Date of Award

January 2014

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Kaveh Khoshnood

Subject Area(s)

Public health, Cultural anthropology

Abstract

PATHWAYS OF HIV RISK AND VULNERABILITY AMONG NEW FEMALE SEX WORKERS IN NORTHERN KARNATAKA, INDIA. Jordan A. Sloshower and James F. Blanchard, Department of Community Health Sciences, University of Manitoba, Canada. (Sponsored by Kaveh Khoshnood, Yale University School of Public Health).

This qualitative research project sought primarily to understand why female sex workers (FSWs) from northern Karnataka, many of whom are Devadasi sex workers, seem to experience an elevated risk of contracting HIV in the initial period after starting sex work. More specifically, it attempted to elucidate key processes and moments of vulnerability around the time period of initiating sex work and how this vulnerability varies based on Devadasi status and migration pattern. Twelve semi-structured interviews and three focus group discussions were conducted with FSWs from northern Karnataka who were within the first two years of practicing sex work.

The interrelationship between financial problems, familial obligation and unfavorable social conditions were found to be primary drivers of Devadasi dedication, non-Devadasi sex work initiation, and decisions made regarding migration. In turn, dedication and initiation into sex work, combined with migration to destination places of sex work, was associated with a range of challenges and problems that could produce risk of HIV infection. Despite facing such difficulties, study participants described following a sex work "learning curve" to overcome such problems and potentially gain self-efficacy and control over one's life and sex work practice. Numerous important actors and other variables, or "risk modifiers," were found to hamper or promote the sex work learning curve. These actors included peers, clients, lovers and brothel madams or gharwalis. Other important risk modifiers included HIV-related services and education, Devadasi status, migration status, and sex work setting.

In sum, FSWs from northern Karnataka are enmeshed in a complex web of social relations and power structures that influence and sometimes constrain their behavior and decision- making. Novel structural interventions should take the sex work learning curve into account in order to speed up the processes through which women gain essential protective skills and knowledge. This temporal approach would entail targeting key actors and critical time points to decrease future Devadasi dedication and avoid high-risk sexual encounters during the initial period of sex work.

Comments

This is an Open Access Thesis.

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