Male Sex Worker In India: A Pilot Study Of Indian Male Sexworker In Three Cities In India

Fiinal nal R eport Report

Pilot Study on

Male Sex Workers in three cities in India

Conducted by

With technical support from

Network of Indian Male Sex Workers Kolkata

April 2006

Sexual Health Resource Centre New Delhi

Acknowledgement This report is prepared by Sexual Health Resource Centre (SHRC), New Delhi on behalf of the Network of Indian Male Sex Workers (NIMSW), Kolkata and is a summary of a quantitative and qualitative research study on Male Sex Workers in three cities – Kolkata, Ahmedabad and Vijayawada. The study is supported by Department for International Development, New Delhi. At the outset, I place on record my appreciation and gratitude to the number of Male Sex Workers and other key stakeholders who cooperated in giving their views to assess the position of MSW and also throw light on the various issues they face in the three cities across the country. I thank Dr. Thomas Philip, Chief Technical Officer for guiding me and Mr.Leo J. Sengo, research Project consltant for supporting me to complete this study rapidly. My thanks are also due for Mr. C. R. Gunashekhar, Consultant, SHRC for shepherding this study into a report that may be used by the readers effectively. My sincere regard and thanks also go to the technical team in SHRC directly related to this project. Mr. Udayan, Technical Officer and Mr. Mohamed Aslam, Associate Technical Officer deserve special mention. In the three states where the study had taken me, I must cite the support and cooperation for ensuring that the field work continued without any bottlenecks by many key individuals. My due regard and appreciation to Ms. Menka, NGO Advisor, West Bengal State AIDS Control Society, Mr. Jayanthi Bai, Managing Trustee and Director, CHUWAL Trust, Ahmedabad and Mr. Yatin J. Patel, Director, SAATHI, Vijayawada. I also extend a word of thanks to the numerous volunteers, outreach workers and staff of the three coordinating NGOs who ensured the smooth completion of this landmark research. Here, mention must be made of Mr. Subarthi Mukherji, Project Coordinator, PLUS, Kolkata, Mr. Chandu Bai, Managing Trustee, and Mr. Balakrishnan, Project Coordinator,CHUWAL Trust, Ahmedabad and Mr. Suresh Kumar, Project Coordinator, SAATHI, Vijayawada. Finally, sincere thanks to all others who helped shape this report. Hope the report sets the ball rolling for furthering the role, status and position of Male Sex Workers in the country. Agniva Lahiri Principal Research Consultant and Network Coordinator (NIMSW)

Abbreviations

AIDS

Acquired Immuno-Deficiency Syndrome

CBO

Community Based Organisation

DFID

Department for International Development

DI

Depth Interview

FGD

Focus Group Discussion

FSW

Female Sex Worker

GLBT

Gay Lesbian Bisexual and Transgender

HIV

Human Immuno-deficiency Virus

MSM

Men who have sex with Men

MSW

Male Sex Worker

NACO

National AIDS Control Organisation

NACP-II

National AIDS Control Programme – Phase II

NGO

Non-Governmental Organisation

NIMSW

Network of Indian Male Sex Workers

PLUS

People Like Us

SACS

State AIDS Control Society

SHRC

Sexual Health Resource Centre

SIN

Sex Industry Network

SPSS

Statistical Package for Social Sciences

SRS

Sex Reassignment Surgery

STI

Sexually Transmitted Infections

TG

Transgender

TV

Television

1.0 INTRODUCTION Male Sex Workers (MSW) are becoming increasingly visible in India but there is limited information about them. Research studies on men who sell sex are urgently needed not because they can be a health treat to the ‘general population’ but because MSW are also an integral part of the Indian society and we need to find out appropriate ways to make them take care of themselves (as they may be at risk) and to protect themselves from acquiring STI/ HIV. Males selling sex are likely to be at higher risk of sexually transmitted infections and HIV than others having multiple sex partners. Transactions of money, gifts or favour in return for sex are known among Men who have Sex with Men (MSM) but these are not always considered paid sex or selling sex. A very thin line exists between recreational sex and survival sex in the country and this is found across cities. This has caused a difficulty in defining MSW. These Male Sex Workers are definitely not a homogenous and networked group who can

be targeted for interventions and sexual health services easily. Sexual health interventions in India that have tried to focus on those males who ‘sell’ sex have come across several barriers. One of the barriers HIV prevention interventions efforts have been facing is the task of identifying “Male Sex workers”. A definition of this group is yet to be agreed upon by community groups and interventions. Most Interventions have ended up focusing on all Men who have Sex with Men (MSM) with the assumption that all MSM could have multiple partners and at higher risk of HIV and a subset of Men who have Sex with Men could be Male Sex Workers with higher risk. However, many men who have sex with men for money alone and also those who have sex with other women (on a commercial basis) have been excluded from interventions despite the fact that the risk and vulnerability of HIV infection for MSW is similar to MSM in the absence of safe sex practices.

1.1 Definitional Issues Suggested Definition MALE SEX WORKER … “… A person passed puberty who receives money or goods in exchange for sexual service and consciously defines those activities as income-generating”. [The definition applies irrespective of the gender of the people involved and whether or not they do this full-time/ part-time or occasional basis]. Source: MSWS (Making Sexwork Safe Project) by INSW, NSWP

A working definition of Male Sex Workers could be “Males who consider themselves as having sex in exchange for money, favour or gifts”. While such a definition has many limitations, it is important to start with a definition to conduct any further enquiry. The hypothesis here is that those males who

consider themselves as having sex in exchange of money, gifts or favour are a significant proportion of those males at higher risk of HIV. This hypothesis could be disproved by this study itself and the reverse could be proved that only a small proportion of those interviewed say that they ‘sell’ sex

or receive money gifts or favour. Also previous research shows in other countries that the risk perception among those who sell sex in terms of money and those who sell sex in transaction with gifts or favour are different it may be applicable in these study as well then we need to design appropriate structure of intervention as well as definition. Other barriers to interventions are a lack of a good mapping and size estimation of Male Sex Workers. Without an effective mapping and size estimation, Interventions,

epidemiological studies and services tend to grope in the dark and effectiveness of intervention efforts cannot be measured. But Before beginning extensive mapping exercises and size estimations of the male sex worker populations which are essential for beginning STI/HIV prevention interventions, it is also crucial to understand the presence and nature of the various forms of male sex work in different parts of India and to find out the issues faced by them and to understand their needs in the context of HIV/STI prevention and care.

1.2 Purpose of Study This study seeks to clarify this issue of defining Male Sex Workers. While different community groups and interventions are discussing the definition of MSW, it is possible to find out from the community itself, the proportion of those that consider themselves as having sex in exchange of money, favour or gifts. Till date, available studies on male sex workers have focused on their sexual risk behaviour pattern in relation to risk of acquiring STI/ HIV and only a few studies have examined the phenomenon of the male sex work itself and the various forms of male sex work and the unique problems faced by Male Sex Workers at various settings and under various circumstances. There may a number of information needs and questions that will remain unanswered

after this study. However many questions that are “qualitative” in nature such as those on social, legal, trade and health environments, behaviour, practices and risk will be opened up through this study. Note: Regardless of anatomy, Hijras in sex work may not feel they come under ‘male’ sex workers. Also, the issues related to HIV prevention and care needs seem to be distinct for this population. However, as gender-variant sex workers in the country are viewed more akin to men than women, they have been included in this study as they too in the wider perspective are generally categorised as male sex workers. What is important is that their exclusion will mean losing a whole lot of information on their needs, perceptions and practices.

Photo courtesy: Srinivas Kurungati

AIM A multi-city pilot study in selected cities to understand the dynamics of Male Sex Workers in the country. [The selected cities were Kolkata, Ahmedabad and Vijayawada in the first phase. These cities were selected as they lie in states (West Bengal, Gujarat and Andhra Pradesh) covered under DFID supported programmes where SHRC has a presence through working with non-government and community based organisations that would facilitate easier access to the hidden community of Male Sex Workers that is critical in such a rapid study.]

SPECIFIC OBJECTIVES 1. To identify and classify different sub-groups of people who consider themselves as having sex in exchange of money, favour and gifts in selected study areas to arrive at working definitions of MSW and different sub-groups of males who together are broadly known as Male Sex Workers 2. To chart out the different locations, sex industry (trade) network-SIN and buddy networks where such males in each sub-group are found to aggregate and find out the selected avenues to reach out those network 3. A qualitative analysis to understand of the social environments wherein Male Sex Workers operate and the barriers they encounter in accessing health facilities 4. To understand the major differences between Male Sex Worker (MSW) and Men who have Sex with Men (MSM) in India 5. To measure the proportion of Men having Sex with Men who consider themselves as having sex in return of money, favour and gifts 6. To find out the indicators and risk perception where sex work does NOT comprise exchange of sex for cash and yet is not survival sex within the male sex worker sector 7. Provide specific recommendations for action on Male Sex Workers in India as a result of the research findings 8. To understand the needs, demographics, composition of partners, vulnerabilities and sexual behaviours at selected cities in the country through a rapid quantitative baseline survey on MSWs and intensive qualitative processes

Transgender or ‘Hijras’ as they are popularly known

1.3 Methodology The study methodology included Primary and Secondary Research to enable triangulation of data and information in an area that has hitherto been hidden. The focus on Male Sex Workers in the study is more pronounced due to the paucity of information about this group and the need to understand clearly the issues facing MSW in the light of the growing HIV/ AIDS epidemic in the sub-continent. A. Desk Research A secondary sources review of relevant literature available on the issues affecting MSW was a must. Caution needs to be applied in differentiating work on MSM in the various projects and interventions that are currently in place. The sources for secondary information included: a) Unpublished reports/ records of grassroots data on the MSW populations and sub-groups b) Published reports on MSW (research studies/ Case studies and so on) c) Conference abstracts, poster presentations and materials on CD d) Newspaper articles, other media coverage e) Information accessed through the Internet f) Personal memoirs of MSW willing to share the same (with confidentiality) g) Any other authentic available sources of information that are documented

– physical (to be read medical), social, psychological and environmental. Both Quantitative and Qualitative research techniques were applied to capture data from the field. Such a combination of tools and techniques, mingled with a review of secondary literature sources facilitated triangulation of data and information contributing to more valid information that could be translated into inputs for designing effective programmatic interventions. a. Quantitative Techniques Quantitative Data collection was done through administering Semi-Structured Questionnaires to the respondents (MSW). A total of 75 Questionnaires were administered in each of the three cities planned in the pilot stage of the project, totaling 225 interviews in 3 cities. Each Questionnaire had 43 main questions with several sub-sections. The purposive sampling technique was adopted as the study deals with Male Sex Workers who are by and large a ‘hidden’ population, who could be approached easily by NGO/ CBO working among them. Moreover, the objective of the study is to obtain the extent of the problems faced by MSWs, in order to provide a better understanding about their lives and identify risks and vulnerability factors. Quantitative data analysis was done using SPSS Version 12 to generate Frequency tables as well as for crosstabulation across multiple variables outlined in the study. b. Qualitative Methods

B. Primary Research In order to understand first-hand the dynamics in Male Sex Workers a primary investigation of the target population was done that sought to obtain insights into not only the demographics of the ‘hidden’ MSW population, but also examine their concerns

Given the uniqueness of the study, it was apparent that certain issues might remain unanswered in the Quantitative study and hence, a Qualitative component of analyzing detailed issues was also added. This aided in crosschecking information obtained in the and provided quantitative phase triangulation.

