Sex Workers & HIV in India

A review of ‘Flying’ Female Sex Workers in Kolkata, India: Using ‘Cultural Biography’ to Understand HIV Risk Perception, by Sunny Sinha.

Sunny Sinha’s dissertation, a study on flying female sex workers in India, focuses on the women’s risk perception in the social, cultural, and health context. Similar research on commercial sex workers tends to put emphasis on a public health perspective with an exploration of the impact and incidence of HIV and sexually transmitted infections. Sinha’s study, on the other hand, is more searching and complex. It roots itself in the delineation of the life experiences of the subjects and becomes the story of their individualities, resilience, and agency amidst their perpetual struggle for existence.

Flying sex workers—i.e. commercial sex workers who are not attached to a brothel and do not have a fixed place of operation—are a marginalized and understudied group in India and across the globe. Prior studies of commercial sex workers in India, whether biomedical or psychosocial, tend to focus on individuals who ply their trade within the confines of a designated red light district. Sinha’s work sheds light on a hitherto under-researched high-risk population. The objectives of the dissertation are to investigate the risk perception of the research subjects and explore the impact of their life experiences on their risk construction and perception. Sinha’s choice of methodology for this study is cultural biography, which offers a unique way to pursue the objectives of the dissertation. In contrast to psychometric approaches involving Knowledge, Attitudes, Belief, Practices (KABP) survey questionnaires and statistical methods for exploring risk factors, the methodology of choice creates the opportunity for obtaining detailed and candid glimpses into the life histories of the research subjects and renders the research project a compelling narrative of humanity and survival.

This is a detailed and well-structured dissertation. Chapter 1 introduces the objectives of the study, the research questions, and the research problem. Providing an overview of the characteristics of flying sex workers, Sinha delineates their physical, social, and economic risk perception as well as the relative importance of the risk of HIV in comparison to other occupational risks. The topic of the impact of the flying sex workers’ prior life experiences on their perception of risk is introduced here as well. The first chapter also provides an overview of the methodology used in the dissertation and briefly discusses the relevance of the study to other scholarship.

Chapter 2 emphasizes the valuable distinction between sex workers operating at brothels and flying sex workers with no fixed place of business. It also highlights epidemiological or biomedical models of risk versus incorporation of socio-demographic contextualizing factors in the characterizing of risk, and the utilization of methodologies like cultural biography in place of psychometric approaches. The study employs a unique methodology of combining ethnography and life history interviews. During the first stage of the study, Sinha collected data through 46 short life portraits. During the second stage of the study, she collected in-depth life histories of three flying sex workers over a period of seven months.

Chapter 3 discusses logistical details of data collection, such as visiting field sites, access to sex workers, and the complex process of establishing rapport with the study subjects. The process of data collection is discussed minutely in this chapter and ethical issues of working with such a vulnerable and marginalized population are explained. Chapter 4 describes in detail the findings from the 46 short life portraits of flying sex workers. The motivations for venturing into commercial sex work are delineated, and the understanding of socioeconomic and health risks by the sex workers are discussed. The impact of contextual factors, like violence and stigma, on the perception of risk and negotiation of social and healthcare-seeking behavior is also analyzed.

Chapter 5 is the crux of the dissertation, describing the findings of the in-depth life histories of three flying sex workers. The banalities of life, dysfunctional family relationships, spousal violence and abuse, poverty, rape, motherhood, and stories of survival irrespective of hardships, are recounted in lucid and poignant detail. The narratives of the women themselves convey their individualities that suffuse the recounting of their sufferings, banalities of existence, charged events, relationships and indomitable spirits. The sixth and final chapter concludes that—in place of an epidemiological model of risk construction which hinges on an individualistic paradigm and incorporates psychosocial theories of disease prevention—contextual elements like violence, stigma, socioeconomic factors, and life experiences of sex workers need to be taken into account to assess risk perception and address the issue of HIV/AIDS among commercial female sex workers.

Throughout the dissertation, the narratives of the subjects are punctuated by the researcher’s own reflections. Her subjective thought processes, anxieties, social conditioning, and preconceived notions mingle and contrast with the experiences of her subjects, presenting a compelling story of individuality and survival. One of the unique characteristics of the study is the positioning of the researcher herself as an active self, interpreting the narratives of selfhood and humanity of her study subjects. Sinha’s dissertation presents a dynamic area of study that offers opportunities for interdisciplinary research across different fields such as social work, medical anthropology, sociology, public health, and health communication. The tropes of insurmountable poverty and desperation, common in studies on similar research subjects, are avoided in her work. Instead, she manages to present, in great richness of detail, the human issue of survival and resilience of an overtly marginalized and stigmatized population.

Satarupa Dasgupta
College of Nursing
New York University
sd106@nyu.edu

Primary Sources

Social Science and Medicine
Culture, Medicine and Psychiatry
American Journal of Public Health
Sexuality and Culture
Sociology of Health and Illness

Dissertation Information

University of South Carolina. 2012. 303 pp. Primary Advisor: Naomi Farber.

Image: Photograph taken during fieldwork with women sex workers in India. Photograph by author.

1 comment

Leave Comment
  1. Apurva kumar Pandya

    Nice study and very well positioned in the context of HIV prevention. I enjoyed reading the review. Author has done a very good job in in capturing the story of sex workers’ individualities, resilience, and agency amidst their perpetual struggle for existence. The reviewer has also done great job in explaining the core of the dissertation in lucid manner.

    It is True, flying sex workers are marginalized and vulnerable for health risks, abuse and violence. With changing social context, new category of sex workers are emerging in many States of the country, home-based sex workers. They are mostly hidden and difficult to track.

Leave a Reply