Abstract
In Surat city of Gujarat, India, female sex workers (FSW)-based targeted interventions (TI) and community-based organizations (CBO) have been functioning since 1998. To document the impact of the COVID-19 lockdown (March–May 2020) on FSWs and STI/RTI/HIV preventive measures provided through TI/CBOs in Surat city, sequential, explanatory mixed-methods design was used. We conducted a desk review of quarterly programmatic data (2018–2020) of four TIs and CBOs and interviewed of 221 FSWs to study pre- and post-lockdown socioeconomic conditions, engagement in sex work, health services during COVID-19 lockdown and coping strategies, followed by five focus group discussions of FSWs and TI/CBO project staff. Study identified four major themes: reasons for working as a FSW during COVID-19 lockdown, entry to sex work during or as a consequence of lockdown, exploitation of FSWs during lockdown, and challenges of TI and CBOs in service provision in pandemic situation. Number of new registrations and STI/RTI detection increased immediately after lockdown. TI/CBO and other NGOs working for women welfare must build financial independence by training them in microeconomics, savings, and entrepreneurship. TI/CBO staff must also include experts in finance or business, trained in emergency response. The presence of strong TI/CBO network facilitated prompt delivery of essential commodities and financial aid to FSWs. However, laboratory and screening services were hampered, which warrants need of introducing self-test kits. In backdrop of decrease in condom distribution, continuation of sex work during lockdown and disruption of routine HIV/STI/RTI screening facilities, our study also recommends intensified HIV/STI/RTI screening among FSWs.
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Acknowledgements
We are grateful to the Gujarat State Health System Resource Centre (SHSRC), under the Health and Family Welfare Department, Government of Gujarat, for the financial support, reviewing the study protocol and providing valuable inputs. We thank Dr. Rajesh Gopal, Additional Project Director and his team at Gujarat State AIDS Control Society (GSACS) for facilitating this study in TIs and CBOs of Surat. We thank all the project staff and female sex workers associated with PARAS-PSM Unit II, PARAS-PSM Unit III, Sahyog and Ekta Mahila Mandal who enriched the study findings with their inputs.
Funding
This project was funded by the Gujarat SSHRC, Health and Family Welfare Department, Government of Gujarat (No. SHSRC/OR/1613–16/2021).
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by U. C. Samudyatha, Manvendra Singh Rathore, and J. K. Kosambiya. The first draft of the manuscript was written by U. C. Samudyatha, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Conflict of interest
Dr. J. K. Kosambiya was instrumental in providing technical guidance to the establishment of PARAS (Prevention, Alliance, Advocacy and Services) Project FSWs in 1997 which was initially supported by DFID, UK. Since 2000, it works as a Targeted Intervention through the Department of Community Medicine, Surat, Gujarat, and is supported by National AIDS Control Organization.
Ethical Approval and Consent to Participate
The study was approved by the Gujarat AIDS Control Society (GSACS/SIMU/Research/2020–21/02/11004–09) and Institutional Human Research and Ethics Committee (No. GMCS/STU/ETHICS/27295). Written informed consent was taken from all participants after explaining the study purpose and procedure.
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Written informed consent was taken from all participants for publication of study results.
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The study protocol was reviewed by the reviewers of the Gujarat SSHRC, Gandhinagar. It was approved by the Institutional Human Research and Ethics Committee and Gujarat State AIDS Control Society.
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Samudyatha, U.C., Kosambiya, J.K. & Rathore, M.S. Impact of COVID-19 on Profession and Health of Female Sex Workers: Apprehension, Acquiescence, and Resilience. Arch Sex Behav (2024). https://doi.org/10.1007/s10508-024-02866-w
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DOI: https://doi.org/10.1007/s10508-024-02866-w