The authors describe the plight of sex workers, a particularly disadvantaged community that is highly marginalized and vulnerable. Sex workers were hard hit by the pandemic. The authors examine the impact of COVID-19 on sex workers’ lives and livelihoods, their response to the crisis, and the strategies that they employed to battle the pandemic.
During the lockdown, female sex workers lost their livelihoods which plunged them and their families into extreme poverty. Even when unlock measures were announced, the business of sex work did not return to normal. Sex work, by its very nature, demands physical proximity—not physical distancing. Consequently, sex workers had to innovate to find work to survive. Loss of livelihoods also brought forth hidden mental health problems. Gripped by anxiety and depression due to the uncertainty about when the pandemic would end, sex workers went into despair. Some even attempted suicide. Violence in the family increased significantly. For sex workers living with HIV, there was the added anxiety about the continuation of anti-retroviral therapy (ART). Community-based organizations (CBOs) took on the responsibility of providing drugs to sex workers by developing a unique supply chain. The CBO members collected the drugs from the health centers and deliver them to sex workers at a mutually convenient place, thereby ensuring confidentiality.
The authors draw attention to sex workers who are invisible in most discourses. This vulnerable, marginalized community was seriously affected by the pandemic. Sex workers were victims but were also the first responders to the pandemic. Sex worker collectives formed to fight HIV, were by their very nature, well-equipped to fight the COVID-19 pandemic. The government’s announcement to provide rations to the poor was a welcome move, but it was not of much help to sex workers as they did not possess ration cards. The sex worker collectives valiantly fought this battle and won. The Supreme Court of India directed the states to provide sex workers with dry rations without insisting on any proof.
The stories of the lives and resilience of sex workers, narrated in this chapter, are inspiring. The authors discuss the plight of female sex workers during the COVID-19 pandemic. The community of sex workers was missing from all government policies and welfare schemes. The sudden lockdown robbed them of their livelihoods. Basic necessities like food and shelter became elusive. The authors relate the stories of the struggles of sex workers from different parts of the country.
They discuss how despite uncertainty, stigma, and loss of livelihoods, sex workers emerged strong. The resilient spirit of sex workers should be celebrated. The stories of sex workers have a common thread of resilience, resourcefulness, grit, and determination in the face of unsurmountable challenges.
We are considered immoral women in society and are subject to continuous harassment, violence, and discrimination. During the past several years, we fought the battle with HIV and made significant progress. We distributed condoms, brought our friends to clinics, and ensured that all HIV positive persons took regular medicines. With the help of our collective strength, we earned self-respect and dignity. HIV taught us to fight our battle collectively.
Now, COVID seems to damage everything. It has destroyed our livelihoods and our lives. We, at our community-based organization, are doing everything that we can. We are distributing dry rations, masks, and sanitizers and are teaching our friends to keep themselves safe. Now, we have to go beyond our community and help many others. It is like living the past. We need to assert ourselves and save lives—once again. WE WILL DO IT and EMERGE VICTORIOUS.
Member sex workers collective, Delhi, India
Sex workers include female sex workers (FSW), male sex workers (MSW), and transgender (TG) persons. They offer sexual services for cash or commodities. Sex workers bear a heavy burden of HIV infection. However, following the HIV/AIDS epidemic and the efforts of governments, non-government organizations, community organizations, and international donors, a deeper understanding of sex workers and sex work has emerged . Multiple identities of a sex worker being a mother, partner, friend, community member, and above all a human being are recognized, and therefore, sex workers are being counted. People have started to understand that the issues sex workers face are similar to everyone’s everyday challenges—earning and managing money, juggling family and other relationships, and being concerned about children’s education and their future. Building on wider acceptance by society, the National Human Rights Commission of India, in its latest advisory, recognized sex work as ‘informal sector work’ .
Like many businesses, sex work has been significantly affected by social distancing/physical distancing measures and closures during lockdowns . The pandemic has made it more difficult to work safely and has cut off reliable sources of income. Millions of sex workers are in the difficult position of having to choose between their health and being able to afford food and rent. The current global pandemic has also re-ignited issues related to stigma and discrimination . While the government announced various measures to help the poor during the lockdown, sex workers were left out from these social protection frameworks . Sex workers continued to be missing, even as an afterthought, from government policies and welfare schemes. They were left to fend for themselves and seek support from limited grassroots and civil society organizations or individual philanthropists. Some of them needed to find ways to work despite the dangers it poses.
