Dhandha, dharma and disease: traditional sex work and HIV/AIDS in rural India

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Abstract

This paper discusses the results of two ethnographic studies with female sex workers in rural areas of Karnataka and Rajasthan, India. In particular, we focus on women whose socio-economic status, and religious and occupational practices, are part of sex work systems that have historical precedents such that they can be termed “traditional” sex workers. The approach taken in the ethnographic work was informed by current critical approaches in medical anthropology and public health. The paper argues that in the context of an expanding HIV/AIDS epidemic in rural areas of India, understanding the historical and structural factors that operate to perpetuate female sex work as a culturally “sanctioned” occupation is critical if interventions intended to reduce the risk of HIV transmission are to succeed. We conclude that interventions designed to empower women collectively in these communities that are consistent with cultural traditions are needed to lead to healthier sexual behaviours and reduced risk of HIV/AIDS infection.

Introduction

This paper discusses the results of two ethnographic studies with female sex workers in rural areas of Karnataka and Rajasthan, India. In particular, we focus on women whose socio-economic status, and religious and occupational practices, are part of sex work systems that have historical precedents such that they can be termed “traditional” sex workers. In one interview, a sex worker said that women have been practicing dhandha (sex work) for generations. “This is “dharma” (religion) and “karma”(righteous duty) to us.” Understanding this statement became the focus for the project. In Karnataka, the women were part of the Devadasi tradition, while in Rajasthan the research was carried out in several Nat communities.

The Devadasi tradition was widespread in South India. Known popularly as “temple dancers”, the tradition involved the dedication of young girls for marriage to a god. Once these girls reached the age of maturity, they would become servants at local temples, often combining dancing and other artistic functions with sexual services to the priests and patrons of the temple. The Nat caste in northern India were entertainers to the ruling castes. The community would travel from one court to another, where young men and women would entertain through dancing, juggling and other athletic and artistic displays. With social change in post-colonial India, this traditional role has eroded and Nat communities now rely on female sex work for economic survival.

The context for this work is strongly influenced by the emergence of the HIV epidemic in India, which has created a greater focus on the practice of female sex work (Asthana & Oostvogels, 1996; Evans & Lambert, 1997). The societal response has been varied, but has often resulted in an intensification of stigmatization and marginalization of female sex workers (Nataraj, 1990, p. 16). The HIV epidemic has also stimulated a substantial response by governments and non-governmental organizations (NGOs), which have initiated various programs for HIV prevention among female sex workers. Generally, these programs have focused on individual behaviour change, usually through peer outreach and education (Jana, 1999). However, the acceptability and impact of such programs in the context of traditional sex work is not known. Therefore, these ethnographic studies were conducted to better understand the socio-cultural context of traditional sex work in rural areas, with the goal of developing effective program models in those settings. This work is linked to a collaborative effort by the governments of Canada and India to improve HIV/AIDS programming in the states of Karnataka and Rajasthan. The India–Canada Collaborative HIV/AIDS Project (ICHAP) is funded by the Canadian International Development Agency. The results of these studies have been integrated into the design of ICHAP-sponsored demonstration projects.

The approach taken in the ethnographic work was informed by current critical approaches in medical anthropology and public health. During the early period of HIV/AIDS research, the disease was often studied by focusing on the behavioural characteristics of different groups who appeared to be the source of infection (Farmer, 1999). However, this approach is unable to grasp the complexity of issues related to sexuality and risk (Seidel, 1993). The development of the political–economy approach in medical anthropology during the mid-1980s, and the growing emphasis on sexuality research generally during the same period (Vance, 1991), helped direct significant changes in HIV/AIDS research methods and design (Treichler, 1999). Research strategies emerged to understand the connections between risk for HIV/AIDS and local histories, gender relations and larger socio-economic systems like colonialism (Packard & Epstein, 1991; Singer, 1998; Urlin, 1992).

Ethnographic and epidemiological research has the potential for blaming and further stigmatizing women, if the research focuses exclusively on female sex workers as “vectors” (Downe, 1997; Glick Schiller, Crystal, & Lewellen, 1994). De Bruyn (1992) warns that if research results in women feeling stigmatized, they may be resistant to preventive activities and avoid contact with hospitals and health care. Seidel (1993) argues that a new focus on development, empowerment and human rights has emerged that provides a more positive and hopeful message for women at risk for HIV/AIDS. In general, these authors recommend that while the particular circumstances and needs of female sex workers require ethnographic attention, the focus must also include the broader social, political, economic and cultural factors that produce the risk behaviours.

