Background Female sex workers (FSWs) in India remain most vulnerable to contracting HIV immediately after initiation into sex work. We explored the process of initiation to inform interventions.
Methods In-depth interviews were conducted with sixteen purposively selected FSWs in Goa (December 2004–December 2005). The life narratives were interrogated using grounded theory.
Results The narratives showed a dynamic interplay between underlying vulnerabilities, precipitating factors, and how women entered sex work: The ubiquitous mitigating theme that emerged was violence: dysfunctional and violent family life; sexual violence; and violence from intimate male partners. Other underlying vulnerabilities were also manifestations of gender disadvantage: being unwanted; sexual naïveté; early sexual debut; entrapment in loveless marriages; and lack of life skills. Loss of social support through bereavement and abandonment or financial need, were the commonest events that precipitated entry into sex work. The clearest division in the route into sex work was between traditional caste-based sex workers (devadassi) and those who were either introduced by peers, or sold through a broker; however the underlying and precipitating factors for both routes were remarkably similar.
Conclusion The interplay between caste, economy, gender, and violence drives entry into sex work. HIV prevention interventions must work upstream on the context within which women enter sex work and downstream to strengthen their agency. The peers who introduce women into sex work are potential vehicles to “deliver” HIV prevention services. Ultimately, the challenge is to ensure that the structural vulnerabilities that prevent effective HIV prevention early after entry into sex work do not also become barriers preventing FSWs from accessing HIV treatment.
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