Sex work by its very nature entails frequent bodily contact and human interface. The ‘unlock’ (re-opening) phases announced by government did not help sex workers get back to work. While teachers moved online, shopkeepers put up small barricades between themselves and their customers, and other businesses made adjustments to maintain the mandatory physical distancing, it has been difficult for sex workers to operate with such restrictions. The pandemic and its ill-effects have severely impacted their livelihood opportunities.
Amidst these dismal tales, there is a glimmer of hope and compassion. During the last decade and a half, the battle with HIV/AIDS brought sex workers together under the umbrella of several community-based organizations (CBOs) across the country. Little did one realize that the efforts of these agencies would bear fruit once again during watershed moments such as these. With the support of the Lawyers Collective, sex workers recently won a battle in the Supreme Court of India which passed an order by which sex workers could be offered dry rations without having a ration card or any identification that the Public Distribution System normally demands .
The authors of this chapter approached female sex workers (FSWs) and their organizations across nine states, including five metropolitan cities in the country, to share their experiences on how they learnt about the pandemic challenges they are facing to survive. The stories from these sex workers are heart-wrenching. These stories underscore their struggle, desperation, coping mechanisms, their ability to share and care, love and bonding, as well as how they are using their collective agency to address problems. These stories have a common thread of resilience, resourcefulness, grit, and determination in the face of unsurmountable challenges. Once again, the power of the people who are viewed as powerless in society demonstrates that this too shall pass.
In this chapter, the social, economic, and mental health aspects that emerged as the most critical issues are discussed.
Social Dimension—Isolation, Marginalization, Societal Pressures, and Solutions Pursued by Sex Workers Collectives During COVID-19
The Immediate Impacts of the Lockdown
With the sudden announcement of the lockdown and physical distancing measures, sex workers were left as stunned as everyone else. Sex workers from small towns and villages normally migrate to large cities like Delhi, Mumbai, and Kolkata to find work in dance bars and brothels to earn a living. Much of their earnings are remitted back home to support their family members. However, with the onset of the COVID-19 pandemic, everything was closed.
Corona is more dangerous than HIV. For any problem, we always discuss amongst us and come out with a solution. During the lockdown, physical meeting was not possible, so we got connected with each other through phones and planned to do something for our members. We have lost our income sources suddenly. Things were changing so fast; it was difficult to keep track. The lockdown days were scary.
We cannot resign to fear alone but need to go that extra mile. We called all our contacts to seek help. We collected money, cooked in a community kitchen, and distributed masks and sanitizers. We might be last in the government’s priority but for us our sisters’ welfare is paramount. Though ours is a sex workers collective, we extended our help to the poor.
Sex worker (Reshma from Rajasthan)
The lockdown announcement was too sudden and too severe . The lockdown was announced toward the month end, and many sex workers were pressured to pay rent to their house-owners. With all their workplaces (bars and brothels) partially or fully closed, there was little hope of any employment or income. Many of the sex workers were also evicted from their homes and were forced to live on the street .
The idea of returning home was a difficult choice for most sex workers. While few chose to return home in hired vehicles, others decided to stay put. ‘Either we die of hunger or we die of disease’ was the common adage heard. Sex workers who left the city during the initial lockdown days found themselves returning to the city once again after a few months. They lamented that ‘the situation in rural areas is more distressing. Lack of employment opportunities and the apathy of our political leaders is too much to bear’. The village economy is not suited to cater to the sudden influx of its own members. Many returned with urban experiences that saddled them with the economic expectations of their families.
Class, Caste, and Religion Are Major Barriers
The fault lines that run through the community are further exaggerated when society is experiencing major structural shocks. At every level, both in urban and rural areas (more specifically in the latter), the feelings of belongingness to one’s community, caste, creed, or religious faith take precedence. When sex workers arrived in their respective villages, the local police began to restrict their movements as was directed by the government. Mandatory quarantine of two weeks was enforced to ensure that the ‘visitors’ from urban areas would not spread COVID-19 in their villages. In many villages, the government schools were converted into makeshift shelters for quarantine. Some women were separated and locked up due to their lower social strata. This was the experience of many sex workers from lower castes.