The qualitative methods aided in understanding the nature of the various subpopulations of male sex workers; also examining their immediate needs better. The qualitative information lead to a clearer understanding of different sub-groups of males with one or more similar characteristics. A working definition and a set of clearly identifiable sub-groups among Male Sex Workers has emerged from the study. In-depth interviews Male sex workers belonging to different subpopulations [Kothi-identified male sex workers, masseurs in sex work, brothelbased male sex workers, etc.] were interviewed. Wherever possible, In-Depth Interviews were tape recorded in order to capture all responses provided by the participants through an Interview Guide. Depending upon the various subpopulations present, around 5 in-depth interviews were conducted in each city, aggregating to 15 Depth Interiews. Focus Group Discussions At least 3 FGDs were conducted in each city using a semi-structured FGD guide, totalling 9 FGDs. The qualitative tools used included

Depth Interviews and Focus Group Discussions (FGD) among Key Informants. The participants for the Depth Interviews and FGD included the following persons: Male Sex Workers Koti (floating population) Network/ NGO/ CBO intervention personnel Peers/ Volunteers working among MSW/ MSM Targeted Interventions Clients of MSW (where possible) Pimp/ Masseur/ Massage parlour owner/ worker Health Care Givers providing services to MSW Others (Gatekeepers and Key Persons with good understanding of MSW The Network of Indian Male Sex Workers (NIMSW) assisted in recruiting participants for both the quantitative as well as the qualitative phase of the study through its established contacts, CBOs in all the three selected cities. In Kolkata, NIMSW roped in PLUS, (People Like Us – a community based organisation working among MSW. Similarly, in Ahmedabad, Chuwal Trust was the coordinating NGO and in Vijayawada, SAATHI, another community based Organisation working among MSM and MSW coordinated the research study.

2.0 DESK RESEARCH 2.1 Introduction India, the region's most populous country, continues to dominate the HIV/AIDS epidemic in South Asia. Although national HIV prevalence is low (between 0.4% and 1.3% in 2003), there are serious epidemics under way in several states, and a total of 5.1 million people were estimated to be living with HIV in India at the end of 2003.1 Most infections are acquired sexually. In the southern states of Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu, HIV is transmitted mainly through heterosexual sex, and is largely linked to sex work. Infection levels of over 1% among pregnant women in sentinel antenatal clinics suggest that a significant number of sex workers' clients may have passed on HIV to their wives. HIV transmission through sex between men is also a major cause for concern in many areas of India. In a study conducted in a poor area of Chennai in 2001, 7% of men who have sex with men were HIV positive. A small proportion of infections are acquired through injecting drug use, particularly in the north-east of the country. In Manipur and Nagaland, HIV infection levels of 60-75% have been found among injecting drug users using non-sterile injecting equipment. Knowledge about HIV is still incomplete--in a 2001 national behavioral study of nearly 85,000 people, only 75% of respondents had heard of AIDS, and awareness was particularly low among rural women in Bihar, Gujarat, and West Bengal. South Asia is faced with a narrow window of opportunity to prevent AIDS from having a more severe impact on the region. Failure to target populations at high risk of HIV exposure, such as sex workers, injecting drug users, and men who have sex with men, 1

Regional Overview abstracted from ‘Report on the Global AIDS Epidemic’ UNAIDS, July 2004 from http://hivinsite.ucsf.edu

will result in a full-fledged epidemic in years to come. The HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) epidemic in India is a rapidly escalating crisis. The government's estimate that about 4 million persons in the country are HIV-positive is widely thought to understate the true figure. Throughout the country, persons in traditionally high-risk groups, including women in prostitution, injecting drug users, and men who have sex with men, have been shown to have alarmingly high rates of infection. In several states of India, such as Maharashtra and Tamil Nadu, the epidemic has spread to the general population. Programs that provide information, condoms and HIV testing to persons in high-risk groups are crucial to preventing the further spread of the disease. HIV/AIDS outreach workers who target men who have sex with men suffer widespread and serious abuses. The taboo in Indian society against men who have sex with men and the denial at all levels of their existence create an environment of moralistic judgmentalism against which AIDS educators battle constantly. The criminalization of homosexual practices under the pre-colonial section 377 of the Indian Penal Code on "unnatural offences" contributes to the impunity with which police harass these men and those who work with them. Organizations that conduct AIDS education activities in Lucknow, Mumbai, Chennai, Sangli, Bangalore, and New Delhi described serious incidents of police abuse that had sometimes prevented them from providing information and condoms to men who have sex with men. Common to all these accounts was the practice of police extortion of money or sex directed against a group of persons who are so marginalized in society that they have nowhere to turn for

redress. Men who have sex with men and women in prostitution are easy targets for police extortion and physical abuse. Discriminatory police practices that keep them from filing complaints or seeking redress, combined with the financial difficulties of making bail, typically mean long periods in detention facilities where they are subject to further abuse. Very little is known about the demand for sex worker services. Sexuality is not a subject that is much discussed in India. Contrary to cultural ideals that stress chastity before marriage and fidelity within it, men commonly stray from this norm. While this behaviour is generally not as pronounced as in societies in East and Southeast Asia there is consistent, although largely anecdotal evidence to indicate that a large minority of men are clients of sex workers. Mobile groups of men: male migrants in the cities; truck drivers; those in the armed forces; and travelling businessmen are frequently cited as important client groups. Many young men are initiated into their sexual lives by prostitutes. Rapidly escalating prevalence rates for HIV indicate that monogamy is not necessarily practised. This applies to men from all social classes. Analysis of sex work in Asia concentrates on FSW and child prostitution. Female sex workers outnumber MSW in most Asian societies. The failure to address the incidence of men who sell sex – and therefore the failure to meet their health needs - derives from cultural patterns that do not allow the social expression of male-male Homosexual behaviours are desire. commonplace. Frequently these behaviours are non-commercial but they also take the form of commercial encounters that fulfil sexual desires whilst at the same time posing no challenge to heterosexual norms and family structures because of their fleeting and anonymous nature. Many men who sell sex will have a variety of partners – some commercial, some non-

commercial, some male and some female. They may not identify themselves as homosexual. Crucially, just as with indirect FSW they will not necessarily see themselves as sex workers. Neither will anyone else. Many will be married and will have non-sex work occupations. In terms of analysing sex work it is important not to apply western categories defining sexual identity to people in non-western cultures and to recognise the fact that many of those involved in sex work have overlapping identities. This applies to both workers and clients.2 Research on male sex workers is even more limited. This is to be expected in a context in which male-male sexual desire is a threat to strong, family-oriented social patterns. However, homosexual behaviours are extremely common. Many of these are noncommercial exchanges but many involve material transactions. There are no clear dividing lines separating the male sex worker from the man who has sex with men. In the same way there is no absolute dividing line between the MSM and the person who is a ‘regular’ family man with wife and children. In many instances all these behaviours and roles are found in the same individual. 3 Male sex workers are often less visible than female sex workers and are therefore more difficult to reach. Their lack of visibility is usually related to taboos on homosexuality. However, it is very important not to assume that male sex workers are homosexual. Homosexuality is defined by identity and lifestyle, not sexual behaviour on its own. Many male sex workers do not identify as 2

From WHO Regional Office for Western Pacific, STI/ HIV, ‘Sex Work in Asia’ July 2001. 3

Khan, Shivananda (1999) ‘Through a Window Darkly: Men Who Sell Sex to Men in India and Bangladesh’ in Aggleton, Peter (ed.) Men Who Sell Sex: International Perspectives on Male Prostitution and HIV/AIDS London: UCL Press.

gay. HIV prevention projects directed at gay men may not reach male sex workers who do not identify as gay. The term "men who have sex with men" (often abbreviated to MSM) is recommended to differentiate between sexual identity and behaviour. Terms like kothi and panthi to indicate different sexual roles rather than one's partner's sex those of penetrator or "fucker" and receiver or "fuckee" and "double decker" for someone who takes either role. It is necessary to include male sex workers who perform any of these roles with any other person. Men also sell sexual services to women. The most visible form of this type of sex work can be found in tourist resorts. Cultural attitudes and the law shape the conditions of male sex work and the quality of support and services available to male sex workers. For example, some men are able to work with less interference from police if the police concern themselves more with female sex workers, while those in places where sex between men is illegal may have greater legal difficulties.4 Male Sex Workers in India are a heterogeneous group characterised by many sub-types that have specific needs and issues that need appropriate programmes and services. There cannot be one generic intervention model for MSW in the country. Currently there exists a lack of knowledge about MSM and MSW among policy makers and donors. The NACP-II (National AIDS Control Programme –II) mentions only of ‘MSM’ (Men who have sex with Men’. The National AIDS Control Organisation (NACO) funds up to 76 Intervention programmes for MSM to NGOs not CBOs through State AIDS Control Societies (SACS). ‘Hijras’ or ‘Transsexual/ transgender’ are not mentioned in NACP-II. Similarly MSW are absent in NACP-II. 4

http://www.nswp.org/nswp/introduction.ht ml

There is near lack of involvement of community in design, implementation and evaluation of programmes aimed at MSW/ transgender. In 2004, NACO had 3 serosurveillance centres for MSM in India. Most Community Based Organisations (CBOs) reach ut to and provide services to Koti identified MSM. There is overlapping of coverage by NGOs both in terms of populations and area.5 Preliminary research conducted by The Naz Foundation in India and Bangladesh among MSM have found a range of issues that are not easily visible or even acceptable for socio-cultural reasons. These include the issue of male rape, adolescent males as sexual objects of older males, high levels of anal sex between males and between males and females, very early experiences of sexual activity and sexual abuse among males, inter-family male to male sex, with sexual partners including brothers, uncles, nephews, cousins, male-in-laws, sexual encounters with servants, male to male sex without identity constructions of homosexual/ bisexual, identity structures around marriage, penetration, age, family, religion, caste and class, feminized identities primarily of males who are penetrated, Hijras as a socially constructed identity of biological males who are "feminized" through social/sexual interactions in prepubescence, sexual desire of many males based on discharge and activity not on gender of partner, some male to male sexual behaviours based on females being seen as disease vectors, gender segregation and limited sexual access to females within a socio-cultural framework of homosociability and homo-affectionism increasing options for male to male sex. Though limited in scope, it has brought out

5

Chakrapani Venkatesan ‘Programmes and policies for Male Sex Workers in India: Current Situation, gaps and recommendations’, 2004. See also www.indianGLBThealth.info

certain vital clues to sex relations among males that were hitherto unknown.6

jobs are undermined by discrimination and police harassment.8

The population of Male Sex Workers is quite significant in India. They multiply their sexual encounter as they cater to men as homosexual as well as women clients. Male sex workers are also a sexual minority apart from the ‘hijra’ community, the population as a community in India are a heavily stigmatised group, and remain socially and politically marginalized. HIV prevention programme directed at MSM not geared towards meeting the specific need of male sex workers.7

