Pandemic impact on sex workers and their children as soon as the COVID-19 pandemic spread, it was clear that the sex workers’ community would be badly hit by it.
Far from being a “non-essential” activity, sex work is their bread and butter. COVID-19 has brought the livelihoods of tens of thousands of sex workers to a standstill and adversely affected their physical and mental well-being and that of those dependent on them. Women in sex work always have had to face difficult situations while earning their livelihood. Their marginalisation results in their having to struggle at all levels, including access to health, education and social justice. COVID-19 has gravely affected their livelihood and the looming uncertainty about when this could end has left them in a lurch.
As the COVID-19 pandemic was making its inexorable sweep across the globe—accompanied by stringent lockdowns and restrictions—it soon became clear that the sex workers’ community would be badly hit. Initially confined to the elite in India—international travellers and their contacts—the novel coronavirus has now affected all strata of society. Because its spread depends upon people’s physical contact with each other, physical distancing and restriction on mobility, or “lockdown,” as advised by the World Health Organization was seen as the primary mode of prevention. This translated into a total ban on human movement and restrictions on physical contact between people. This is devastating for those sections of society whose livelihood itself depends upon human contact. The looming uncertainty about when this will end has left them in a lurch. Besides the medical profession, other professions dependent on physical contact, such as masseurs, hair stylists, sports persons, etc, are all facing the brunt of the lockdown. Sex workers, a large population that earns its livelihood through work pivoted around human touch and intimacy, has been gravely affected.
Sex work is defined as the provision of sexual services for monetary benefit or kind. A conservative estimate of the number of female sex workers in India is 1.2 million (UNGASS Country Progress Report 2010) with an estimated 6,88,751 “registered” female sex workers receiving services from the Ministry of Health and Family Welfare. Providing sexual services is the sole means of livelihood for them, and far from being a “non-essential” activity, sex work is their bread and butter. The lockdown has thus placed on hold the livelihoods of tens of thousands of sex workers, their physical and mental well-being and that of those dependent on them.
Thus, when discussions began on COVID-19 and its mode of transmission, it was clear to sex workers that this would badly hit their livelihoods. That such a pandemic would affect their physical as well as mental well-being, was certain. Women began to discuss the issue and questions that were uppermost were: Would medical services be available to women who were already suffering from various conditions? Would the HIV treatment, which is only available in government hospitals, continue to be available? The stringent lockdown once again highlighted the perils of those whose livelihoods are directly dependent on their day’s work. Existing vulnerabilities intensified, and they bore witness to the grave turn taken by the problems of the migrant workers.
Sampada Grameen Mahila Sanstha (SANGRAM), Veshya Anyay Mukti Parishad (VAMP) and their partners in the National Network of Sex Workers (NNSW), anticipated the looming danger, as soon as the lockdown was announced. Basic rations and medicines were prioritised. The tensions in the community were on a rise. The streets, usually buzzing with activity and a booming business, were now as deserted as a graveyard. This was unprecedented. The women were familiar with day-long, statewide or nationwide “bandhs,” and even then, their neighbourhood would see bustling activity in the evenings as there was no curfew. But this lockdown dealt a severe mental blow to the women in this profession. Restrictions on movement lead to loss of customers and thus, loss of livelihoods. And the struggle for survival began anew.
One of the first casualties of the lockdown was not due to direct viral infection. A 34-year-old mother of a 6-year-old, earning her livelihood through sex work, died by suicide. Bereft of work, no interaction with customers, no man-friend, she was driven to take her own life in a fog of depression and succumbed to 90% burn injuries. A field worker from VAMP/SANGRAM had met her only a day before for a survey to estimate the extent of relief measures to be undertaken and had included her name in the list of beneficiaries. However, before relief could reach her, she ended her life, fearing the impending doom of the virus. Her untimely death was a stark reminder of the fragility of communities on the margins.
Exacerbating Vulnerabilities
The COVID-19 pandemic and accompanying lockdowns and restrictions have only deepened existing cleavages, pushing those on the margins closer to the edge. Women in sex work have always had to face myriad challenges, their marginalisation pushing them to struggle at all levels, including access to health, education and social justice.
One of the main reasons for their marginalised existence is that providing sexual services, the sole means of livelihood for this community, has been denied social sanction. An understanding of the context in which sex work is carried out is necessary in order to estimate the damage inflicted by the lockdown.
The primary bane of sex work, colloquially known in Maharashtra as dhanda (business), is that it has been criminalised. The existing law continues to criminalise aspects of sex work including soliciting, brothels and living off the earnings of sex work. Sex workers are raided, “rescued” and confined in shelter homes usually under abysmal conditions. For these reasons, those who practice it often do so clandestinely and sex workers are not willing to come forward, acknowledge their identity and access services provided by government. Their lives and work are in a grey zone that is considered illicit, spills over into practical issues such as a lack of identification documents such as voters’ ID cards, Aadhaar numbers, caste certificates or ration cards which remain inaccessible to the majority of sex workers. Many are single mothers and unable to produce proof of residence for long periods of time or show ancestral documents required for obtaining caste certificates.
