Flying’ female sex workers in Kolkata, India: Using “cultural biography” to understand HIV risk perceptionedit
While epidemiologists and HIV practitioners have focused significant attention on sex workers’ high risk of HIV infection, very little empirical data exists about the ways of life, socio-cultural contexts, sexual practices and risk perceptions of these women, and particularly those in non-brothel based or flying sex work in India. In addition, the differential risk of HIV incidence among different types of sex workers based on specific features of their working situations (e.g., contexts, routines and health-seeking practices) remains to be explored.This study examined how women in flying sex work in Kolkata, India perceive their risk of HIV relative to other risk factors. To do so, it used ‘cultural biography,’ a method that combines ethnography and life history interviews, to answer the following research questions: a) What do women in flying sex work perceive as risks to their physical, social, and economic well-being?; b) How salient is the risk of HIV compared to other occupational risks?; c) How are women’s current understandings of risk related to early life experience with risk? The data for this study was collected in two stages. In the first stage, 46 short life portraits and in the second stage, 3 in-depth life histories were collected over a period of seven months (December 2009-July 2010) in Kolkata, India.The findings generated from 46 short life portraits suggest that women who engage in flying sex work perceive a wide array of occupational risks. Women in this study were overwhelmingly concerned with the fear of ‘whore’ stigma because being discovered as a prostitute would result in severe negative consequences for themselves and their families, such as losing ‘izzat’ (self-respect and honor) in society. Further, women spent a considerable amount of time maintaining secrecy about their work and therefore avoided using targeted HIV prevention programs or reporting to the law enforcement authorities instances of rape, violence, and sexual harassment because they feared being perceived as a prostitute.While women seemed concerned about the risk of HIV in their lives, it was not perceived as the most dangerous type of health risk because they were surrounded with other pressing types of risks (e.g., arrest, client-initiated violence, rape, and stigma associated with sex work), while working in a fairly complex and competitive working environment. In short, the imminent risk of HIV was transformed into a secondary risk in the broader context of violence and poverty.The findings from the three in-depth life histories suggest that cultural norms and pervasive discriminatory attitudes towards young girls’ right from childhood negatively affect their overall health and well-being. The themes of ‘absence of a father figure,’ losing ‘izzat’ (honor), and ‘precarious mother-daughter relationship’ clearly reflects the patriarchal nature of Indian society, where a father (or father figure) symbolizes male protection. Thus, the absence of a ‘father figure’ from the lives of young girls, especially during their childhood, makes them vulnerable to exploitation and harm in society, increasing their risk for HIV. Young girls are married off early by their single mothers due to the perceived fear of losing ‘izzat’ (honor) in society, as they question, ‘what if anything wrong happens to them’.The findings also suggests that childhood poverty, childhood abuse, child marriages, early pregnancies, husband’s or partner’s poor income, and few alternate employment opportunities for women with poor literacy skills make women socially and economically dependent on their male partners for survival, and also increase their risk of HIV infection.While these women face oppressive structures, they also demonstrate the ability to navigate these structures as they gain experience in the sex industry. This suggests an urgent need for HIV prevention programs to include sex workers in designing the individual, community and structural intervention strategies that will reduce their vulnerability. For instance, women explicitly mentioned that economic opportunities promising better pay scales, health benefits, and pension upon retirement will help in reducing their vulnerability to HIV infection.Unlike studies that are based on epidemiological categorization of risk behavior, this study makes a novel contribution by examining risk from the point of view of these women, whose voices are often silenced and whose health and social needs go unmet.