Maitreya agrees that there are male sex workers. In fact there are two types of male sex workers – one catering to the men and the other to the women clients. The MSW catering to the men are not only homosexuals but also may be bisexuals. It is not voluntary work but paid work. There are reportedly thousands of MSW in Kerala alone. The MSW catering to women are called gigolos. They are not many in number in our country. They reside in big cities and in tourist spots. Women who are economically free are their clients, especially from the upper class. The relationship of the gigolo and woman client is much better than the man and FSW because of power relations.9

In Bombay, according to health workers, an estimated 40 percent of male sex workers are said to be married, and the human immunodeficiency virus is often passed to children in utero or through breast feeding. India has an estimated 2.3 million female prostitutes in brothels and 1.2 million hijra, an Urdu term for transsexuals, crossdressers, hermaphrodites and castrated men. In medieval times, the original hijra -eunuchs -- commanded a certain fearinspired respect as the guardians of royal harems. Modern-day hijra are mostly transsexuals who had the operations voluntarily, although some were street children mutilated by other hijra. They know about AIDS, but most are working without protection," says Khairati Lal Bhola, who has worked with hijra health and legal issues for 40 years. "Their customers want more enjoyment, not condoms." Estimates on the hijra community in Delhi estimate that as many as 80 percent are HIV-positive and complain that efforts to find them alternative

6

http://www.ilga.info/Information/Legal_sur vey/Asia_Pacific/supporting%20files/sexual _health_workshops_in_bangl.htm 7

National Strategic Meeting on Male Sex Workers in India by Agniva Lahiri, India as discussed in http://eforums.healthdev.org/

Hijras (Eunuchs) in India have virtually no safe spaces, not even in their families, where they are protected from prejudice and abuse. The main factor behind the violence is that society is not able to come to terms with the fact that hijras do not conform to the accepted gender divisions. In addition to this, most hijras have a lower middle-class background, which makes them susceptible to harassment by the police. The discrimination based on their class and gender makes the hijra community one of the most disempowered groups in Indian society.10 8

“AIDS IN ASIA”, The Continent's Growing Crisis, Fear on the front line in India, by Juliette Terzieff, Chronicle Foreign Service, Sunday, November 17, 2002 from www.sfgate.com

9

http://www.ashanet.org/focusgroups/sanctu ary/sanctuary/sex-work.pdf 10

“Being A Eunuch”, by Siddarth Narrain in Frontline 14 October,2003 from http://www.countercurrents.org/gennarrain141003.htm

2.2 Some Definitions A look at some of the definitions on sex work and sex workers is inevitable. Here are a few definitions propounded: Sex worker is defined as “one who proffers personal sexual services to a variety of customers chosen primarily for what they are prepared to pay”.11 Sex work is also defined as … “not as a fixed state or identity, but rather as a continuum ranging from organized prostitution, through brothels, escort agencies, and so on, through to unmediated transactions resulting from chance encounters…”. “For most it is a practice enforced by poverty, degradation, homelessness, hunger and powerlessness, a form of slavery to economic, social and cultural deprivation, stigmatization and marginalization…”12 Another main defining theme examines male prostitution thus: “young males identify their involvement in prostitution from an occupational perspective that downplays a “deviant self-perception” (the actors define prostitution as part of a “hustle”); young male prostitutes experience conflict with colleagues, customers, and legal and social service agents; and, prostitution occurs within a variety of social relations.13

11

West, D.J. (1992). Male prostitution: Gay sex services in London.London, England: Gerald Duckworth & Co. Ltd.

12

Aggleton, P. (Ed.). (1999). Men who sell sex: International perspectives on male prostitution and AIDS. London: University College London Press Limited.

13

Visano, L. (1987), ‘This idle trade: The occupational patterns of male prostitution’. Concord: Vista Sana Books.

2.3

Demographics and occupation

Literature suggests that young males involved in the sex trade had run away from physically and sexually abusive home environments (Janus, Burgess and McCormack, 1987; Tremble, 1993; Earls and David, 1989a and 1990). Tremble’s research on gay street youth revealed that a majority of respondents had come from abusive home environments or “placement families.” Earls and David (1989a and 1990) found that in comparison to control groups, male prostitutes had experienced more physical and sexual abuse while growing up, and had witnessed more violence between parents, more drug and alcohol use among family members, and were more likely to identify male partners as their first sexual experience. Janus, Burgess and McCormack (1987) found that male runaways had experienced more sexual and physical abuse than “randomly sampled [male] populations.” The literature also reveals several characteristics that are unique to the male sex trade. Weisberg (1985) noted that many adolescent males involved in prostitution exhibited homosexual preferences (also see Earls and David, 1989a; Price, Scanlon and Janus, 1984). Several items suggest that many young males involved in prostitution had run away from home because of antihomosexual/ homophobic sentiments in mainstream society (e.g., family, friends, school) (see, Kruks, 1991 and Visano, 1987) – in essence, they were ridiculed and ostracized for their homosexual preferences (Badgley, 1984). In this respect, discriminatory attitudes in “square society” propelled some young males to the street where situational factors contributed to their decision to prostitute.14

14

‘Youth Involvement in Prostitution’, Steven Bittle 2001, 13ed. Research and Statistics Division April 2002.

2.4 Social Issues In a study by Cates and Markley, semistructured interviews were conducted with 15 male hustlers and 15 male non-hustlers to examine male participation in the sex trade by choice. Respondents were asked questions about their “living status, education, employment status, values, relationships, use of drugs and alcohol, knowledge of HIV and AIDS, and family history.” Male hustlers were asked about their entry into the sex trade and their experience as prostitutes. Contrary to previous studies, the data suggest that male hustlers were involved in prostitution by choice, “primarily to earn extra money.” The data also suggest that male hustlers were more likely to have substance abuse issues, be more antisocial (limited support for this finding), and have “limited vocational aspirations”.15 Another research examines teenage male prostitution on two levels: 1) different methods of prostitution, and 2) patterns of street behaviour. The authors conducted interviews with teenage males involved in prostitution to explore their “family history, parental and sibling relationship patterns, school involvement, and friendship patterns.” Among the findings: the youth indicate family problems, characterized by memories of fights between parents, alcohol abuse, and neglect. Poor relationships with families, adults and friends were commonplace. The youth identified themselves as isolated, victimized, and having negative experiences in school and with peers.16

Clarke views that “…child sexual abuse is a result of our patriarchal social structure… an overwhelming majority of those who sexually assault, abuse and exploit children and youth are males”. However, there is no analytical recognition of this important gender dynamic. Further, the Report identifies child sexual abuse as repulsive, however it ignores especially the role of the family in protecting male interests. The author concludes that male sexual socialization and other patriarchal power structures must be addressed if we are to reduce the incidence of sexual offences against children and youth.17 Male prostitutes under the age of 18 are studied to reveal that many have the necessities of food shelter and clothes, and many “return to a family at the end of an evening.” Two case studies explore reasons for entry into adolescent male prostitution. The author suggests that, contrary to common assumptions, adolescent males become involved in prostitution for “emotional rather than economic needs.” Adolescents who prostitute by choice appear to be victimized by their feelings of “inferiority, insecurity, and development of peer-oriented or delinquent orientation”.18 Factors identified by Brown as precipitating involvement in prostitution include: broken homes, parental neglect and abuse, educational difficulties, poor work prospects and “psychological disorientation.” Once exposed to deviant socialization, several motives potentially draw youth into prostitution (e.g., financial needs, the desire for adventure, associating with delinquent

15

Cates, J., & Markley, J. (1992). Demographic, clinical, and personality variables associated with male prostitution by choice. Adolescence, 27, 107, 695-706.

16

Price, V., Scanlon, B., & Janus, M.D. (1984). Social characteristics of adolescent male prostitution. Victimology: An International Journal, 9, 211-221.

17

Clark, L. (1986). Boys will be boys: Beyond the Badgley report: A critical review. In J. Lowman, M. Jackson, T. Palys, & S. Gavigan (Eds.).

18

Cates, J. (1989). ‘Adolescent male prostitution by choice’. Child and Adolescent Social Work Journal, 6, 151-56.

girls, situational factors associated with being a runaway).19

2.5 Psychological Concerns Coleman (1989) found that disruptions in the psychosexual and psychological development of young males may contribute to their participation in “destructive and non-ego enhancing prostitution activities.” Dorais (1996) suggested that some male victims of childhood sexual abuse might become involved in “aggressive prostitution” as a means of diverting revenge against the true aggressor.20 Allen categorises male prostitutes into four groups: 1) full-time street and bar hustlers; 2) full-time callboys or kept boys; 3) parttime hustlers; 4) those involved in prostitution as an “extension of other delinquent acts.” The data suggests that parttime male prostitutes, who remain in educational or vocational programs, are the only category of male prostitutes who express the ability to achieve a “stable social adjustment.” The author asserts that there is no “typical” young male prostitute; respondents had various backgrounds and motives for becoming involved (and staying involved) in prostitution.21 In another study, the subjects were matched on age, sex and socio-economic status (SES). Questions focused on family background, sexual and criminal history, present life circumstances, substance use, and “sexual practices with clients.” The data suggest that differences between the groups do not support previous research on demographic profiles of male prostitutes. 19

Brown, M. (1979). Teenage prostitution. Adolescence, 14, 665-679.

20

21

Op. cit., Steven Bittle, April 2002.

Allen, D. (1980). Young male prostitutes: A psychological study. Archives of Sexual Behavior, 9, 339-426.

The authors argue that factors associated with financial gain, homosexuality, and early sexual experiences may be more significant in determining entry into prostitution than family background.22 The author asserts a relationship between gay and bisexual adolescent psychosexual and psychological development and vulnerable situational variables. “More severe disruptions in psychosexual and psychological development seem to result in more destructive and non-ego enhancing prostitution activities.” The development of this process is presented through a clinical case study and incidence of “self-destructive prostitution activity among male adolescents” is also discussed.23

2.6 Criminalization A study by Silbert and Pines reveal a cycle of victimization, both before and after the respondents entered prostitution. Most subjects ran away from abusive (sexually and physically) homes and subsequently became involved in prostitution. Sixty percent of the respondents indicated they were victims of childhood sexual exploitation, and everyone experienced physical and emotional abuse. Once involved in prostitution, respondents were raped, beaten, robbed and abused by both customers and pimps. Respondents were victimized in non-prostitution related situations. Most did not report their victimization to authorities, and they did not attempt to seek help for the “negative emotional impact” of their abuse.24 22

Earls, C., & David, H. (1989a). A psychosocial study of male prostitution. Archives of Sexual Behavior, 18, 401-419.

23

Coleman, E. (1989). The development of male prostitution activity among gay and bisexual adolescents. Journal of Homosexuality, 17, 131149 24

Silbert, M. & Pines, A. (1982b). Victimization of street prostitutes. Victimology, 7, 122-133.