Sex workers move frequently to avoid identification by family or for better earning opportunities. This makes it doubly difficult to provide relief work though government channels that ask for ration cards and other identity and address proof. The COVID-19 pandemic stranded many sex workers in cities, towns and districts, especially those coming from Kutch and Ranchi. They were refused rations and any relief since they did not have ration cards belonging to the city or district they were found in. Once their savings ran out, women were asked to vacate their rented rooms amidst the nationwide lockdowns. Women reported attempting to resort to desperate measures to return to their hometowns.
Additionally, a large proportion of sex workers (male, female and transpersons) work from home and arrange clients via mobile phones, independently or through an agent. A large percentage of women are housewives, and their families do not know of their work (VAMP 2020). During the pandemic, their livelihood came to a complete halt. They were unable to explain the loss of livelihood to their families or approach collectives who were extending relief to sex workers in brothels.
The invisibilisation by the state and the long history of conditional government assistance has been evident during the pandemic. While the government identified several categories of marginalised groups such as transgender people, persons with disabilities, informal sector workers and migrants for immediate relief, sex workers were left out of all relief packages. States historically make assistance contingent on giving up sex work. For instance, the scheme of the Karnataka government in 2018 under assistance for “exploited” women requires them to provide an undertaking that they will not return to sex work.
After sustained lobbying over the years, in July, the Government of Maharashtra in a first, recognised sex work as work and a special category requiring assistance during the pandemic (Chandra 2020). This good practice however was not replicated in other states.
The circular issued by the Department of Women and Child Development on 23 July 2020, called upon the district administration and WCD to support sex workers and those rescued under ITPA, making a clear distinction between the two groups. The circular states:
“With reference to the COVID-19 pandemic and the lockdown since March 2020, we want to inform you that, women who have been rescued under ITPA and those who are in sex work are finding it difficult to survive and take care of their families. … The women in sex work (Veshya Vyavsay) and the women who have left sex work have lost their income generation options. Due to lock down they are not able to get other jobs either which leads them and their families to starve. You should provide free ration and all essential services to the above mentioned women.” [Translation of letter dated 23 July 2020, Women and Child Development Department, Government of Maharashtra]
The lack of relief made it particularly difficult for sex workers whose livelihoods are precarious, with no state-sanctioned safety net or family support. Sex workers’ families often depend on their daily earnings to run their families, and do not have savings, access to loans and other financial institutions. Public sector banks routinely refuse loans to sex workers since they have no one to stand surety. Private money lenders take advantage of this situation, lend them money at exorbitant interest rates, compounded on a weekly or monthly basis, thus leading to their debt burden. During the pandemic, sex workers took loans from private money lenders, self-help groups (SHGs) and obtained gold loans to support their families. They are being pressured to pay back their loans at high interest rates, which is difficult without any income.
The lack of regular income had a domino effect on access to other basic necessities, including housing. Most sex workers who run single-headed households live in rented accommodation; paying rent on a weekly basis. During the lockdown period, there have been accounts of sex workers being asked to given rent or else vacate the premises. Moreover, their children who were staying away from them for educational purposes have returned home due to the lockdown. Providing for them has further added to their distress.
Studies such as Bhattacharjya et al (2015) have shown that sex workers experience high levels of physical, sexual, emotional and economic violence in several settings: at work, in health care and custodial settings, in society and in their homes. “Violence denies sex workers their fundamental human rights—to equal protection under the law; protection against torture, cruel, inhuman and degrading treatment; and their right to the highest attainable standard of physical and mental health” (Bhattacharjya et al 2015). It is not surprising then, that the pandemic and lockdown increased sex workers’ experience of violence. The stigma attached to sex work exposes them to violence in personal spaces from family members, including intimate partners. Sex workers reported facing higher levels of abuse (verbal, and physical) from their families due to their inability to bring in money during this period.
Impact on Health
The most visible and severe impact of the pandemic has been on basic necessities like food security and good nutrition.
As sex workers were largely excluded from food relief packages provided by the government, out-of-work sex workers had to depend on food relief provided by non-governmental organisations (NGOs) and individual philanthropists. They were not able to access adequate quantity or quality in terms of nutritious food. This has particularly impacted HIV positive sex workers, older sex workers living with co-morbidities and pregnant women in sex work.
