“I have seen the problems of my sisters” 

Asha is an auxiliary nurse midwife and also a female sex worker. Dr Kirti Iyengar is National Programme Officer for Reproductive Health & HIV/AIDS with UNFPA India. Together they work at the community level on increasing access of female sex workers to integrated sexual and reproductive health (SRH) and HIV services. 

Asha* is from the northern state of Uttar Pradesh, India’s most populous. She got married at the age of 17. A year later she was divorced, and became a single mother when she was just 18 years old.

She worked in the city hospital as a midwife. The monthly salary was the equivalent of US$ 15 a month. “I was really poor,” Asha recalls. “I had a baby and the bills were so much. I wanted to educate my son in a good school.”

She remembers a woman who would come for treatment at the hospital. “She was a female sex worker. The woman suggested casually that I should become a female sex worker, as a way to earn some extra money.”

"The woman suggested casually that I should become a female sex worker, as a way to earn some extra money.”

As financial pressures increased, Asha decided to try part-time sex work. Nearly two decades later she is still a sex worker and now working as a community outreach worker providing peer-to-peer support. “I have seen the problems of female sex workers,” Asha says. “I follow them as a sister.”

The outreach program supported by UNFPA engages female sex workers as educators and equips them with supplies and basic counselling skills. “I carry materials, condoms and something that demonstrates how to use the condoms.”

Since the COVID-19 pandemic began, Asha brings extra supplies for sex workers like hand sanitizers, masks and soap. “I also started bringing oral contraceptive pills, emergency pills and pregnancy tests for distribution.”

Asha says most of the female sex workers in the network have two to three children and sex work was critical for them to earn enough income to feed their families. “Because they are not getting clients during the pandemic, many female sex workers are taking risks in order to get clients, including having sex without using condoms and other unsafe sex practices.”

“Because they are not getting clients during the pandemic, many female sex workers are taking risks in order to get clients, including having sex without using condoms and other unsafe sex practices.”

-Asha, auxiliary nurse midwife and female sex worker

It has become even more important that outreach workers are able to provide information and services. “During the lockdowns the services shifted to virtual weekly meetings to create a point of contact. Even accessing essential medicines, people had problems. Fortunately through the outreach workers, we were able to provide antiretroviral treatment to sex workers living with HIV at home”

Peer educators like Asha were equipped with ID cards and authorized to deliver essential services, even during periods of lockdown. This has helped maintain the network and gather reports from communities. “Peer educators were able to reach female sex workers through some unusual ways,” Asha says. “Sometimes, when female sex workers would go to buy their vegetables, peer educators would meet and hand them condoms along with information about services.”

In these brief outdoor exchanges and through online chats, peer sex worker outreach members explained about sexual and reproductive health and rights and COVID-19 related issues like hand sanitizing, handwashing and social distancing. “I phone them up and have virtual discussions with them. As restrictions ease, I am able to meet them on a one-to-one basis.”

In India, female sex workers frequently face discrimination by neighbours. The network works as a conduit for women to share stories of discrimination, gender-based violence and even cases where doctors refuse to treat female sex workers.

Asha says financial problems are having an effect on mental health. The call centre number is available 24 hours and clear guidelines are in place on how to handle complex calls from distressed individuals.

“New female sex workers do not know what their rights are. Legal sessions help them to build awareness of their rights and what protections they are entitled to.”

-Dr Kirti Iyengar, UNFPA India

Dr Kirti Iyengar from UNFPA’s India office has helped coordinate the emergency response team. The team is notified when there is a call from someone who has suffered physical violence. They help the survivors access services through the network.

The community holds monthly sessions on the legal rights for female sex workers. “New female sex workers do not know what their rights are,” says Kirti. “Legal sessions help them to build awareness of their rights and what protections they are entitled to.”

For people living with HIV, the sessions helps them know what is covered under new anti-discrimination laws. One of the protections is that people should not be asked to leave a rental property if they are HIV positive.

Asha says the most important lesson from the pandemic is that female sex workers need to try to accumulate more savings. Studies show that less than four percent of female sex workers can save at all. “We should have savings so if there is a crisis, we can look after our children,” she says.

“We conduct sensitization with female sex workers so they are aware of which services are available and they are informed about their rights.”

-Dr Kirti Iyengar, UNFPA India

Asha says financial instability makes female sex workers more vulnerable to abuse and gender-based violence. “Some people hate female sex workers,” she says. “Men deceive them and promise there will be one client, but there might be multiple clients, even up to 10. Because of financial pressures, they are willing to compromise on these issues.”

The project is a bridge for UNFPA to reach key populations and address their sexual and reproductive health and HIV testing and treatment needs. “There is a violation of human rights when it comes to sexual and reproductive health,” Dr Kirti says. “Even today when women want to access abortion services, there are a lot of questions and apprehensions for the service provider as well as on the client side.”

Kirti says without access to abortion services or family planning, a woman cannot decide when she wants to have a child. She says the program aims to improve the quality of the services being provided at every level. “We deliver trainings so service providers can address the complex issues of key populations,” she says. “We conduct sensitization with female sex workers so they are aware of which services are available and they are informed about their rights.”

*Asha is a pseudonym to protect her identity