2.7 Risk Authors Pennbridge et al. compare participants involved in “survival sex” and those involved in “recreational sex.” The data reveal that 90% of the males in the sample were sexually active; 27.1% had prostituted in the last 3 months, and participation in prostitution was most common among older, gay males. The authors identify several risk factors that emerge from the data, including inconsistent condom use, high-risk sexual activities (during both survival and recreational sex), numerous sexual partners, intravenous drug use, and the consumption of alcohol and drugs during sex.25 Closer home in Thailand the authors of a study find that beliefs and attitudes toward sexuality and prostitute patronage result in higher risk-taking behaviours among Thai citizens (men are traditionally expected to have more than one woman to satisfy their needs, whereas women are expected to remain pure until marriage). This double standard helps condone the use of prostitutes by both single and married men, thereby contributing to the spread of AIDS. Despite increased knowledge of AIDS (especially among university students) sexual practices appear unaffected in Thailand – men continue to engage in unsafe sex.26 Among the findings on Male Sex Work in Canada: research suggests that a majority of males entered prostitution before 18 years of age; money is the ‘primary’ reason why

25

Pennbridge, J., Freese, T., & MacKenzie, R. (1992). High risk behaviours among street youth in Hollywood, California.AIDS Education and Prevention(Suppl.), 24-33.

26

Belk, R. W., Ostergaard, P., & Groves, R. (1998). Sexual consumption in the time of AIDS: A study of prostitute patronage in Thailand. Journal of Public Policy & Marketing, 17(2), 197-210.

young men enter prostitution; male sex workers experience violence from “homophobic onlookers who assault and/or rob them”…According to the author, although there is variation in the research on condom use, the available evidence refutes “…the label of male sex workers as AIDS vectors.” “Instead, it suggests that increasingly, male sex workers are protecting themselves, their clients and their sexual partners from STD and HIV infection and transmission”.27 Sullivan reveals high-risk profiles among these socially marginalized youth. Community-based education programs may have some impact on “lower-risk behaviour among this population.” The author identifies “cofactors of risk” that must be addressed (i.e., sexuality and marginalization), and argues for practical educational programs to transform the living conditions of street involved youth.28

2.8 Clients Findings from a study of customers of male prostitutes, as reported by male sex workers in 3 Australian cities are interesting. Male sex workers were asked to complete a brief questionnaire (referred to as a diary) following a sexual encounter with a client. The largest proportion of clients were in their 40s (31.7%), followed by those in their 30s (28.7%) and 16% who were in their 20s. Most clients were perceived as being “middle class.” “Rich” clients tended to use services provided by an escort agency, while “poor” clients used the services of street workers. Most clients were identified as being gay (45%) or bisexual (31.3%). Drug and alcohol use by clients before the sexual 27

Allman, D. (1999). M is for mutual A is for Acts: Male sex work and AIDS in Canada. Ottawa: Health Canada.

28

Sullivan, T. (1996). The challenge of HIV prevention among high-risk adolescents. Health and Social Work, 21, 58-65.

encounter was uncommon. Sex workers reported having some personal information about their clients (61.2% of the cases). Greater trust between the client and the sex worker may result in increased risk-taking in sexual practices (7% of the clients requested unprotected intercourse). Customer violence was reported infrequently (occurring more frequently with street clients than with other types of clients).29

2.9 Services Snell’s study samples 70 young male prostitutes to explore and analyze their “help-seeking behaviour.” The authors conducted in-person structured interviews and direct observation of places where young street males assemble. Most respondents indicated they received high levels of emotional and physical support from family members. Friends supplied emotional support, but were not identified as offering physical support. Medical and legal services and ministerial help were identified as most accessible. The police and social and mental health services were described as less “available or useful.30 Back home the Indian experience in Chennai as assessed by Chakrapani is revealing. Services provided to MSM in general are also usually accessed by MSW (mainly Counselling/ Testing – STD/ HIV, Drop-In facilities, Clinical centres, Outreach education and Condoms). Specific needs/ services may not be understood by NGO/ CBO and not articulated by MSW who are to access such services. Some important services that are needed but not available in 29

Minichiello, V., Rodrigo, M., Browne, J., Jamieson, M., Peterson, K., Reuter, B., &Robinson, K. (1999). A profile of the clients of male sex workers in three Australian cities. Australian and New Zealand Journal of Public Health,23(5), 511-518.

the Indian context for MSW include: Legal services, especially about legal rights, Psychosocial support counselling, referral services for mental health and de-addiction problems, assistance and support for disclosure on HIV/ STD to steady partners, condom negotiation skills, appropriate ‘empowerment’, counselling and referrals for Sex Reassignment Surgery (SRS) among transgender population, absence of advocacy to challenge criminal assault and training specific groups as ‘masseurs’ (massage parlour workers) to lobby for their protection.31

2.10

Discussion

A glimpse of the review of available literature does throw some light on the role, position and status of male sex workers around the world though western societies are different and Asian or Indian social settings have unique characteristics within which male sex workers need to blend into in order to survive. An important issue that emerges is that there exists a stark difference between identity (defining a person as a Male Sex Worker or MSM or Kot, Panthi, Dubli or Hijra) than actual sexual behaviour that are typical to each of these major subtypes of MSW. Therefore, even though a male sex worker may practice insertive anal sex (classically Panthi), he may identify himself as typically Koti or one who conventionally engages in receptive anal sex. Another important issue is the thin line dividing recreational sex and survival sex in the Indian context. Moreover, many MSW or even MSM engaging in sex where there is no exchange of money or gifts, etc. do not consider them to be homosexual. Added to it is the fact that many MSW here lead lives like any other male and go about their business and their (sexual) behaviour or orientation is largely hidden, so much so many even get married due to familial

30

Snell, C. (1991). Help-seeking behavior among young street males. Smith College Studies in Social Work, 61, 293-305.

31

Op. cit.,Chakrapani Venkatesan, 2004. See also www.indianGLBThealth.info

pressure but engage in sex with other men after marriage, with or without the knowledge of the spouse. This seemingly discreet silence against same sex relationships is because under Indian law homosexuality is illegal and therefore it attracts legal sanctions. Police and official authorities take MSW and MSM to task easily and this further gets these groups on the run. No wonder then, that the phenomenon of male sex work is dark and hitherto hidden, affecting needed programme interventions focussing on HIV prevention, treatment and care. Unlike the western model, male youth in India are drawn into sex as they are influenced by excessive social control where sex is taboo, broken homes, violence between parents, sibling rivalry, elders physically assaulting youth and early sexual abuse by other males within the family – relatives, friends and peers. Another factor contributing to male youth into sex is the physical setting, poor living environments, exposure to deviant social behaviour early in life. Patterns of sexual activity among male sex workers reveal that many start off having recreational sex but in due course, (mostly when they are exposed and stigmatised) move on to survival sex and, especially in certain rapidly growing cities with increasing migrant labour and growth of slums, the demand for sex is high. Young boys are easy to be drawn into the sex trade by older men as none would doubt their intentions. Getting a teenage girl into a hotel room for instance would be impossible in many cities. But getting a lad of 18 to 20 years into a room would go unnoticed and this fuels increasing same sex behaviour among males. In most instance, this ‘idle profession’ does bring in the extra money that young boys need to satisfy their ever growing demands – watching movies, drinking, smoking, drugs, etc. Many boys are known to run the entire household on the income obtained from sex work.

Family level influence indicates that many MSW hail from larger families. With the number of siblings beyond five or six, those with little or no parental attention get drifted and fall into isolation, victimization and finally turn to commercial sex activity. Moreover, not all MSW consider themselves gay and there are a sizeable number of MSW who are bisexual. This complex scenario poses a nightmare for programme planners and managers. Therefore, a holistic and full-scale prevention and care programme can be the answer to improving the sexual health of MSW thereby decreasing their risk of HIV infection and of AIDS. In the Indian context, MSW reportedly select clients more based on his/ her ‘paying capacity’. Many indications are that sex workers will chose clients of their own socio-economic milieu or better as they are assured of payment at the end of the job. In rare instances, if an MSW is lucky, he gets overpaid by the client or when a rich client feels he has been satisfied by the MSW. However, in times of economic trouble, a sex worker would not hesitate to sell sex to a larger number of clients from poorer backgrounds in order to sustain himself economically.32

Photo courtesy: Srinivas Kurungati 32

Discussion based on readings from literature in Asia and the country as well as from qualitative data, depth interviews with MSW and key influencers and FGD in the three cities.

3.0 KEY FINDINGS The results of this study reveal that male sex workers are present in this country in quite good number and they are engaged in sex work to augment their poor economic status. Though there are socio-cultural differences between regions (cities) across the country, with specific societal changes across geographic regions, a common thread knits the issues of MSW. The risk factors, poor levels of correct knowledge and awareness on HIV/ AIDS, vulnerability due to individual, societal and economic pressures as well as age and physical stamina (including other demographic variables such as education, media habits, occupation and income, peer group influence, disposable income and family support) play an important role with regard to chances of (increased) HIV infection. It is also observed that they are by and large a hidden group and hence very difficult to identify (that poses a challenge for interventions) that can be more successful through community-based outreach. To begin with, testing and diagnostic facilities are unknown to MSW and few who know such services are not motivated to test for HIV even though they may be at increased risk of infection. As individuals, many MSW suffer from a sense of low self-esteem, poor confidence fuelled by stigma when identified as a sex worker. Decreased family support, economic hardship, non-availability of need-based services put tremendous pressure on the Male Sex Workers across the country. Where services exist, they are inadequate and out of reach of MSW owing to cost (of maybe even reaching there), stigma, poor quality of service delivery, inconvenient timings/ place and most significantly ignorance about existence of such services that contribute to poor access for treatment as well as other services required by MSW. Overall, it is observed that the Male Sex Workers in Kolkata are younger, better educated, employed suitably, better informed with good media habits and indulge in sexual activities both as recreational sex as well as in survival sex. The clientele is rather old with most clients being older than MSW themselves and there is a good potential for sex work in the big metropolis. Urbanization, increased migration, growth of slums, chaos in controlling the sex industry that is hidden and rather unorganised (especially male sex industry) witness the rise of male sex work. Ahmedabad portrays a contrastingly different picture with many sex workers being comparatively older, while their clientele are younger. Unemployment is rampant as education and skills among male sex workers are poor, hence many are engaged in odd jobs and barely manage to eke out a living. One does not see a thriving market for sex activity in Ahmedabad unlike Kolkata and Vijayawada but the fact is that male sex workers have to increasingly engage in sex work to supplement their income. Large numbers of MSW are married and bisexuals may have increased risk of infection as well as transmitting it to their spouses. Hence, service provision needs to be done appropriately with increased partner treatment and so on. Vijayawada is tastefully South Indian stereotype, closed family and social relationships, rigid moral codes, taboo on even talking about sex (leave alone engaging in it!), and sex outside marriage or with same sex partners viewed with contempt. Yet, the study reveals the setting and behaviour of MSW is more akin to those in Kolkata. Being one of the most rapidly growing cities in the country, with increased mobility and migration to and from the city, poor growth of jobs, increasing competition and the need to earn more have compelled many youth to take to sex work as they are lured into the industry by older males and the expanding demand for sex. External influences as cinema, other media, increased connectivity with other important places and rural areas have all propelled male sex industry in Vijayawada. With respect to service access though, all cities indicate poor response.

