Madras in 1986 and also on subsequent publicity about the phenomenal rise of HIV infection among prostitutes in the red-light areas of Bombay and other cities. It reflects a lack of knowledge about the complex nature of both prostitution and the spread of HIV infection in India.
AIDS was first detected in India in 1986.  Since then HIV infection has spread uncontrollably. Mumbai city had 1.1-1.3% infections among FSWs in 1986, which had skyrocketed to 71% in 1997 and was expected to reach 80% by 2000. India has the world's highest number of HIV/AIDS infections for any country outside Africa. Eighty-five percentage of HIV transmission in India occurs through heterosexual contact. India has a traditional male-dominated society, where indulging in sex outside marriage is still considered a male prerogative.
The risk of infection per single sex act, from a HIV-positive male to HIV-negative female in developed country settings is estimated to vary from 0.1 to 1.0%. Women are estimated to be at 2-3 times higher risk than men.  The risk in developing countries with poorer hygiene and health care standards is estimated to be many times higher. The risk is estimated to be 2-9 times higher where one of the partners has or had, STIs and up to 11.3 times higher where genital ulcers are present. One billion population, a large number of FSWs, high prevalence of sexually transmitted infection (STIs) and low condom use make a potent combination for explosive growth of the HIV epidemic in India.  Taking available estimates of the number of FSWs, their work patterns, prevalence of HIV and STIs and condom use among them in 1999 as the base and adopting reasonable infectivity rates, authors had attempted to present a model to estimate the spread of HIV infection in commercial sex networks until 2005. HIV infections in commercial sex networks are estimated to increase from the 1999 level of approximately 2.49 million to about 3.93 million by 2005 in a favourable scenario and to 6.87 million in a worse scenario. They speculated that spread of HIV is influenced in the short term by condom use and prevalence of STIs and these are the only factors that can be manipulated to limit the spread of the infection.
Legislation passed in India regarding prostitution in 1956 and 1986 did not have the objective of abolishing prostitutes and prostitution; the stated objectives of the legislation were 'suppression' and 'prevention of prostitution'.  The 1956 Supression of Immoral Trafficking Act (SITA) assumed that prostitution was a 'necessary evil' and prohibited a prostitute from soliciting clients in public places and forced her to work in certain areas known as red-light areas, thereby exposing her to exploitation by pimps and others. Though the SITA did not aim to punish prostitutes unless they solicited, it gave enough powers to police and other government agencies to terrorise, harass and financially exploit a prostitute. The 1986 Immoral Trafficking (Prevention) Act (ITPA) provides marginal benefits to prostitutes by prohibiting male police officers from searching them unless accompanied by two female police officers; and also by seeking to draw women away from prostitution through rehabilitation in Protective Homes. However, a recent review of the conditions in a well-known Protective Home in Delhi indicates little success in meaningful rehabilitation of its inmates. 
Legislation regarding AIDS was introduced in the Rajya Sabha in 1989 which gave some government agencies sweeping powers to infringe the liberties of certain categories of people, but, owing to strong opposition by a few activist groups, it was withdrawn in 1992. 
Role of police in child prostitution
To assess the role of police in child prostitution, a random sample of 28 out of 86 brothels along the GB Road in India was taken which revealed that almost 60% of prostitutes were children.  The law does not punish prostitutes who are older than 18 and do not solicit business publicly, but it does punish running a brothel, living on the earnings of prostitutes, procuring or inducing people to become prostitutes and soliciting in public places. The law, which is mostly used to harass prostitutes, invokes penalties of imprisonment for procuring or trafficking and for forcible detention for the purpose of prostitution while creating a special police force to stop trafficking, special courts to deal with cases and protective homes for "rescued girls". The law fails to punish clients or make provisions for the rehabilitation of rescued women.
Offences rarely end in convictions.  In fact, police officers extort money from traffickers, prostitutes and madams and abet the system of prostitution through a scheme of false registration of the girls that creates the fiction that they are not minors and creates a debt paid by the madams that places the girls in virtual bondage.
Use of condoms among prostitutes and their customers
There is a very low level of use of condoms among female prostitutes in India.  Reports of rapid increase of prevalence of HIV-positive cases among prostitutes' in red-light areas of Bombay and a few other Indian cities have persuaded non-government and government agencies to start intervention projects in pockets of those areas for motivating prostitutes to use condoms and distributing condoms free or at subsidised prices. As stated earlier, one common factor accounting for the success in these projects is the effective use of selected prostitutes as peer-group educators in project implementation. The main problem lies in the persisting unwillingness of the customers to use condoms and prostitutes' powerlessness to insist on their use or reject the customers.
A few well-designed and well-executed intervention programs by non-government and government agencies in a few red-light areas have started showing signs of increased use of condoms and reduced prevalence of STDs among prostitutes.  A positive outcome of a prevention programme among prostitutes can be found in Sonagachi.
| Conclusion|| |
The commercial sex industry is a multibillion dollar Indian and global market which now includes strip clubs, massage brothels, phone sex, adult and child pornography, street, brothel and escort prostitution. For the vast majority of the world's prostituted women, prostitution is the experience of being hunted, dominated, harassed, assaulted and battered. In prostitution, it is the demand that creates supply. The key factors for these women adopting this type of life style (prostitution) in India are lack of family support and inability to provide for themselves due to poverty and illiteracy. As long as these factors remain operative, the supply chain will remain intact. Moreover, so long as men want to buy sex, prostitution is assumed to be inevitable and therefore 'normal' whether it is in India or other parts of the world.
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