Human Rights and Public Health Interventions: The Complexity of Female Sex Workers' Lives and Work in India

Public health researchers have long focused on female sex workers because of their role in spreading HIV and other sexually transmitted diseases—and therefore their importance in disease prevention.

But in the last decade that Subadra Panchanadeswaran, Ph.D., an associate professor at the School of Social Work, has been studying female sex workers in India and violence in intimate relationships, she came to realize that viewing women just along this narrow axis gives researchers an incomplete picture of the women’s complex lives and relationships.

Dr. Panchanadeswaran’s research has shown that rather than just being at risk from a one-time client or pimp, female sex workers also face risks of violence and HIV infection from police, thugs, intimate partners, husbands and regular clients, with whom they have an emotional connection and trust.

“There are so many different relationships that female sex workers are negotiating,” she says. “If we don’t understand the complexity of relationships and how they’re negotiated, we will be very narrow in our HIV-prevention efforts.”

In a series of papers, Dr. Panchanadeswaran described the complexity of female sex workers’ identities—as daughters, mothers, partners, wives, family breadwinners—and the risks they face in their different intimate relationships. Now, she’s studying the challenges to the unionization of sex workers in India and its implications.

Public health workers typically distribute condoms in red-light districts, bus stops, railway stations and other physical gathering points for sex workers. But now, they need to figure out how to reach and assess at-risk populations who are arranging assignations via telephone or the Internet. A planned future project will study how the explosion in cell phone and Internet use has affected the sex work industry.

“Does this mean they are more and more with people they know and the risk is reduced? Or is it that they don’t know who is on the other end of the phone and they are called to unknown locations and the danger is increased?” Dr. Panchanadeswaran says. “This is something we want to find out from the women themselves.”

She would like to see structural intervention to reduce violence and disease transmission, as well as new technology (such as female condoms), policies to ensure human rights and economic opportunities for female sex workers in India.