3.1

The proposed working definition that MSW agreed that though there are several subgroups among MSW, persons who have sex in exchange for money, favour and gifts are defined as Male Sex Workers. The above definition is approved by consensus across all the three cities studied. They also agreed that increasing numbers of MSM who engaged in recreational sex move over to survival sex due to economic reasons. The main sub-types of MSW known include Koti (feminised males practicing receptive anal sex), Panthi (‘real’ males practising insertive anal sex), Dubli (known to practice both receptive and insertive sex and Hijras (gendervariant male as well as transvestites) considered more male than female in the country. (In West Bengal and Gujarat, male sex workers are known to dress as women and participate in cultural festivals, also buying sex from other males. Such fairs and festivals are held regularly annually) MSW in Andhra Pradesh attend the annual Koovakam festival (for gender-variant male) held every year in neighbouring Tamil Nadu. Male Sex Workers are known to constitute MSM who engage in sex in exchange of money, favour and gifts, Koti – feminised males who practice receptive anal sex, Panthi – masculine male persons who practice insertive anal sex, many of whom also have sex with women, Dubli or double deckers who are known to engage in both receptive and insertive sex and Hijras (to be read gender-variant males)

3.2

Across the country, the Sex Industry Network (SIN) is known to operate in two types a) outdoors: more open and in public places predominantly, unconcerned of the general public – in parks, streets, bus and railway stations and b) indoors: more clandestine and discreet manner where only MSW and client are in the know of things. Such encounters take place in houses, brothels, hotels and massage parlours. While MSW from lower socio-economic classes are known to engage in outdoor activities, closed and secret practices are engaged by MSW and their clients from higher socio-economic strata. Other key stakeholders within the SIN include pimps, madams, police, lodge and brothel owners, informers, drug and liquor peddlers, petty shop keepers, older MSW, traditional and allopathic health care givers and the general community in the vicinity of the hotspot who accommodate MSW. All three cities are on banks of rivers that are an important hotspot for increased MSW activity – Hoogly in Kolkata, Sabarmati in Ahmedabad and Krishna in Vijayawada. MSW also reportedly known to operate in large numbers in places such as army cantonments – Ahmedabad and Vijayawada have military establishments and MSW are known to have clients from such places. (Individual city reports have pinpointed areas where MSW can be reached).

3.3

Access to health facilities primarily rests on knowledge about such services and the study indicates that those who are aware have accessed services. However, the numbers of those who accessed are extremely low that indicates a serious barrier – the lack of information among MSW. Other barriers identified include inadequate infrastructure facilities in affordable centres, inconvenient location of such centres, sustained affordability, and absence of the range of services that are needed – such as condom programming or diagnostic and testing facilities. Inconvenient timings, untrained personnel, non-availability of drugs and medicines and gels and lubricants also contribute to their poor access. Moreover, it is observed that professional services such as counselling and referrals are few and far between. Many MSW refuse to access even known services for fear of exposure or discrimination from general public. (A large majority of MSW cannot be identified thus and live as other men do and so accessing a facility meant for and advertised as a centre for MSW and MSM really puts them off.)

3.4

Male Sex Workers per se constitute a larger universe of male persons having sex in exchange for money, favours, gifts, etc. (of economic value) into which may be included Men who have Sex with Men as not all MSM may practice sex on a

commercial scale. (Large numbers of MSM are known to engage in recreational sex though at some point of time also receive money subscribing to engaging in survival sex). It is important to note that neither all MSM nor all MSW consider them as homosexual. Thus, there is a wide chasm between identity and behaviour, and these are so often bundled up together, especially by those not belonging to the community. It is also seen that overall, always MSM are in conflict with MSW as both have their eyes pinned on the same client. However in some places (such as Vijayawada), it is difficult to distinguish between the two. To make matters complex, they also switch roles. However, programme planners understand that whichever way, the element of risk and vulnerability make them the centre of HIV prevention and care. 3.5

As far as risk perception is concerned, across the cities, MSW do not rightly perceive them to be at risk of HIV infection indicated by poor condom use despite awareness of HIV/ AIDS. MSW in Kolkata and Vijayawada understand and reportedly adopt safer sex practices compared to Ahmendabad where perception of risk is extremely low. The important myth that MSW have is that they consider HIV infection can occur only by sex with a woman (heterosexual contact). As a majority MSW practice anal sex, they do not understand the importance of condoms. Moreover, even for anal sex condoms preferred are lubricated that are either not available or unaffordable. Condom use during oral sex too is reportedly very poor across the three cities.

3.6

Socio-demographic analysis on age factors of MSW indicates that the age of MSW in Kolkata is the lowest, followed by Vijayawada, 47 percent and 41 percent respectively in the 19-25 years age group. MSW in Ahmedabad are reportedly older with a sizeable number aged above 40 years. Data on age at first sex is similar in all 3 cities with 80 percent MSW in Kolkata and Vijayawada reporting the same below 18 years while in Ahmedabad 93 percent first had sex during the same time. However, with respect to having first sex in exchange for money, gifts, etc, 55 percent respondents in Kolkata were below 18 years of age while in Ahmedabad and Vijayawada, 50 percent and 70 percent reportedly had first commercial s when they were between 19 and 25 years of age. Interestingly the average age of the clients is different in each of the cities. While 33 percent clients in Kolkata are 26-32 years of age, 45 percent clients of MSW in Ahmedabad are below 18 years and the average age among 55 percent of clients of MSW in Vijayawada is between 19-25 years.

3.7

The educational status of MSW is similar across the 3 cities with roughly 30 to 40 percent educated up to middle school followed by 20 to 30 percent with primary education. As far as marital status is concerned, majority of the MSW interviewed are unmarried, 71 percent in Kolkata, 60 percent in Ahmedabad and 56 percent in Vijayawada and consequently 29 percent in Kolkata, 40 percent in Ahmedabad and 44 percent in Vijayawada were ever married. In Kolkata only 12 percent of MSW are married and living with spouse. Educational data reveals low education – up to middle/ primary level mainly with large numbers illiterate, hence unaware of preventive measures. MSW in Kolkata are more aware of risks to HIV infection followed by those in Vijayawada. In Ahmedabad, though awareness is there, many myths and misconceptions also exist among MSW. In all three cities, mere knowledge or awareness of safe sex practices has not indicated significant change in behaviour of MSW. Condom use is still reportedly low and this points to absence of specific communication needs of MSW. Marital status too indicates large number of unmarried males though of marriageable age. Among married MSW (bisexual) too, sexual practices indicate non-adoption of safe sex methods. Many are known to delay marriages and several others remain single. In the south, more emphasis is laid on marriage.

3.8

The occupational status of MSW indicates that majority in Kolkata, 63 percent are employed in full time jobs, while in Ahmedabad, 80 percent MSWs work as parttimers. In Vijayawada, 45 percent are in full-time jobs and 36 percent in part-time jobs. Unemployment is high in Kolkata, 33 percent and Vijayawada, around 20 percent fuelling sex work as an alternative income generating avenue. Many sex workers argue that disclosure of their status as MSW leads to being thrown out of jobs and not being able to start their own businesses due to lack of finance and poor or no skills and training.

3.9

The data on average monthly income of MSW reveals that majority of them, 64 percent earn below Rs.2500/- a significant number, 33 percent earn between Rs.2501/- and Rs.5000/-. However, in Ahmedabad, an alarmingly high 93 percent of MSW earn below Rs.2500/-. Comparatively, MSW in Vijayawada are economically better off with a majority, 52 percent earning between Rs.2501/- and Rs.5000/- and 40 percent earn below Rs.2500/-. This indicates that the economic position of MSW in Ahmedabad is extremely poor and many are forced to engage in increased sexual activity in order to earn more. (Such a trend points at increased risk of infection when coupled with poor adoption of safe sex practices. Poor economic status also has a bearing on accessing affordable, quality services, timely treatment of STI and using (lubricated) condoms). Overall, it is observed that larger number of MSW in Vijayawada earn on an average more than MSW in Kolkata or Ahmedabad where MSW are poorly paid for sex work. In Kolkata, depending on looks and demand with high-class clientele, there is potential for few MSW to earn very high income but by and large many just manage to make a living.

3.10 Media habits of MSW across the 3 cities reveals that Television is the main media channel followed by Newspapers and the Radio. Besides, magazines and cinema are also prominent mass media accessed by MSW. As far as other personal habits are concerned, in Kolkata and Ahmedabad, around 70 percent of the MSW and 46 percent MSW in Vijayawada have the habit of smoking, larger number of MSW, 73 percent in Vijayawada take alcohol, compared to 44 percent in Kolkata and Ahmedabad. Media exposure is wide among MSW with TV, newspapers and radio being the most important media channels. It is also noticed that MSW with higher literacy levels have better media exposure and are able to understand messages better than illiterate or poorly literate peers. However, with low education levels and fast urban pace of living, it is doubtful if MSW are able to understand preventive messages projected through such media (especially hoardings/ posters that are in transit places such as bus stands and railway stations or wall paintings that they have hardly time to read the message fully. Provision of leaflets and handbills with pictures and information on preventive and curative measures (STI) are welcome by MSW. Those who have seen such materials feel they create better impact. A multi-pronged communications approach is warranted. 3.11 With regard to awareness on MSW genre, larger numbers of MSW in Vijayawada have better clarity with regard to Koti, Panthi, Dubli and Hijras followed by Ahmedabad and Kolkata. MSW in Kolkata are observed to have an identity problem and there is so frequent changing of roles depending on the circumstances that fluidity exists in terms of arriving at a definite definition. In terms of identification with a particular group or subtype of MSW, many MSW in Ahmedabad, 87 percent considered them as also being Koti compared to 61 percent in Kolkata and 36 percent in Vijayawada. However, all MSW interviewed identified them as Panthi too in Ahmedabad compared to only 24 percent in Vijayawada and only 7 percent in Kolkata. Almost an equal number also identified them as Dubli in Kolkata and Vijayawada, around 32 percent compared to only 12 percent in Ahmedabad. However, a reversal of trend is observed in MSW with 30 percent in Ahmedabad also identifying as Hijra compared to 10 percent in Kolkata

and 8 percent in Vijayawada. There are also gender-variant male and transvestites in all three cities with their distinct characteristics and culture. A majority of MSW across all three cities consider them Koti and buy sex from other men. However, in Vijayawada and Kolkata there are typical male sex workers catering to female clients as well and there are bisexuals. In terms of role played during sex, a lot depends on the demands of the clients. For instance, MSW reportedly play a role of Panthi though he may always consider him as Koti. Some clients pay more for demanding switching of roles and diverse sexual demands from sex workers. 3.12 Sexual practices and condom use behaviour indicate that condom use is proportionate to extent of sex in exchange for money, gifts, etc. with condom use reportedly high in Ahmedabad followed by Vijayawada and then Kolkata. However, qualitative data indicates the opposite with MSW in Kolkata reporting high condom use followed by Vijayawada and very poor condom adoption practices in Ahmedabad. On the whole, it may be seen that condom use is lowest in Ahmedabad. In Kolkata it is reportedly good and MSW from Vijayawada reportedly use condoms extensively. However, the issue of availability and affordability of lubricated condoms for anal sex and social marketing by NGO/ CBO are issues that alter condom use pattern. Ultimately, there is indication of the absence of an effective condom programming strategy in any of the cities and few MSW aware of the risks of HIV/ STI infection use condoms for self-protection. 3.13 The type of sex practices reveals that anal sex is very popular though oral sex is also very common especially in Ahmedabad and Vijayawada. Vaginal sex is practiced by married MSW and gigolo and thigh sex is popular among Hijras. Though condom use is reported across all cities, it is not satisfactory. The socioeconomic condition of MSW too has a bearing on knowledge, risk perception, need for and use of condoms. Thus, MSW in Ahmedabad report poor condom adoption compared to Kolkata and Vijayawada where it is more a matter of choice and depends on the clients. 3.14 Acts of physical violence and criminal assault are reported by about half the number of total MSWs interviewed in the study (despite possible underreporting of the same). Larger numbers of MSW in Vijayawada, 57 percent reported having forced sex and physical violence such as thrashing, beating, burning with cigarette ends and so on. In Ahmedabad, 48 percent and in Kolkata 45 percent reported similar acts. However, more MSW in Kolkata around 50 percent compared to 45 percent in Ahmedabad and 20 percent in Vijayawada faced criminal assault. In all three cities, police are known to exploit MSW, extortion, threat of arrest and repeated harassment is reported. Here too, MSW in Kolkata and Vijayawada feel more secure than those in Ahmedabad. Media sensitization and efforts at increasing awareness of law-enforcing authorities can improve rights of MSW. Local newspapers, regional media publicity have a strong negative opinion on male sex workers and their occupation. 3.15 As far as awareness, availability and access to services by MSW is concerned, across the 3 cities, a rather dismal picture emerges. Services provision is pathetic and the range of services offered are grossly inadequate, facilities ill-equipped, with untrained or unskilled personnel and non-user-friendly atmosphere that deters MSW from accessing services. The indication of sources of awareness of various services may be harnessed to evolve effective communication dissemination to MSW and make available such services that are need-based, cost-effective and with the right delivery mechanisms in place.