Some of the women working in Mumbai as dance girls or sex workers returned to Rajasthan, where they belong to a specific community that lived in small hamlets outside the main village. People from lower castes and tribes often live in separate hamlets away from the main village. Social and physical distance ensure that people from upper castes are protected from any form of pollution from those from lower castes. People from upper castes live in their secured neighborhoods. Lower caste women from this community traditionally provide various forms of entertainment, including sexual services. Men from the main village seek sexual services from these women.
In times of a pandemic, communication based on scientific facts is often muted as rumors and misconceptions override it. With little information about the pandemic, the community chieftain barred the women from engaging in sex work. Following his directives, many young men started to keep vigil on women during the night, ensuring that they do not slip away to meet their clients. The men brandished sticks and knives, clutching them in their fists, ready to strike. Thus, a cloud of fear and anxiety was cast, leaving the women concerned about food for their children and the next meal for the family. Trapped in a situation that could escalate, the women felt isolated, worthless, and depressed.
Sex workers are unable to find alternative employment due to stigma and discrimination based on caste, class, and religion . Some Muslim women in rural areas spoke about starting small businesses such as vegetable selling but were unsuccessful as patrons were unwilling to purchase vegetables from them. Some sex workers took up work in cottage industries (carpet-making and garments) but were later replaced with employers’ own kith and kin. Only a handful of women from the lower sections of society were employed in the Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA) scheme. While the young and physically able-bodied women were employed, they often had to provide a portion (up to 50%) of their income as informal payments to the contractors. Urban areas provided wider choices of vocations and anonymity allowing sex workers to make a temporary shift in their professions. They were employed as tea stall vendors and vegetable sellers.
With the strict rules of physical distancing, sex work came to a grinding halt during the lockdown. Women were scared as each piece of the puzzle of the pandemic portrayed a more dismal picture, weighing heavily on their lives. Their sources of income were threatened alongside concerns about infection from continuing to work in the absence of social protection. Many sex workers’ husbands or boyfriends, who were employed as drivers, manual workers, and rickshaw pullers or sometimes took up the odd job, were rendered unemployed by the sudden lockdown. Growing uncertainties, unemployment, and distress led to more vulnerability among the women. Husbands turned to alcohol to ease their distress, which further enhanced their frustrations. Women and children, with ‘stay-at-home’ messages, however, had nowhere to go to escape from domestic violence. Hardships and sufferings among the community were indeed on the rise.
In metropolitan cities, sex workers with access to technology learnt to apply innovative techniques to keep their clients engaged. In this ‘swipe-left or swipe-right’ world, losing clients meant parting with their only source of income. Some women attempted novel ways to keep their regular clients entertained. They moved to video chats, offered video sex, and were paid through digital payment gateways. Keeping abreast with technology was imperative for the business of sex work. Sex workers knew that well-paying customers used modern methods to reach them. However, lucrative as it sounds, shifting to video chats was not easy. Many sex workers lacked private space in their small, crowded homes, and many did not possess smart phones.
Sex Workers Collectives and Support
Across the country, many sex workers formed collectives, governed, and managed by the community. These CBOs were instrumental for health and development initiatives and were responsive to their needs. It was but natural for sex workers to share their concerns and challenges with the CBO leaders and volunteers when they faced hardships. In Mumbai, the CBO leaders reported that either the sex workers were stuck in the brothels as they owed substantial amounts to their madams and local money lenders or were unwilling to leave the city as they were well aware of the limited opportunities in rural areas. In the cities, there were still some opportunities. The CBOs helped some women to raise initial investments to start small ventures like tea stalls and vegetable shops as well as make sanitary napkins and masks. There was a mixed response to these initiatives as they did not provide enough money.
With the disease, desperation and depression engulfed all households. Sex workers faced discrimination and were almost the last to receive dry rations or any type of support. Many CBOs reached out to the media, individual donors, and faith-based organizations to seek immediate relief. Responding to the media’s stories on the plight of sex workers, some organizations stepped in with financial aid. These organizations extended support to as many vulnerable families as was possible—especially to pregnant women, senior citizens, ailing patients, and children. Through the sex workers collectives, food, water, and other essential items moved freely from hand-to-hand, blurring the rigid caste and class lines.
