Flesh trade and HIV in India

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Out of the total population in India, 25 percent live in the urban areas with an annual growth of 1 percent. Over eleven thousand children die every day in India while the average poverty level is gradually decreasing. According to various reports, there are an approximate 1.2 million sex workers in India, where 31 percent are children. A proportion of child prostitution is increasing at the rate of 8-10 percent per year. About 15 percent of the sex workers in Mumbai [Bombay], Delhi, Madras, Kolkata [Calcutta], Hyderabad and Bangalore are children. It is estimated that 30 percent of the sex workers in these six cities are less than 20 years of age. Nearly half of them became commercial sex workers when they were minors. Conservative estimates state that around 300,000 children in India are suffering commercial sexual abuse, which includes working in pornography. The problem of child prostitution in India is more complicated than in other Third World countries where it is directly related to sex tourism. In India, sexual exploitation of children has its roots in traditional practices, beliefs, and gender discrimination. According to some research, child prostitution is socially acceptable in some sections of Indian society through the practice of ‘Devadasi’ [Slave of god]. Young girls are ‘dedicated’ to the ‘gods’ and they become a religious prostitute, though the Devadasi system is banned by the Prohibition of Dedication Act of 1982 in India. Parents or guardians dedicating their girls are liable to five years in prison and US$ 120 fine.

In Hinduism, the devadasi tradition [slave of God] is a religious tradition in which girls are “married” and dedicated to a deity [deva or devi] or to a temple and includes performance aspects such as those that take place in the temple as well as in the courtly and mujuvani [telegu] or home context. Dance and music were an essential part of temple worship. Originally, in addition to this and taking care of the temple and performing rituals, these women learned and practiced Sadir [Bharatnatya], Odissi and other classical Indian artistic traditions and enjoyed a high social status. During British rule, kings who were the patrons of temples and temple arts became powerless. As a result, devadasis were left without their traditional means of support and patronage. During colonial times, reformists worked towards outlawing the devadasi tradition on grounds that it supported prostitution. Colonial views on devadasis are hotly disputed by several groups and organizations in India and by western academics. Devadasis are also known by various other local terms, such as Yogini. Furthermore, the devadasi practice of religious prostitution is known as Basivi in Karnataka and Matangi in Maharastra. It is also known as venkatasani, nailis, muralis and theradiyan. Devadasis are sometimes referred to as a caste; however, some question the accuracy of this usage. “According to the devadasis themselves, there exists a devadasi ‘way of life’ or ‘professional ethics’ [vritti, murai] but not a devadasi jati [sub-caste]. Later, the office of devadasi became hereditary but it did not confer the right to work without adequate qualification” [Amrit Srinivasan, 1985]. In Europe, the term Bayadere [from French: bayadère, ascending to Portuguese: Balliadera, literally dancer] was occasionally used. Whereas in places such as Orissa, devadasis were traditionally celibate, in some other places a devadasi would usually acquire a “patron” after her “deflowering ceremony”. Patronship in a majority of cases is achieved at the time of the dedication ceremony itself. The patron who secures this right of spending the first night with the girl can pay a fixed sum of money to maintain a permanent liaison with the devadasi, pay to maintain a relationship for a fixed amount of time, or terminate the liaison after the deflowering ceremony. A permanent liaison with a patron does not bar the girl from entertaining other clients unless he specifies otherwise. In case the girl entertains, other men have to leave the girl’s house when her patron comes. Traditionally the young devadasi underwent a ceremony of dedication to the deity of the local temple which resembled in its ritual structure the upper caste Tamil marriage ceremony. Following this ceremony, she was set apart from her non-dedicated sisters in that she was not permitted to marry and her celibate or unmarried status was legal in customary terms. Significantly, however, she was not prevented from leading a normal life involving sex with individuals of her choice and childbearing. The very rituals which marked and confirmed her incorporation into temple service also committed her to the rigorous emotional and physical training in the classical dance, her hereditary profession. In addition, they served to advertise in a perfectly open and public manner her availability for sexual liaisons with a proper patron and protector. Very often in fact, the costs of temple dedication were met by a man who wished thus to anticipate a particular devadasi’s favors after she had attained puberty. It was crucially a women’s ‘dedicated’ status which made it a symbol of social prestige and privilege to maintain her. The devadasi’s sexual partner was always chosen by ‘arrangement’ with her mother and grandmother acting as prime movers in the veto system. Alliance with a Muslim, a Christian, or a lower caste was forbidden while a Brahmin or member of the royal elite was preferred for the good breeding and/or wealth he would bring into the family. The non-domestic nature of the contract was an understood part of the agreement with the devadasi owing the man neither any house-holding services nor her offspring. The children, in turn, could not hope to make any legal claim on the ancestral property of their father whom they met largely in their mother’s home when he came to visit.