A Tale of Three Cities ANALYSIS OF MALE SEX WORKERS IN THE 3 CITIES

Age in completed years KOLKATA Age in completed years

14.7

2.7

6.7

46.7

29.3 < 18 Years 33-39 Years

19-25 Years Above 40 Yrs.

26-32 Years

AHMEDABAD Age in completed years

1.3

13.3 17.3

41.3

18.7 < 18 Years 33-39 Years

19-25 Years Above 40 Yrs.

26-32 Years

VIJAYAWADA Age in completed years

2.7

10.7

2.7

50.7

33.3 < 18 Years 33-39 Years

19-25 Years Above 40 Yrs.

26-32 Years

Age at first sex & age at first commercial sex KOLKATA Age at first sex & first commercial sex

81.3 54.6 40

19-25 Years

18.7

< 18 Years

100 80 60 40 20 0

Age at 1st sex

Age at 1st com. Sex

AHMEDABAD

Age at first sex & first commercial sex

93.3

100 80 44 49.3

60 40

6.7

20

0

6.7

0 < 18 19-25 26-32 Years Years Years

Age at 1st sex

Age at 1st com. Sex

VIJAYAWADA 78.7

Age in completed years 69.3

80 60 40

26.7 20 1.3

20 0

4

< 18 19-25 26-33 Years Years Years Age at 1st sex

Age at 1st com. Sex

Average age of clients KOLKATA Average Age of clients of MSW 35 30 25 20 15 10 5 0

< 18

30.7

33.3 25.3

6.7 4

Avg. age of client

19-25

26-32

33-39

40 & >

AHMEDABAD Average Age of clients of MSW 50

45.3

42.7

40 30 20

10.7

10

< 18

0

1.3

0

Avg. age of client

19-25

26-32

33-39

40 & >

VIJAYAWADA

Average Age of clients of MSW 54.7

60 50

36

40 30 20 10 0

< 18

8

1.3

0

Avg. age of client

19-25

26-32

33-39

40 &

Educational status of MSW KOLKATA Education status of MSW

40

30.7

30

25.3

21.3

20 8

6.7

10 0

6.7

1.3

Education

Illiterate Hr. Sec. No Resp.

Primary Technical

Middle school Hr. Edu.

AHMEDABAD Education status of MSW

36

40 29.3

30 20

13.3

13.3

10

0

0

2.7

5.3

Education

Illiterate Hr. Sec. No Resp.

Primary Technical

Middle school Hr. Edu.

VIJAYAWADA Education status of MSW

50

41.3

40 30

20

20 10 0

Illiterate Hr. Sec. No Resp.

21.3 9.3

6.7

1.3

0

Education

Primary Technical

Middle school Hr. Edu.

Marital status of MSW KOLKATA Marital Status of MSW

80

70.7

60 40 12

20 0

9.3

6.7

1.3

Marital status

Unmarried Married, living without spouse No Response

Married, living with spouse Separated/ Divorced

AHMEDABAD Marital Status of MSW 60

60 34.7

40 20

1.3

0

4

0

Marital status

Unmarried Married, living without spouse No Response

Married, living with spouse Separated/ Divorced

VIJAYAWADA Marital Status of MSW

60 40

56

37.3

20 0

2.7

4

0

Marital status

Unmarried Married, living without spouse No Response

Married, living with spouse Separated/ Divorced

Occupational status of MSW KOLKATA Occupation Status of MSW 80

62.7

60 40

33.3

20

4

0 Occupation

Unemployed Part-time employed

Full-time employed

AHMEDABAD Occupation Status of MSW 80

80 60 40 20 0

13.3

6.7

Occupation

Unemployed Full-time employed Part time employed

VIJAYAWADA Occupation Status of MSW 45.3

50

36

40 30

18.7

20 10 0

Occupation

Unemployed Full-time employed Part time employed

Average Monthly Income of MSW KOLKATA

Average Monthly Income - all sources 2.7 33.3

64 < Rs.2500

Rs.2501 – Rs.5000

> Rs.5001

AHMEDABAD

Age in completed years 2.7 4

93.3 < Rs.2500

Rs.2501 – Rs.5000

> Rs.5001

VIJAYAWADA

Average Monthly Income - all sources 8 40

52 < Rs.2500

Rs.2501 – Rs.5000

> Rs.5001

Media habits of MSW KOLKATA Media habits of MSW 94.7

100 80

65.3

70.7

60 40

22.7

21.3

20 0

Media channels

Television Magazines

Radio Cinema

Newspaper

AHMEDABAD Media habits of MSW 92

100

82

80

61.3

60 40

17.3

20 0

9.3

Media channels

Television Magazines

Radio Cinema

Newspaper

VIJAYAWADA Media habits of MSW 100

84

80 60 40

33.3

29.3

20 0

Television Magazines

6.7

0

Media channels

Radio Cinema

Newspaper

Other habits of MSW KOLKATA Other habits of MSW 80

68

60

44

40

40

25.3 18.7

20 0

Other habits

Smoking Drugs Other habits

Alcoholism Consuming tobacco

AHMEDABAD Other habits of MSW 80

68

60

44

40

40

25.3

18.7

20 0

Other habits

Smoking Drugs Other habits

Alcoholism Consuming tobacco

VIJAYAWADA Other habits of MSW 73.3

80 60

46.7 36

40 20 0

Smoking Drugs Other habits

13.3 1.3

Other habits

Alcoholism Consuming tobacco

Awareness of Male Sex Workers Genre Male Sex Worker Subtypes (N=75)

Awareness Koti (%) 67 89.3 75 100.0 75 100.0

CITY Kolkata Ahmedabad Vijayawada

Panthi (%) 38 50.7 63 64.0 75 100.0

Dubli (%) 64 85.3 58 77.3 75 100.0

Hijra (%) 64 85.3 74 98.7 69 92.0

Gigolo (%) 17 22.7 10 13.3 10 13.3

Masseur (%) 32 42.7 11 14.7 43 57.3

Escort (%) 7 9.3 2 2.7

Londa (%) 55 73.3 21 28.0

---

---

Dancer (%) 58 77.3 63 84.0 8 10.7

Type of Male Sex Workers MSW Type

Male Sex Worker Subtypes (N=75) Koti (%) 46 61.3 65 86.7 27 36.0

CITY Kolkata Ahmedabad Vijayawada

Panthi (%) 5 6.7 75 100.0 18 24.0

Dubli (%) 23 30.7 9 12.0 24 32.0

Hijra (%) 8 10.7 23 30.7 6 8.0

Gigolo (%) 1 1.3 1 1.3

Masseur (%) 24 32.0

---

---

---

Escort (%) 1 1.3 2 2.7

Londa (%) 11 14.7 2 2.7

Dancer (%) 15 20.0

---

---

---

---

Place of soliciting/ pickup/ aggregating by MSW

Park (%)

Brothel (%)

Hotel (%)

House (%)

Telephone (%)

Pimp (%)

Public toilet (%)

Internet (%)

Chat room (%)

Vijayawada

Railway Stn. (%)

Ahmedabad

Bus stand (%)

Kolkata

Massage parlour (%)

CITY

Male Sex Worker soliciting/ pickup/ aggregating points (N=75)

Street (%)

Pickup point

50 66.7 65 86.7 64 85.3

23 30.7 4 5.3 6 8.0

39 52.0 61 81.3 62 82.7

45 60.0 45 60.0 41 54.7

48 64.0 55 73.3 67 89.3

9 12.0 35 46.7 13 17.3

25 33.3 35 46.7 28 37.3

32 42.7 26 34.7 27 36.0

25 33.3 6 8.0 58 77.3

27 36.0 1 1.3 10 13.3

6 8.0 38 50.7 4 5.3

1 1.3 1 1.3 7 9.3

4 5.3 1 1.3 9 12.0

Sexual practices, behaviour and client profile of MSW by Age group Sexual history

CITY

Kolkata Ahmedabad Vijayawada

Sexual practices, behaviour and client profile (N=75) Sex for money/ gifts (Last time) (%) 66 88.0 71 94.7 71 94.7

Clientele

Condom use (6 months) (%)

Condom use (Last time) (%)

High class (%)

Low class (%)

53 70.7 66 88.0 55 73.3

47 62.7 63 84.0 47 62.7

47 62.7 24 32.0 14 18.7

25 33.3 36 48.0 58 77.3

Type of sex by MSW by Age Group Type of sex CITY Kolkata Ahmedabad Vijayawada

Type of Sex (N=75) Oral (%) 59 78.7 72 96.0 65 86.7

Anal (%) 66 88.0 75 100.0 59 78.7

Vaginal (%) 16 21.3 7 9.3 12 16.0

Thigh (%) 27 36.0 50 66.7 50 66.7

Others (%) 11 14.7 1 1.3 4 5.3

Violence and criminal assault against MSW by Age group Violence, Forced sex, violence and etc. criminal assault (N=75) Forced sex Criminal CITY & violence assault (percent) (percent) 34 35 Kolkata 45.3 46.7 36 33 Ahmedabad 48.0 44.0 43 15 Vijayawada 57.3 20.0 Awareness on HIV/AIDS of MSW by Age group Awareness on Awareness HIV/ AIDS (N=75) Age in Average completed age of CITY years client (Percent) (Percent) 62 62 Kolkata 82.7 82.7 75 75 Ahmedabad 100.0 100.0 Awareness on HIV/AIDS and sexual behaviour of MSW Kolkata Awareness on HIV/AIDS and behaviour of MSW (N = 75) Sexual behaviour Last time had sex for money/ gifts, etc. (MSW) Last time used condoms while having sex

Kolkata (Percent) 53 70.7 41 54.7

Ahmedabad (Percent) 71 94.7 63 84.0

Vijayawada (Percent) 59 78.7 44 58.7

Awareness, Availability and Access to services by MSW by Age Group Service access CITY Kolkata Ahmedabad Vijayawada