It is with these general principles in mind that we have undertaken participatory ethnographic research with female sex workers in rural areas of two states in India. Our goal in these projects has been to both inform programmatic development and to contribute directly to the self-knowledge and empowerment of sex workers in these two regions.

Section snippets

HIV/AIDS and sex workers in India

Although AIDS was identified in India over 15 years ago, until recently it was considered a “new” or “foreign” disease limited to certain groups like sex workers, migrant workers, truck drivers, drug users, and those who receive blood products (Arnold, 1997; Nag, 1996; Ramasubban, 1998). The fact that a female sex worker in the city of Chennai (formerly Madras) in the southern state of Tamil Nadu was the first official case of AIDS in India may have reinforced this perception in relation to

Collaborative approaches to ethnography with traditional sex workers

In Karnataka, this work was undertaken in close collaboration with an NGO that has been working with sex workers in rural areas of northern Karnataka for the past 5 years. The Belgaum Integrated Rural Development Society (BIRDS) has developed a strong base of trust and rapport with sex workers throughout the area. Their activities in the past few years have focused on developing Sanghas or Collectives among sex workers and training women as peer educators to distribute condoms and educate their

Traditional sex work in Karnataka: the Devadasis

From the Sanscrit term “devadasi” (“deva”-God, “dasi”-servant or slave), the earliest recording of the term “devadasi” in present-day Karnataka is from 1113 A.D. at Alanahalli (Goswami, 2000; Shankar, 1990). Devadasis were women dedicated through marriage to different Gods and Goddesses, after which they became the wives or servants of the deities and performed various temple duties (Tarachand, 1991). These duties included decorating shrines, dancing in festivals or important ceremonies,

Traditional sex work in Rajasthan: the Nat community

The Nat community traditionally entertained feudal rulers and common people through acrobatics (kalabaazi), rope dance, and traditional plays (kartab). Nat women, called “Natani”, were dancers who used to display their art in the court of Rajput rulers. The practice of “Paasvan” (mistress) in some situations permitted dominant persons to keep “Natani” for deriving sexual pleasure. With the decline of the Rajput ruling houses, the Nats have lost their patrons. Entertaining the general public

Discussion

This paper has described the situation of “traditional” sex workers in two areas of rural India. It is important to note that in both Karnataka and Rajasthan, there are other forms of sex work that should not be considered as “traditional”. Similar to other regions of the world, there are many women forced into this occupation through systemic gender discrimination, poverty, and social violence (Farmer, 1999). To some extent, both “traditional” and “non-traditional” sex workers share the same

Acknowledgements

The research for this paper was supported by a generous grant from the World AIDS Foundation and Canadian Institutes of Health (CIHR) Career Awards to John O’Neil, James Blanchard and Stephen Moses, and a CIHR Doctoral Fellowship to Treena Orchard. The paper would not have been possible without the full participation of both our academic and community partners in Karnataka and Rajasthan. In particular, we wish to thank Professor Hussain Khan at Karnatak University and Mr. R.M. Patil and Mr.

References (47)

  • Chakrabarty, K. (2000). “Nat”—Anthropological survey of India (pp. 690–693). New Delhi: Oxford University...
  • K Chakraborthy

    Women as devadasis. Origin and growth of the devadasi profession

    (2000)
  • C Datar

    Reform or new form of patriarchy? Devadasis in the border region of Maharashtra and Karnataka

    Indian Journal of Social Work

    (1992)
  • P Downe

    Constructing a complex of contagionThe perspectives of AIDS among working prostitutes in Costa Rica

    Social Science & Medicine

    (1997)
  • Epp, L. (1997). Violating the Sacred?: The social reform of devadasis among dalits in Karnataka, India. Unpublished...
  • K Evans

    Contemporary DevadasisEmpowered auspicious women or exploited prostitutes?

    Bulletin. John Rylands Library—University Library of Manchester

    (1998)
  • P Farmer

    Infections and inequalities. The modern plagues

    (1999)
  • N Glick Schiller et al.

    Risky businessThe cultural construction of aids risk groups

    Social Science & Medicine

    (1994)
  • Godwin, P. (Ed.). (1998). The looming epidemic. The impact of HIV & AIDS in India. New Delhi: Mosaic...
  • K.P Goswami

    Devadasi. Dancing damsel

    (2000)
  • J.L Hanna

    Feminist perspectives on classical Indian danceDivine sexuality, prostitution, and erotic fantasy

  • S Jana

    Intervention through peer-based approachA lesson from Sonagachi

    AIDS Research and Review

    (1999)
  • Karnataka State AIDS Prevention Society. (2001). Report on HIV Sentinel Surveillance,...
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