Young people aged between 10 and 24 years represent 30 percent of India’s total population. Over 35 percent of all reported AIDS cases in the country occur among those in the age group of 15-24 years indicating that young people are not only at high risk of contracting HIV infection but already constitute a significant percentage of people living with HIV/AIDS. The cumulative number of AIDS cases from 1986 to August 2010 shows that the disease burden is highest among the 15-49 year age group. Globally, India is second only to South Africa in terms of the total number of people living with HIV/AIDS. The annual sentinel surveillance estimated the number of adults [15-49 year age range] living with HIV/AIDS in 2009 to be 7.1 million. Almost 57 percent of these infections are in rural areas. The overall HIV prevalence among the adult population was observed to be 0.91 percent. Though India is considered to have a low national prevalence, due to its large population profile, a mere 0.1 percent increase in the prevalence level would raise the number of HIV-positive people by over half a million.

The HIV epidemic in India is characterized by a number of distinct epidemics, sometimes coexisting within the same state, among the various vulnerable groups at different stages of maturity and impact. Transmitted mainly through unprotected sex in the south and injecting drug use in the north-east of the country, HIV has spread beyond the “at risk” groups to the general population and from urban to rural areas.

As many as 111 districts are considered as high prevalence areas with HIV prevalence of more than 1 percent in antenatal women and/or more than 5 percent in high-risk behaviour groups. The states of Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland and Tamil Nadu are considered “high-prevalence” states. Data generated from sentinel surveillance 2009 shows that the HIV prevalence among the ANC population remained more than 1 percent in the high prevalence states except Tamil Nadu which has shown HIV prevalence of less than 1 percent [among ANC] for past few years. Among the high-risk population, HIV prevalence among the STD population was estimated to be more than 5 percent, more than 8 percent among commercial sex workers and remained around 10 percent for injecting drug users. Most young people are infected with HIV through unprotected sex. The main transmission route for HIV in India is heterosexual.

There is also a high prevalence of other Sexually Transmitted Infections [STIs] in India. The overall HIV prevalence among STD population during 2009 was 8.22 percent. It is estimated that during 2009 the contribution of HIV infection from STD population was 2.9 million in comparison to 1.33 million during 2004. HIV prevalence among STD patients has increased significantly over previous years in low prevalence states like Rajasthan, Delhi, and Orissa. STIs have significant implications for the vulnerability of young people to HIV. High levels of STIs among young people reveal increased unprotected sexual activity, which puts them at greater risk of contracting HIV. The probability of contracting HIV increases significantly in the presence of STIs, as a person with an STI is 8 to 10 times more vulnerable to contracting HIV.

While HIV continues to spread predominantly amongst the poor and marginalized sections of society in India, including sex workers, injecting drug users, men who have sex with men and migrant laborers, infections are spreading among other groups as well. One in every four AIDS cases reported in India is a woman. Furthermore, the number of women being newly infected with HIV is steadily rising6. Almost 41 percent of all Indians living with HIV currently are women. The HIV prevalence rates for young women also exceed those for young men. According to the WHO health indicators, the HIV prevalence was 0.46 percent for 15-24 years old females while it was 0.22 percent for men in the same age group. Prevalent gender inequalities in Indian society leave girls and young women socially and economically disadvantaged, greatly increasing their HIV vulnerability. The culture of silence surrounding sexual issues leads to girls and women remaining ignorant about HIV/AIDS, its spread and prevention options.