Economic Dimension—It is Expensive to Live in Poverty: Limited Choices—Disease or Death
The year 2020 is packed with different tragedies all around us. Nobody seems to care for the poor, as everybody is looking after their own interest. The government announced some schemes for the poor, but they are simply not enough. Rich and poor, all of us, are experiencing this together. But the difference is this – when the rich catch cold and sneeze, the poor die of pneumonia. To feed my baby a milk packet everyday costs about 20 Rupees. I need 600 Rupees for one month. But the government, as part of its Pradhan Mantri Garib Kalyan Yojana (PMGKY), provides cash transfers of only 500 Rupees per month. Therefore, to feed the rest of my family, I have to venture out to seek clients and earn money. There is simply no alternative for us. If I am infected maybe…maybe I will be treated, but there is no healing for my hunger…
Sex worker, Mumbai, India
During natural calamities like floods, drought, earthquakes, or even the sudden decisions of government like demonetization or COVID-19 lockdowns, the poor are most negatively impacted. Sex workers who tread the narrow line of surviving on income from client to client are the unseen poor who have little savings, no job guarantees, and no health insurance. The HIV epidemic taught sex workers collectives to be prepared for uncertainties. NGOs and CBOs worked tirelessly to ensure that sex workers had access to bank accounts and government identification cards (Aadhar Card and PAN Card). But many sex workers still do not have access to these entitlements.
‘The year 2020 has robbed us of everything’, a sex worker from Madhya Pradesh explained. ‘It devoured our savings, our health and our income sources. It is a hopeless situation for us—our dreams are shattered, and our future appears bleak’. Sex workers rely on daily money from transactions. With the lockdown, cash evaporated from their hands. Less money generally meant shorter and sicker lives, smaller meals, and sacrificing children’s education.
Police who were stationed at key junctions to monitor movements enforced mandatory lockdown. The police used force on those who dared to step out of line. Sex workers were confined to their brothels, and no client dared to visit them. While the lockdown continued to be extended in its various stages, people could no longer stay locked up in their houses, especially as prospects of containing the virus appeared dim. Slowly, the government loosened its grip on the lockdown measures and allowed life to crawl back to normalcy. However, the normal was not recognizable anymore. Sex workers said that there was suspicion everywhere. It did not feel like the same city, the same neighborhood, or the same people.
Public service announcements, newspapers, and every radio jingles promoted the ‘Holy Trinity of Prevention’—wearing masks, washing hands, and maintaining physical distance. While these measures worked for many, they were challenging for sex workers, especially for those living in crowded brothels in slum areas or in joint living conditions. Water scarcity, lack of sanitizers, soap, and masks posed major challenges. Mandatory physical distancing was lethal to business. Many sex workers indicated that during the initial days of the pandemic, their decisions were guided by fear and the need to protect themselves. The hope of winning against the pandemic was quickly fading. Hunger and uncertainty of the future now took hold of their minds. They could no longer heed the advice of the government or the experts, but had to take their fate into their own hands. They slowly let their customers in, but with an abundance of caution. Many started to sprinkle their clients with disinfectants and even applied sanitizers on their genitals which indicated that effective health messaging was urgently needed. Some women stated that they only catered to their regular clients. While in some situations, they tried to engage in safer sex, and others explored video sex and sex chats and transacted through money transfers. Some even shifted operations outside the containment zones hoping that their clientele would pick up since they needed money desperately.
Case study 1
Against the odds, we made it possible
Ajmer, an important pilgrimage town located in Rajasthan, hosts the Ajmer Sharif dargah of Khwaja Moinuddin Chishti which attracts millions of tourists. The economy of the town revolves around the various small enterprises connected with the dargah and tourism.
COVID-19 and the lockdown decimated tourism and sex workers were negatively impacted. Any truck carrying food and other essential items was gheraoed (surrounded) by poor men and women. There was no money for sex workers to even buy milk packets for their children.
‘I wanted to sell whatever little I had, like gold and brass utensils. There were simply no takers. Shopkeepers refused to take these as cash was a problem. They were not confident if people would buy such things when all they could think of was the next meal’, recalled Sameera (name changed), the leader of the sex workers’ CBO.
The dargah was closed. Earlier sex workers engaged in small cottage industries making flower garlands and agarbathis (scented sticks used for worship). They also sold small souvenirs for tourists. With both the earning members in the house getting furloughed, it was difficult to manage. Earlier, at least one member was employed. This lockdown was harsh. Everything was closed.