Awareness, Availability and Access to services (N=75) Aware (%) 49 65.3 75 100.0 24 32.0

NGO (%) 48 64.0 19 25.3 18 24.0

Range of services Condom Clinic Drugs (%) (%) (%) 3 6 7 9.3 4.0 8.0 54 56 38 50.7 72.0 74.7 1 ----1.3

Jelly (%) 2 2.7 55 73.3 ---

Access (%) 15 20.3 75 100.0 24 32.0

Sources of Awareness on HIV/AIDS of MSW Kolkata

Sources of aw areness on HIV/AIDS 88

90 80 70 60 50 40 30 20 10 0

69.3

66.7 58.7

53.3 54.7 42.7

45.3

42.7

Sources of aw areness Telev ision Post er NGO/ CBO

Rad io Pamphlet Friends

Newspaper Doctor Other sources

Problems faced by MSW Kolkata Problems face d by MSW

80

68

60

54.7 57.3

40

57.3

50.7 37.3

32

49.3 52

42.7 32

20 0

Problems faced

Jealousy

Robbing clients

Police harassment

Blackmailing

Cheating/ free sex

Switching loyalty

Hiding from family

Fear of disclosure

No co nsent to open

Expo sure

Oth er problems

Sources of Awareness on HIV/AIDS of MSW Ahmedabad

Sources of awareness on HIV/AIDS 98.7

100

88

80

72

66.7

60

45.3

56 53.3

52

40 20 1.3

0

Sources of awareness Television Poster NGO/ CBO

Radio Pamphlet Friends

Newspaper Doctor Other sources

Problems faced by MSW Ahmedabad Problems faced by MSW

100

85.3

80

74

60

65.4 53.3 50.7

58.6

56

40

41.3

20 0

48

53.3

4

Problems faced

Jealousy

Robbing clients

Police harassment

Blackmailing

Cheating/ free sex

Switching loyalty

Hiding from family

Fear of disclosure

No consent to open

Exposure

Other problems

Sources of Awareness on HIV/AIDS of MSW Vijayawada

Sources of awareness on HIV/AIDS 80

77.3

73.3

66.7

70 57.3

60

50.7

54.7

50 40

32

30

14.7

20 10

0

0

Sources of awareness Television Poster NGO/ CBO

Radio Pamphlet Friends

Newspaper Doctor Other sources

Problems faced by MSW Vijayawada Problems faced by MSW

100

88

80

70.7 68

72 60

60 40

29.3

20

20 0

21.3

16

24 1.3

Problems faced

Jealousy

Robbing clients

Police harassment

Blackmailing

Cheating/ free sex

Switching loyalty

Hiding from family

Fear of disclosure

No consent to open

Exposure

Other problems

Pilot Study on MSW in India

CITY REPORTS 4.0 MALE SEX WORKERS IN INDIA KOLKATA CITY

The Victoria Memorial in Kolkata Kolkata – The City of Joy, as it is known is one of the largest cities of India and the world. Greater Kolkata has a population of over ten million. It is the capital of the Indian state of West Bengal and the only metropolis of Eastern India. It is located on the east Banks of the Hoogly River and lies 120 kilometres from the Bay of Bengal. With humid summers and pleasant winters, it attracts a large number of people in eastern India. Light and heavy industries are the main businesses. The various modes of transport range from the handcart to the tram and tube rail. With industrial strikes (bandhs), processions (michlis) and leftists (bampanthis) and with ever-growing population, pollution, traffic snarls, blackouts and water-logging, Kolkata offers a perfect recipe of urban chaos. True to its cosmopolitan character, people of all communities converge in the city with Bengali, Hindi, English being spoken as the main languages. The analysis of the quantitative data begins with the socio-demographic profile of Male Sex Workers in Kolkata in order to understand the physical and environmental conditions that affect MSW and also lead to a better understanding of the respondents through a macro perspective. An analysis of the socio-demographic profile of the MSW reveals that 47 percent are between 19 and 25 years of age, and 81 percent reported having their first sexual experience as well as involving in sex first in exchange for money, gifts, etc., when they were below 18 years of age. Further, 33 percent opined that the average age of their clients is between 26 to 32 years. Education status indicates that 31 percent have studied only up to middle school, and a majority comprising 71 percent are unmarried. Occupational status data shows that 63 percent are employed in full-time jobs, with 64 percent earning below Rs.2500 a month from all sources with 55 percent earning up to Rs.1500 from engaging in sex work. Statistics also reveal that 95 percent view television and 77 percent read the newspapers and that 68 percent are smokers and 44 percent have the habit of consuming alcohol.

NIMSW

38

Pilot Study on MSW in India

NIMSW

39

Pilot Study on MSW in India 4.1 Socio-demographic characteristics Figure – 1 Age of Male Sex Workers (MSW) Age in completed years

2.7

14.7

6.7

46.7

29.3 < 18 Years 33-39 Years

19-25 Years Above 40 Yrs.

26-32 Years

According to the data presented in Figure-1 given above, the age of Male Sex Workers in Kolkata City has been described. It may be observed that a majority of the MSW, 47 percent are between 19 and 25 years of age, followed by 29 percent who are older in the 26 to 32 years age group. While 15 percent of the MSW interviewed in the study are between 33 and 39 years, 7 percent are below 18 years of age. Hence, it may be concluded that a majority of the Male Sex Workers are below middle age and therefore those below 30 years need to be targeted for any health or HIV/ AIDS related initiatives. Figure – 2 Age at first sex and Age at first Commercial Sex of Male Sex Workers (MSW)

Age at first sex & first commercial sex

100 80

81.3 54.6

40

60 40

18.7

20 0

< 18 19-25 Years Years Age at 1st sex

NIMSW

Age at 1st com. Sex

40

Pilot Study on MSW in India Figure-2 above portrays the age at first sex and age when MSW first had sex in exchange for money, gifts, etc., of Male Sex Workers in Kolkata City. It is seen from Figure-2 that 81 percent reported having their first sexual experience below 18 years of age while the remaining 19 percent said their first sex experience occurred when they were between 19 and 25 years old. A similar trend can be observed with respect to the age at which the MSW had sex for the first time in exchange for money, gifts, etc. While 55 percent reported such experience below 18 years of age, 40 percent reported engaging in paid sex first when they were 19 to 25 years of age. Figure – 3 Average Age of the clients of Male Sex Workers (MSW)

Average Age of clients of MSW 40

30.7

33.3

30

25.3

20 10

6.7 4

0

< 18

Avg. age of client

19-25

26-32

33-39

40 & >

Figure-3 analyses the average age of the clients of the Male Sex Workers that reveals a different pattern. While majority of the MSW, 33 percent opined that the average age of the clients is between 26 to 32 years, a marginally lesser number, 3I percent said their clients were 19 to 25 years old and a good percentage, 25 percent said their clients were older at 33 to 39 years of age. This indicates that older clients prefer younger males as their partners and there is a large demand for young boys.

The Howrah Bridge, also a hotspot for MSW activity

NIMSW

41

Pilot Study on MSW in India Figure – 4 Educational status of Male Sex Workers (MSW) Education status of MSW 40

30.7

30

25.3 21.3

20 8

6.7

10 0

6.7 1.3

Education

Illiterate

Primary

Middle school

Hr. Sec.

Technical

Hr. Edu.

No Resp.

The educational status of the MSW is indicated in Figure-4 above. It is noticed that majority of the MSW interviewed, 31 percent have completed only up to middle school followed by 25 percent who have had only primary education. A further 21 percent of the respondents were educated up to higher secondary. This indicates poor education levels among male sex workers that points out to the need to cater to information and education needs of respondents with respect to health/ HIV/ AIDS efforts.

A typical market place in the heart of Kolkata

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42

Pilot Study on MSW in India Figure – 5 Marital status of Male Sex Workers (MSW)

Marital Status of MSW 70.7

80 60 40

12

20 0

9.3

6.7

1.3

Marital status

Unmarried

Married, living with spouse

Married, living without spouse

Separated/ Divorced

No Response

Figure-5 describes the marital status of the MSW covered in the study. With a predominantly large younger group, expectedly a large 71 percent are unmarried. Among ever-married MSW, 12 percent are living with their spouse and close to 10 percent are living without their spouse. Marriage is a crucial factor as it determines risk and vulnerability to HIV infection during unprotected sex. Figure – 6 Occupational status of Male Sex Workers (MSW)

Occupation Status of MSW 80

62.7

60 40

33.3

20

4

0 Occupation

Unemployed Part-time employed

Full-time employed

From Figure-6, the occupational status of the MSW may be ascertained. The data reveals that majority of the respondents, 63 percent are employed in full-time jobs while 33 percent are unemployed and only 4 percent engage in part-time jobs. The type of occupations that have been observed include petty traders, rickshaw pullers, male commercial sex workers, vendors, drivers,

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43

Pilot Study on MSW in India boatmen and the like. A few have taken up working with NGO/ CBO as peers and volunteers and continue to engage in sex work. Many MSW are also reported to be working in blue collar and white collared jobs in manufacturing companies, at the port and petty business. Figure – 7 Average monthly income of Male Sex Workers (MSW) (All sources) Average Monthly Income - all sources 2.7 33.3

64 < Rs.2500

Rs.2501 – Rs.5000

> Rs.5001

According to Figure-7, the gross Average Monthly Income of the MSW has been recorded. This indicates that two-thirds, 64 percent earn below Rs.2500 a month from all sources while for the remaining one-third, 33 percent the monthly income ranges between Rs.2501 and Rs.5000. Only 3 percent reportedly earn more than Rs.5001 a month. It may therefore be concluded that the economic condition of MSW is not very good and many are forced to work hard for a living. Poor earnings also have an effect on expenditure on health care and prevention methods as purchase of condoms, testing and treatment. Figure – 8 Average monthly income of Male Sex Workers (MSW) (Sex work)

Average Monthly Income - sex work 8

37.3


54.7

Rs.1501-3000

>Rs.5001

The average monthly income of MSW from sex work is described in Figure-8. From the table, it may be inferred that a large number, 55 percent earn up to Rs.1500 from engaging in sex work followed by a sizeable percentage, 37 percent who earn between Rs.1501 and Rs.3000 from sex work alone. This is done to augment their meagre income they earn from their full-time employment. As observed in other studies and in qualitative phase of the study, many MSW are forced to engage in sex work on commercial basis to support the family or need to earn more to lead a better quality of life. It is also observed that in certain instances, clients offer money willingly and when satisfied with sexual experience are reported to pay extra to MSW in gratitude.