During the pandemic, private hospitals turned away sex workers on the grounds that they were attending only to COVID-19 patients. If they did admit them, they charged exorbitant sums for treatments. There is a continuing fear amongst sex workers about visiting government hospitals for fear of contracting COVID-19. Sex workers’ access to reproductive health services has been severely impacted during the lockdown. Women were unable to get oral contraceptives from government hospitals due to shortages and NGOs supplying these under various programmes had shut services during the initial phase of the pandemic. Women who are pregnant and required to attend gynaecological and obstetric services are facing the brunt of the backlash. Pregnant woman in sex work are being told to access sonography at private clinics at exorbitant rates. They are being refused physical check-ups and told to leave or come back after a couple of months. Some of them choose to deliver outside the healthcare system in the brothel itself under very unhygienic conditions. Abortion services were denied by government and private hospitals. Sex workers had to contact NGO workers who then accompanied them to private hospitals and got them emergency support.
STI departments in the government hospitals were shut during the lockdown. Since private STI doctors were charging high fees, sex workers were forced to access less qualified doctors and quacks for remedies in Gumla and Ranchi. Sex workers have reported an increase in verbal abuse and stigma from healthcare providers while accessing gynaecological or STI health providers.
With regular health services through the public healthcare systems severely impacted, sex workers faced immense difficulties. Outpatient services in the government hospitals were shut, forcing sex workers to approach private doctors who charged them exorbitant sums of money. Many women in Gumla, Ranchi went to quacks as they could not afford the medical fees. Sex workers with post-operative follow-up approaching the civil hospital were refused, saying that they would not be able to provide service. Physical check-ups were not being done in Parbhani, Sangli.
Sex workers who are diabetic, have high blood pressure, thyroid or other complaints have not been able to undergo confirmatory tests or obtain medicines from the government hospitals. They are being forced to visit two or three hospitals before they are given check-ups and tests or they purchase medicines at higher prices from medical shops. Many women in Hassan, Kolar, Pune, Miraj, and in Tamil Nadu have stopped medications for these diseases as they are simply not able to afford it. There is an increase in mental health concerns amongst sex workers, due to their livelihood being impacted and uncertainty about the future. Closure of government mental health facilities impacted women’s abilities to seek counselling support. Suicide and depression among sex workers were reported in Sangli and Pune brothels, respectively.
Some sex workers need special healthcare measures, an important group among them being those living with HIV/AIDS. Positive sex workers who are stuck in other districts are being denied ART medication from those districts like Bapatla, Pune, Sangli. The ARV medication was made available at the primary healthcare centre (PHC) in the villages, but the staff refused to hand over medicine to collective representatives, stating that they needed to hand it over to the woman who was positive. Positive sex workers refused to have their identity revealed by coming to the PHC—some women did not take their medication due to the inflexible attitude of the PHC staff in Karnataka. In Tamil Nadu, women were not able to access ARV medication, since doorstep delivery of medication was not done and public transport was not available. As a result, many women missed their ARV medications.
Interventions
To deal with this issue, VAMP approached the courts to raise the issue of access to third-line ART treatment from the government. A favourable order by the high court ensured access to such treatments and district collectors were directed to carry out the order. Additionally, there were also several problems encountered in the first and second line ART treatment reaching the beneficiaries. It is the government that has to take decisive steps to resolve this crisis caused by the lockdown without adequate planning for the most vulnerable. The government must show sensitivity towards the sex workers’ community, and design and implement policies and schemes for them. Currently, none of the schemes declared by the central government include this particular section of society.
However, relief measures can only be of help for a short term. A more fundamental issue is the recognition of sex work as work. Women in sex work have to be acknowledged as “workers” and be accorded due status in order to accrue the necessary assistance from the government. This has been our struggle all along. Our demand has always been to grant the status of “workers” to this community and this will continue in the future. A step in this direction was the recent judgment in September 2020 of the High Court of Mumbai which observed the following about the Immoral Traffic Prevention Act (ITPA),
“It is interesting to note the relevant provisions of the said Act, which go to show that the purpose and the object of the Act is not to abolish prostitution or the prostitute. There is no provision under the law which makes prostitutions per se a criminal offence or punishes a person because he indulges in prostitution. What is punishable under the Act is sexual exploitation or abuse of person for commercial purpose.”
Another timely intervention took place on 29 September 2020, when the Supreme Court passed directives for sex workers to receive dry rations and other benefits without insisting on proof of identity through documents.
A further step in the acknowledgement of sex workers as informal sector workers was recognition by the National Human Rights Commission in its advisory issued on 7 October 2020, on the rights of women during the pandemic, stating that sex workers must be “recognised as workers and be registered so that they are able to get worker benefits.” The advisory also recommends the issuance of temporary identity documents, especially for migrant sex workers, to enable them to access welfare benefits, healthcare and protection from domestic violence. While these are welcome responses to the crisis brought about by the COVID-19 pandemic and the lockdown, there is still a long journey to transform social perception and accept sex workers as equal citizens and an integral part of our society. #livehyd #LiveHyd