Many sex workers felt that their problems were similar to the ones that they had faced during demonetization. Cash became a most precious commodity. Nobody was lending cash. However, little children fell sick often, and they needed cash to buy medicines, milk, and other essential items.
The CBO members discussed amongst themselves and made plans to meet with industry owners and political leaders. ‘We needed help to organize ourselves. The local Member of the Legislative Assembly (MLA) came to our rescue when we shared the struggles of sex workers’, Sameera said. She, along with other members, sought help from philanthropists and set up a small unit to make sanitary pads and face masks. They decided that this would help sex workers and other women stuck at home to access cheaper products and would also provide employment opportunities in both manufacturing and distributing the products.
Necessity is the mother of invention. The CBO members came up with innovative ideas of negotiating with some housing cooperatives and distributing vegetables, fruits, and other essential items at their doorstep. They promised that complete hygiene would be maintained and with help of some housing society members, they could employ some more women.
Finding gainful employment in the vegetable business was not free of problems. They faced challenges with the police as movements were restricted. They were asked to get permission letters from the administration. The CBO members did try to intervene, but police were adamant. They refuse to let them travel on the road. They also arrested one of their members who was released only after paying a high bail amount.
When she returned from work, Lakshmi, a sex worker, found that her luggage and her children had been thrown out of the house. She was evicted since she could not pay the rent. A CBO member gave her shelter and accommodated her and her children in her house for a few days. The neighbors provided her food.
COVID-19 presented a gloomy picture as more and more women began to lose their homes and were in need of shelter which was not forthcoming from the government. These were the daily realities of sex workers. Therefore, instead of lamenting, the CBOs took proactive steps to come to the aid of their members and turned the crisis into an opportunity by thinking outside the box.
Sameera recalled the many lessons that she had learned and how she had implemented these learnings during the crisis. She said that the message was loud and clear, ‘We must not, yet again, end up more fragile than when we started during our initial days of HIV’.
Health, Especially Mental Health—COVID-19’s Additional Burden on Sex Workers
The music has stopped. We do not feel up to doing anything – loud giggling, quarreling over customers, whistling old songs – are all silenced. We just sit and worry. I have suffered alone for such a long period of time. Earlier, if one of us was sick or had lost a loved one, the other girls came to encourage her. Now it appears as if all of us have lost something. There is a lot of uncertainty. We don’t know till when this will continue.
A female sex worker, Mysore
The lockdown led many people to shift to working from home. However, sex work cannot shift home when it is basically a one-room dwelling with many residents. During the lockdown, most sex workers were confined to their home where they had problems. In conversation, a sex worker from Mysore said ‘I have been staying at home for over two months. There is no certainty of resuming business. If I continue like this, I think I will become a complete wreck’.
‘Television, which is the main source of information on COVID-19, is continuously displaying grim pictures of large-scale migration, impoverishment, and death. It is imperative for the vernacular television channels to also provide information on hope, safety, and well-being, during a time when the world is still awaiting a cure for COVID-19’ said another sex worker.
Loss of work and livelihood brought forth hidden mental health issues among sex workers. Gripped by anxiety and depression due to uncertainty, sex workers were continually treading on water, trying to keep from drowning in despair.
However, on many occasions, they displayed anger and resentment saying, ‘I do not know with whom I should be angry? The coronavirus for causing this pandemic or the government for implementing the lockdowns or the police and people around me that I am scared of or myself for feeling helpless?’ said one sex worker.
Case study 2
Hopelessness, hunger, and hardship—A deadly concoction
It was late in the evening. Rekha, a young sex worker from Ahmedabad, Gujarat, was staring vacantly at her kids, Rakhee and Rajesh, aged 7 and 4. The children were hungry. Her husband had abandoned her a few years ago. It had been over two months of the lockdown and all her resources had dried up. As the children huddled close to her, she started telling them how worthless life is. She started to cry and so did the children. Her thoughts were around putting an end to this misery. She got up slowly and went to the adjoining room that served as a kitchen. She reached out for a bottle of kerosene. The kerosene had been sitting there for the last few days since she had not cooked anything because she did not have anything to cook.
