Abstract: Examination of Risk Perception and Sexual Healthcare Seeking Behavior of Male and Transgender Sex Workers in India

◆ Satarupa Dasgupta, Ramapo College of New Jersey

Background and Purpose:
The purpose of this study is to examine the sexual health belief, risk perception, and decision-making behavior of male and transgender commercial sex workers in India in order to reduce HIV/STI transmission, increase adherence to screening/testing and improving healthcare seeking behavior among this population. Male and transgender sex workers comprise 15% of the sex workers’ populace in India. While a significant body of research exists on commercial female sex workers in the field of HIV/STI intervention, scant information is available on male and transgender sex workers. Previous research shows that HIV/STI prevention, treatment, and care programs for male and transgender Indian sex workers are heavily under-funded and fall short of community needs. It is anticipated that the study will help to formulate future programmatic interventions that can cater more effectively to the health needs of the Indian male and transgender commercial sex worker population, contribute to HIV/AIDS risk reduction among this group and increase positive health practices. The study is expected to serve as a pilot study for future funded research of an understudied population.
The methodology used for this project was structured and semi-structured interviewing of 38 male and transgender sex workers. Administration of a structured and semi-structured interviewer led questionnaire enabled data collection on several of the research questions. The sex work sites that were visited included neighborhoods in a red light district in Kolkata, namely Sonagachi, which is also the biggest red light district in South Asia. The interviewer also visited the red light area of Sheoraphuli---a town in Hooghly district of West Bengal and the red light district of Kalna, a town in Bardhaman district of West Bengal. Each interview took between forty five minutes to an hour on average. All communication took place in Bengali, the native language of the interviewees. No videotaping or audiotaping was performed. The interview transcripts were translated into English, transcribed and analyzed. The transcripts amounted to 187 pages of translated text. Twenty seven pages of field notes were also recorded. IRB research approval was obtained both in USA and India, and permission was also sought from the state ministry of health of West Bengal and the sex workers’ union in Sonagachi, Calcutta.
The sexual identity of male sex workers in India is fluid, subject to personal interpretation and affecst risk perception and sexual health behavior. The interviewed sex workers were aware of the risks of infection HIV and STI from unprotected sex. Yet condom compliance among the interviewees was significantly poor. The slippage and breakage of condoms and non-availability of condoms were the primary reasons rendering condom compliance was poor. This in addition to contextual factors like criminalization, unchecked violence against sex workers and stigmatization significantly hindered safe sex practices. Stigmatization also hindered positive health behavior like testing and screening.