Social constraints also limit their access to HIV prevention services. Furthermore, they do not have control over decisions related to their sexual and reproductive health and lack the power or skills to negotiate safe sex. Early marriage also poses risks to young women as their reproductive tracts are not fully developed and therefore prone to tearing during sexual activity. This is especially relevant as 50 percent of women are married by 18 years in India. However, the same is not true for boys of the same age, often leading to the considerable age gap between spouses. Young women are also affected due to the risky sexual behaviour of their partners/spouses, many of whom indulge in unprotected sex with multiple partners and with men or are injecting drug users. Social norms, economic dependence, and fear of violence often prevent young women from insisting on prevention methods such as the use of condoms with their sexual partners. A significant proportion of HIV infections in India occur in women who are married and have been infected through unprotected sex with an infected spouse.

Young sex workers constitute one of the most vulnerable groups for HIV infection and transmission. Of the estimated two million women involved in sex work in India, 25-30 percent is minors. According to the Social Welfare Board of India, two out of five sex workers are under the age of 18 years. One of the highest HIV prevalence rates is among sex workers and their clients9. HIV surveillance of 2005 reveals that around 13 percent of female sex workers in Andhra Pradesh, 18 percent in Karnataka and more than 23 percent in Maharashtra were infected with HIV. In Mumbai [Maharashtra] HIV prevalence among female sex workers has remained around 52 percent since 2000. The overall HIV prevalence in female sex workers was estimated to be 8.44 percent in 2005. An increasing trend was noted among female sex workers of Nagaland, West Bengal, Rajasthan and Bihar compared to earlier years. Early initiation into commercial sex, exposure to multiple partners, no negotiating power for safe sex leading to low or no condom use, exposure to STIs, stigma, and discrimination, limited access to information, prevention and treatment are some of the factors increasing the vulnerability of young sex workers to HIV in India.

Findings of the Behavioural Surveillance Survey [2001] among groups perceived to be at higher risk of the infection showed that young brothel-based female sex workers were more vulnerable to HIV infection compared to their non-brothel-based peers. They were also found to be less literate, exposed to sex much earlier in life and were four times more likely to have first sold sex before they attained the age of 15 years. Brothel-based sex workers entertained 1.5 times more clients compared to non-brothel-based workers. Information about and awareness of HIV/AIDS among female sex workers, especially those working on the streets was also found to be very low. Surveys in different parts of the country showed that 30 percent of street-based sex workers were not aware that condoms prevent HIV infection. Nationally 42 percent of female sex workers felt that they could identify an HIV positive client on the basis of his physical appearance.

There is growing evidence of the early onset of sexual activity among young people in India. Studies in different cities showed that almost 10 percent of young women and 15-30 percent of young men indulged in premarital sex. Research suggests that young people who become sexually active during adolescence are more likely to have sex with high-risk partners or multiple partners. An early sexual debut of Indian women is generally in the context of marriage while young men become sexually active by the age of 16-19 years. Behavioural Surveillance Survey [2001] findings show that young men aged 15-19 years and 20-24 years reported more casual sex compared to females in the same age groups. Rural males reported more casual sex compared to urban males. More than 54 percent urban male respondents in the age group of 15-19 years and more than 64 percent in the 20-24 year age group reported using condoms with their last casual sex partner. However, only about 36 percent urban males in the 15-19 age group and 40 percent in the 20-24 year age group, of those reporting casual sex in a year’s recall, stated that they had consistently used condoms. An increasing number of young people are also experiencing forced sexual activity. Though young women are generally more vulnerable to sexual coercion and violence, young men and boys also experience non-consensual sex. A study in Goa reported that 7 percent of the boys were forced to have sex with an older male while 6 percent of girls reported forced sexual relations. Many street boys in Bangalore also reported that they were sexually initiated through forced sex at an early age by an older male.

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Flesh trade and HIV in India

By: Salah Uddin Shoaib Choudhury Read time: 40 min