She managed to drink almost half of it and forced the kids to do so. Soon the neighbors heard the kids and her vomiting loudly and barged into her home to realize what she had done. Using her phone, they called one of the leaders of the community organization that she was a member of and within a short period of time a group of sex workers, including the leaders, were at Rekha’s home. They managed to get her to the hospital. After talking to the doctor, who conducted camps for them during the better days, they took Rekha and the children, who were now safe, back home. It was a traumatic night for everyone.
The leaders and the other women around talked about this, knowing that this attempted suicide was not an isolated event. They knew that many sex workers were facing mental health issues such as (what they called ‘tension’), lack of coping, buckling under pressure to survive, depression, and other issues.
They decided that there should be a way to provide psychological support. They made plans and rolled out a peer tele-counseling service. This was both reactive to people reaching them as well as proactive through regular calls to the members of the community organization to make sure that someone was enquiring about their well-being. This was most appreciated by all the women. They felt there was someone with whom they could talk about their situation, someone who was willing to listen and help. An antidote to the ‘pandemic of loneliness’ was produced.
Sex workers who lived with their family members—husband and children and in some instances their mothers and dependent children—faced several challenges. Relationships grew strained, and arguments and conflicts became common place. When their partners lost their jobs and did not have any income, partner violence, ranging from verbal to physical, was triggered. The children too faced violent outburst of elders in the family. It was increasingly reported that sex workers were facing domestic violence more than ever before. Many times, it would go unreported. Women who could gather the courage to report, feared arrest of their husband or boyfriend, which would exacerbate the problem.
Since the schools were closed and most of the children were trying to adjust to studying at home, the stress of providing them with educational tools, such as smartphones and computers, was a major challenge that the sex workers faced—a set of issues that went beyond the payment of fees. Providing supplemental educational aids and actual space for children to attend class from home in a single room was a challenge. This stress often resulted in the child discontinuing school. These women were forced to stop their children’s schooling. The additional problem of engaging the children gainfully became increasingly problematic. Adolescents’ exposure to drugs and other addictive substances was a serious threat. Watching their own elderly parents suffer in silence was also very difficult for the women. Caught between the children and the parents, often times, the women lost their sense of purpose. All these factors led to a significant level of stress, frustration, distress, and hopelessness. Many sex workers resorted to alcohol consumption. Increase in alcohol consumption and incidents of domestic violence became a complex web of daily life .
To keep children engaged with the online school system required better devices with quality Internet connection. Sex workers from Gujarat said that some children of sex workers were found begging as the parents could not afford food and other essentials for them. The collective members arranged to engage children of sex workers, along with other children in the slum who could not afford to go to school or join online classes. Many women talked about young girls (children of sex workers) being pushed to sell sex. Some of the collective leaders narrated their experience of how they were able to intervene in a few cases while in others they could not as they did not have any alternative. Some children were pushed to seek employment and to contribute to the family’s income. Needless to say, children were easy prey to abuse, violence, and exploitation. It is imperative that they are protected.
For sex workers living with HIV, there was a general anxiety about continuation of antiretroviral therapy (ART). ART centers, located at government hospitals, were transformed into COVID-19 centers, causing people to be worried about access to an uninterrupted ART supply. Coupled with that was the fear of infection with COVID-19 since government messaging indicated that those who were immune-compromised were very vulnerable to COVID-19. With immune-compromised conditions, it was too risky for them to seek medical care and treatment .
COVID-19 lockdowns and restrictions in transportation were added barriers to seeking social support. Peer educators and outreach workers, who regularly followed up with their networks to distribute medicine and provide ongoing psychosocial support, were suddenly halted which resulted in increasing sex workers’ social isolation. Fear, anxiety, worry, and challenges of living with HIV became more complex. Therefore, many sex workers living with HIV referred to themselves as the ‘living dead’ because they did not know what to do. Many people living with HIV (PLWH) had other underlying medical conditions such as tuberculosis (TB), hypertension, and diabetes. These not only added to their risks of contracting COVID-19, but furthered their apprehension of collecting medicines from ART centers.
Some of the young PLWH were employed and were fearful of losing their jobs if they were unable to take their regular medicines—including ART and other drugs. COVID-19 unleashed an array of emotions around being unemployed, socially and physically isolated, and unable to support the family. CBOs took on the responsibility of developing a unique supply chain for ART. They obtained information of their members in need of ART, collected the drugs from the center, and made sure that the medicines were delivered at a mutually convenient place (without compromising their confidentiality). CBOs also initiated tele-counseling for their members in order to keep in touch with and advocate for social benefits schemes. It is important that the government considers the needs of sex workers, PLWH, and children, especially girl children, and plans measures in a non-stigmatizing manner. Mental health is emerging as a growing and alarming issue in the lives of sex workers including those living with HIV, during the pandemic.
