The global COVID-19 pandemic has created disruption to everyday life unprecedented in recent memory. Nobody’s life has been untouched by the pandemic. However, for marginalised groups, the disruption is acutely felt – and one group hit especially hard by COVID-19 is sex workers.
Estimates as to the number of sex workers in India vary. A 2016 UNAIDS survey posited the figure to be 657,829 although, as a report published in The Guardian noted, “the true number is likely to be much higher.” Others posit figures between 800,000 and three million. One estimate puts the number of commercial sex workers in India as high as ten million.
Statistics tell only so much, however. For sex workers, life was hard even before the COVID-19 pandemic – and life has become harder since. Access to healthcare – or lack thereof – is a significant challenge.
Limited accessibility to healthcare is an issue sex workers regularly face despite, as a 2017 study emphasises, “commercial sex workers…are a vulnerable section of the society with diverse health problems.” As Kranti, a Mumbai-based non-government organisation (NGO) that works with sex workers in the city’s red-light district Kamathipura (itself home to an estimated 4,000 workers according to Kranti), has pointed out, “access to healthcare is anyway difficult for sex workers due to the stigmatisation surrounding their work. Even at normal times, many doctors don’t want to touch or examine them because they think they will get sexually-transmitted diseases or other diseases from sex workers.”
The lockdown, Kranti says, means that “it has become impossible to get healthcare.” For sex workers with existing conditions, this is no less than a matter of life or death.”Many sex workers are HIV-positive or have other chronic illnesses like tuberculosis have been unable to get antiretroviral therapy or TB-DOTS,” Kranti said.
The impact is disastrous. In the case of HIV, Avert notes that 1.6 percent of India’s female sex workers live with HIV. In Maharashtra, the prevalence is posited at approximately at 7.4 percent. The absence of antiretroviral therapy (ART) is deeply concerning, given that it “requires following a strict timetable. A single missed dose plummets the immunity of the patients.” Health Issues India has noted previously the disruption of COVID-19 on the accessibility of medicines such as ART.
For one sex worker supported by Kranti, who lives with HIV and has been affected by tuberculosis previously, a case of vomiting blood left her with limited options. Unable to afford private treatment, a government hospital was her only recourse. After hours of waiting, she returned – having not been seen by a doctor in all the time she was waiting, and without receiving any treatment.
Even in the case of minor conditions, sex workers face difficulties. “If they have minor ailments, then they visit the small clinics in their area for treatment,” Kranti said. “However, all these clinics are shut…so they aren’t able to get the most basic treatment either. And they don’t have money to go to the big hospitals or get private healthcare.”
The vulnerability of sex workers extends to basic needs: not only healthcare, but food, water, sanitation, and shelter too. COVID-19 exacerbates this. In Kamathipura, Kranti notes “about ten to twelve people live on bunks in a single room in a chawl. Over fifty people use the same public bathroom, which often doesn’t have water. Social distancing and maintaining hygiene is an impossibility for them.”
Much of the rhetoric surrounding COVID-19 amplifies the need to reopen the economy and to sustain the livelihoods of workers in a time when they cannot work. Yet, Kranti notes, “sex workers are invisible daily wage earners. They earn for their rent, food and other basic needs through their customers on an hourly basis. But since the lockdown, they have not been able to earn anything.”
Government assistance for sex workers is virtually non-existent. The Rs 1.7 lakh crore allocated under the Pradhan Mantri Garib Kalyan Yojana to help the impoverished would, in theory, enable women to avail Rs 500 monthly over a three-month period. But this requires an account – and most sex workers do not have one, so go without.
They “have no documents, no bank accounts, no savings” according to Kranti. They do not have the ration cards needed to benefit from the Public Distribution System (PDS). For those who have migrated from rural India, or been trafficked illegally either from rural India or neighbouring countries such as Bangladesh and Nepal, there are logistical challenges. A sex worker working in Mumbai will not have a Mumbai address – so the food grains they would receive from the PDS otherwise does not come. For those who are undocumented, public welfare is inaccessible.
The provision of essentials to sex workers is largely being done through NGOs. No sex worker Kranti spoke to in Kamathipura has received aid from the Government.
Sex workers are participating members of the economy, invisible and marginalised though they may be. Times of crisis do not exclude them: they hit them harder. The most vulnerable in society are always most easily ignored and forgotten. As India talks of reopening its economy, it must also discuss in an equitable way – providing the assistance to the sex workers and other vulnerable groups they need to live and ensuring, in future health emergencies, their health needs are heard, responded to, and met.