Case study 3
Sex workers double up as frontline workers to help society
Over the last twenty years or so, apart from being on the frontlines of HIV, the sex worker community has also been ready to provide a helping hand when it comes to social issues. They have, therefore, been earning social capital in situations where they were engaged on the frontline in providing solutions. For example, when there were floods, droughts, and other natural calamities, sex workers collectives, through their collective power, made inroads into the area of preventing sex trafficking.
During the HIV epidemic, sex workers were the barefoot soldiers distributing condoms, convincing other sex workers to visit clinics, and advocating for their rights. Most of the time, they moved during the night often in dangerous places. They never worried about the harm that could come to them as they always kept the need of their peers in their sight.
COVID-19 threw up major challenges but also presented opportunities. One was clear about the routes of transmission of HIV and outreach work which—despite being conducted at odd hours—did not pose as much risk as COVID-19. A mere conversation or a touch or a hug could be a gateway for infection with the virus. News was also flashing on television that doctors and nurses were facing stigma because they treated COVID-19 infected patients. Many sex workers, who lived in slums in urban settings, were aware of their own community members getting infected with COVID-19. Homeowners started to throw sex workers out and locked their doors. Not many people came forward to help.
Neeta Ben (name changed) was a CBO founding member in Gujarat. In the last 15 years of the CBO’s existence, she had fought many battles for sex workers. Her opponents were the police, politicians, government officials, and common citizens. She raised her voice without fear and always stood for the progress of the sex worker community. She was well known for her ‘impromptu’ helping nature. So, when she decided to take the plunge into politics, nobody expected her to lose. She was a local counselor in the city representing a well-known national party. It was a proud moment for sex workers to see that one of their own in the City Council dared to talk about their rights. She was a strong voice in representing their issues.
When Neeta Ben learnt about the severity of the problem of COVID-19 that infected sex workers and their family members who were not fit to travel to the local government hospital, she arranged for transportation and helped them to get admitted. Slowly, the CBO learnt that stigmatization and discrimination were not confined to sex workers alone but extended to most people living in impoverished settlements. The CBO mobilized its team and helped many COVID-19 patients who were unable to seek immediate medical assistance. In this way, the work of Neeta Ben and her team soon expanded beyond sex workers to many others.
Doctors and nurses were also appreciative of the CBO’s efforts and applauded them. Neeta Ben worked tirelessly for many months transporting, helping, and being with COVID-19 patients. Unfortunately, age was not on her side, and she tested positive to the same disease. She passed away after a few days of admission to the hospital. Her heart condition and other medical issues led to her death. Her commitment to selflessly help, not just sex workers but all poor people in need, will always be remembered. Other members promised to continue her legacy.
Her life was a living example of valor, sacrifice, and heroism.
Resilience of Sex Workers
The year 2020 will be known as the ‘Year that changed the World’. The ‘normal’ as we previously understood it was disrupted. There were major transitions in economy, health care, education, jobs, and livelihoods. Schools and jobs quietly shifted online. Governments, charitable organizations, faith-based organizations, students, and the private sector tried to put their best foot forward to help those in need. Such a tectonic shift in the nature of humanity could not escape the sex worker community. Like everybody else, they too were victims of and also first responders to the pandemic. Sex workers collectives, most of which were formed to fight the HIV epidemic, were by virtue of their very nature well-equipped to respond to the COVID-19 pandemic. ‘If we have to survive, we have to be COVID compatible!’ said a female sex worker from Karnataka.
During the past few months, the authors have been having conversations by telephone and by holding virtual meetings with various sex workers across India. Conversations have been held with individuals, leaders, and collectives as well as with staff and supporters of sex workers and sex workers organizations. The idea was to learn about what happened during the lockdown period and during the unlocking (1 to 4) and to better understand the impact of these events on their lives.
Discussions with the community enabled sex workers to learn that the fight is on and is continuing with added vigor and strength. The COVID-19 pandemic hugely affected sex workers. While sex work was greatly impacted, sex workers learnt to take help from the collectives that they were associated with without fear of discrimination.
Many sex workers belong to the lower strata of society. They are identified by their class, caste, convictions, and customs. Sex workers belonging to different castes, creed, and religions faced discrimination. Sex workers CBOs, not restricted by any of these issues, were able to provide aid (dry rations, baby food, and milk) to their members and to other people in their neighborhood. The COVID-19 pandemic offered them an opportunity to fight the social evils of stigma and discrimination, to earn back their respect, and a rightful place in society.
The government’s announcement of providing dry rations to the poor was a welcome move but was not much help for sex workers as many did not have ration cards. As per the demand of the sex workers collectives, the Supreme Court of India directed all the states and union territories to provide them with dry rations without insisting on any proof. These are important battles won, where the sex workers collectives fought for dignity and financial help during the pandemic and were recognized by the highest court of India.
With the growing numbers of COVID-19 cases across the country, sex workers were increasingly faced with limited options for fighting the pandemic. Finding work in these troubled times was posing risks to their own health and safety. Many of their peers were getting infected, and the situation did not seem to be getting back to normal any time soon. Sex workers began to find ways to keep themselves engaged. They began to organize their own responses to the crisis. They continuously strove to be a part of the mainstream, not just to fight for their rightful place and to be heard, but more importantly, to extend their support to all who needed it. It was their camaraderie which needs to be celebrated.
One of the successes of HIV was the fight against myths and misconceptions. COVID-19 brought the need for effective communication to the fore again. Self-protection measures needed to go beyond mandatory masks, hand washing, and physical distancing. These are important no doubt, but it was also imperative to develop strategies for sex workers to minimize harm while providing sexual services. Health is paramount for all to survive and so is employment. The need of the hour is to balance the two. Effective communications need to be disseminated to all.
Mental health issues, of critical importance, needed to be addressed in a scientific manner. Newer counseling techniques had to be learnt. A committed pool of workers needed to be trained.
When unlock measures were announced, the businesses of sex workers never went back to normal. Some found ways to cope like shopkeepers putting up barricades to maintain distance. Others insisted on digital payments instead of cash. Still others moved to the digital space like teachers, doctors, and consultants. Sex work, by its very nature, demands physical proximity not physical distancing. Sex workers had to innovate to find ways to work. Despite all these hardships, sex workers as a community looked after and fought for one another. Their resilient spirit needs to be celebrated. In response, many individuals, organizations, and student communities came forward to donate money. In some cases, community organizations provided direct cash transfers to sex workers. In other locations, CBO members advocated successfully with local politicians, district administration officials, private companies with corporate social responsibility (CSR), and philanthropists. Along with food, it was imperative to hand over small amounts of cash to enable sex workers to purchase essential items.
It is important to understand that sex workers, one of the most marginalized communities, were one of the worst hit by the pandemic. While the fight to prevent COVID-19 continues, the fight that sex workers are fighting is also far from over. The stories of their lives and resilience are indeed inspiring. They teach us about self-respect, self-worth, dignity, and the passion to fight back and emerge victorious.
Figure 15.1 shows some reports on sex workers that were published in print media during the pandemic (Fig. 15.1).
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UNAIDS. COVID-19 responses must uphold and protect the human rights of sex workers. UNAIDS, United Nations. 2020 Apr 24.
Talwar S. SC directs states to provide dry rations for identified sex workers sans insistence on identity proof and file affidavit on benefits accrued. Live Law. 2020 Sep 29.
Ara I. Ground report: the sudden lockdown has dried up sex workers’ incomes overnight. The Wire. 2020 Apr 06.
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We would like to acknowledge all the sex workers who poured their heart out to us. We thank all the sex workers collectives who shared their stories with enthusiasm. Though most of these members were busy organizing many initiatives, they were gracious enough to take out some time to recollect events and share them with us. While some of the sex workers were open to sharing their names, many preferred to remain anonymous. We respect their privacy and are, therefore, acknowledging all sex workers and their collectives who are the real heroes.
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Reza-Paul, S. et al. (2022). From Vulnerability to Resilience: Sex Workers Fight COVID-19. In: Pachauri, S., Pachauri, A. (eds) Health Dimensions of COVID-19 in India and Beyond. Springer, Singapore. https://doi.org/10.1007/978-981-16-7385-6_15
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