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Pilot Study on MSW in India 4.2 Lifestyle, environmental influences Figure - 9 Media habits of Male Sex Workers (MSW)

Media habits of MSW 94.7

100 80

65.3

70.7

60 40

21.3

22.7

20 0

M edia channels

Television

Radio

Newspaper

Magazines

Cinema

The media habits of the MSW in this study may be gauged from the multiple response Figure-9 given above. It is observed that majority of the MSW, 95 percent view television and 77 percent read the newspapers. A large percentage, 65 percent also reportedly listen to the radio and an equal percentage of 22 percent read magazines and watch movies. It may thus be concluded that MSW are exposed to both electronic and print mass media and hence these may be used for getting messages on prevention, education, treatment, care and support in relation to HIV/ AIDS. Figure – 10 Other habits of Male Sex Workers (MSW)

Other habits of MSW 70 60 50 40 30 20 10

68

44

40 25.3 18.7

0 Other habits

Smoking Drugs Other habits

NIMSW

Alcoholism Consuming tobacco

45

Pilot Study on MSW in India Figure-10 presented above describes the other habits of MSW. It may be seen from the above table that 68 percent are smokers and 44 percent have the habit of consuming alcohol. A large number, 40 percent also reported chewing tobacco (local ‘paan’) and many are addicted to locally available tobacco and ‘masalas’ with intoxicants. A significant number, 19 percent also reported taking drugs. Such habits as alcoholism and drugs are known to induce to poor adoption of protective measures leading to increased risk of HIV infection.

Comment Profile of a typical MSW in Kolkata City From a study of the overall socio-demographic profile of Male Sex Workers in Kolkata City, a typical profile of an MSW may be constructed. Thus, a male Sex Worker in this city is young, say around 20 years of age, who had his first sexual experience below the age of 18 years, and also had sex in exchange of money, gifts, etc., below 18 years. This MSW caters to most clients with an average age of 26-32 years. The typical MSW is educated up to middle school, unmarried, employed in some full-time occupation and engages in sex work on a part-time basis. The average gross monthly income from all sources is below Rs.2500/- and to augment income earns an additional Rs.1500/- through sex work. The typical MSW is a keen TV viewer and also reads newspaper regularly. Other habits include smoking, taking alcohol and usually chewing tobacco in various forms. The MSW exhibits a casual attitude and is constantly on the move, in keeping with the quick pace of the city and mostly runs into new clients through which he earns more income from sex work.

One of thousands of handcart pullers, many of who are pimps or male sex workers themselves

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Pilot Study on MSW in India 4.3 Identity and sub-types Awareness of MSW on types and subtypes of Male Sex Workers in Kolkata City Table – 9 Awareness of Male Sex Workers Genre by MSW by Age Group Awareness Age TOTAL < 18 19-25 26-32 33-39 40 & >

Male Sex Worker Subtypes (N=75) Koti (%) 67 89.3 4 5.3 32 42.7 20 26.7 9 12.0 2 2.7

Panthi (%) 38 50.7 1 1.3 21 28.0 9 12.0 7 9.3 ---

Dubli (%) 64 85.3 2 2.7 33 44.0 18 24.0 10 13.3 1 1.3

Hijra (%) 64 85.3 4 5.3 31 41.3 18 24.0 10 13.3 1 1.3

Gigolo (%) 17 22.7

Masseur (%) 32 42.7

Escort (%) 7 9.3

---

---

---

11 14.7 5 6.7 1 1.3

15 20.0 14 18.7 3 4.0

3 4.0 3 4.0 1 1.3

---

---

---

Londa (%) 55 73.3 3 4.0 28 37.3 15 20.0 8 10.7 1 1.3

Dancer (%) 58 77.3 4 5.3 27 36.0 17 22.7 9 12.0 1 1.3

The data in table - 9 presented above describes the Male Sex Workers awareness of the various types and sub-types of MSW that are reportedly existing in society in various proportions with respect to their age. It is seen that majority of the MSW know about groups such as ‘Koti’ (which in common parlance means a person (biologically male) who is a recipient during a sexual act also termed passive partner). Similarly ‘Panthi’ denotes a person who plays a dominant or active role (read penetrative) during sexual act. ‘Dubli’ is a colloquial term (in Kolkata) used to describe a person who performs both an active and passive role. It is observed that they are also popularly called ‘Double Decker’ or ‘DD’. ‘Hijra’ are transgender or transsexual population and ‘Londa’ a group popular in eastern parts of the country – mainly West Bengal and Bihar are mainly transsexuals or males who attire in female clothing and dance during specific cultural festivities. After the fair or festival, they engage in sex with other men or women and earn a living through sex work. ‘Dancer’ is a term describing a typical dancer (usually entertaining people in public). After or during the dance programme, he is approached by clients and negotiates an agreement for paid sex. Masseur is a male ‘body massager’ who works in a massage parlour. Many massage parlours are reportedly known to also provide sexual services for an additional sum and masseurs engage in sex with clients who visit massage parlours. Some masseurs also service clients for massage in the clients houses. A ‘Gigolo’ is a commercial male sex worker who caters to mainly to women alone. An ‘Escort’ is a male sex partner who is usually kept by the client in his house/ workplace and is used for sexual activity when desired by the client. Escorts are known to accompany clients on outstation trips and frequent travel.

Comment The overall analysis of MSW on awareness pertaining to MSW genre indicates that a majority of the MSW in Kolkata City is aware of predominantly main groups in the MSW network in the city. While more than 85 percent respondents knew about Koti, 89 percent Dubli, 85

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47

Pilot Study on MSW in India percent and Hijra, a similar 85 percent, a lesser percentage knew of Dancer, 77 percent followed by Londa, 73 percent. However, only half the respondents, 51 percent mentioned knowledge about Panthi and still lesser number, 43 percent about Masseur. Comparatively, while only 23 percent knew about Gigolo, only around 10 percent heard reportedly heard of Escort as a subtype of MSW in Kolkata City. An analysis of the age-wise classification of data reveals that majority of the MSW in the 19 to 25 age group are aware of the various types and sub-types of MSW existing in society. Within this group, a majority, around 43 percent are aware of Koti, Dubli and Hijra. The other sub-types known by MSW, around 30 to 35 percent of this age group are Londa, Dancer and Panthi. However, Masseur, Gigolo and Escort are not very popular among these respondents, only around 15 percent. Next, most MSW in the 26 to 32 age group are aware of various types and sub-types of MSW. The trends in knowledge about various sub-types is similar to the younger age group seen with around 25 percent aware of Koti, Dubli and Hijra. However, fewer MSW knew about ‘Panthi’, 12 percent that indicates that more older MSW may not be playing the dominant or active role during sexual act. Around 20 percent of MSW in this age group also were aware of Londa Dancer and Masseur. It is also observed from the table that an equal number of respondents, around 10 to 12 percent in the older 33 to 39 age group knew about Koti, Dubli, Hijra, Panthi, Londa Dancer and Masseur. However, many MSW in the young age group of less than 18 years do not seem to know about the various types and sub-types within MSW. Similarly, among respondents aged above 40 years, only 1 or 2 knew about various sub-types. It is observed that no clear definitions demarcate the various types and sub-types and there is overlapping of context and meaning that leads to confusion among MSW in defining their genre. This is compounded by the public having their own perspective of MSW. Table – 10 Awareness of Male Sex Workers Genre by MSW by Education Awareness Education TOTAL Illiterate Primary Middle Hr. Sec. Technical Hr. Education Others

NIMSW

Male Sex Worker Subtypes (N=75) Koti (%) 67 89.3 5 6.7 18 24.0 20 26.7 14 18.7 5 6.7 4 5.3 1 1.3

Panthi (%) 38 50.7 4 5.3 13 17.3 8 10.7 9 12.0 2 2.7 2 2.7 ---

Dubli (%) 64 85.3 4 5.3 14 18.7 20 26.7 15 20.0 6 8.0 4 5.3 1 1.3

Hijra (%) 64 85.3 4 5.3 17 22.7 19 25.3 13 17.3 5 6.7 5 6.7 1 1.3

Gigolo (%) 17 22.7 1 1.3 4 5.3 3 4.0 5 6.7 2 2.7 2 2.7 ---

Masseur (%) 32 42.7 2 2.7 2 2.7 10 13.3 10 13.3 4 5.3 3 4.0 1 1.3

Escort (%) 7 9.3 ----2 2.7 2 2.7 1 1.3 2 2.7 ---

Londa (%) 55 73.3 4 5.3 14 18.7 16 21.3 13 17.3 4 5.3 3 4.0 1 1.3

Dancer (%) 58 77.3 4 5.3 17 22.7 15 20.0 13 17.3 5 6.7 3 4.0 1 1.3

48

Pilot Study on MSW in India

Table - 10 depicts the Male Sex Worker’s understanding of the various types and sub-types prevalent with respect to their education. It may be deduced from the above data that majority of the respondents aware of various types and sub-types within MSW are educated up to middle school, around 25 percent followed by those educated up to higher secondary level, say 18 percent. This is followed by MSW who are educated only up to the primary level. More MSW may be aware of types as a majority of the respondents are educated only up to this level. Another explanation could be many educated up to primary level are in sex industry for longer period and such experience has increased their awareness. It is also seen that MSW with technical, higher education and those who are illiterate are not very conversant with various types and subtypes. Responses from the field indicate that higher educated MSW are engaged in such activity only occasionally or do so to fulfil immediate economic needs, and hence do not understand nor are they keen on knowing various types and sub-types. On the other hand, illiterate MSW neither know nor understand the dynamics of the MSW genre in society. Table – 11 Awareness of Male Sex Workers Genre by MSW by Marital status Awareness Marital status TOTAL Unmarried Married living with spouse Married living without spouse Separated/ Divorced No Response

Male Sex Worker Subtypes (N=75) Koti (%) 67 89.3 47 62.6 9 12.0 6 8.0 4 5.3 1 1.3

Panthi (%) 38 50.7 31 41.9 2 2.7 1 1.3 4 5.3 ---

Dubli (%) 64 85.3 44 58.6 8 10.7 6 8.0 5 6.7 1 1.3

Hijra (%) 64 85.3 44 58.6 9 12.0 6 8.0 4 5.3 1 1.3

Gigolo (%) 17 22.7 14 18.7 1 1.3

Masseur (%) 32 42.7 19 25.3 6 8.0 6 8.0

Escort (%) 7 9.3 7 9.3

2 2.7

---

---

---

1 1.3

---

---

-----

Londa (%) 55 73.3 38 50.7 7 9.3 5 6.7 4 5.3 1 1.3

Dancer (%) 58 77.3 41 54.7 6 8.0 6 8.0 4 5.3 1 1.3

Table - 11 provides an analysis of awareness of MSW genre in relation to their marital status. The statistics reveals that most unmarried respondents are aware of various types and sub-types among MSW, as majority of respondents are unmarried. Among them, a majority are aware of Koti, Dubli and Hijra, around 60 percent followed by awareness about Londa and Dancers, 52 percent. While 40 percent unmarried MSW knew of Panthi, 25 percent knew Masseurs and close to 20 percent heard of Gigolo. Among older, married respondents, roughly 20 percent knew about all the main types and sub-types of MSW. This indicates that engagement in sexual male sex work is important in knowing about types and defining sub-types within MSW.

NIMSW

49

Pilot Study on MSW in India Table – 12 Awareness of Male Sex Workers Genre by MSW by Occupation Awareness Occupation TOTAL Unemployed Full-time Part-time

Male Sex Worker Subtypes (N=75) Koti (%) 67 89.3 24 32.0 42 56.0 1 1.3

Panthi (%) 38 50.7 13 17.3 24 32.0 1 1.3

Dubli (%) 64 85.3 25 33.3 38 50.7 1 1.3

Hijra (%) 64 85.3 25 33.3 37 49.3 2 2.7

Gigolo (%) 17 22.7 6 8.0 11 14.7

Masseur (%) 32 42.7 13 17.3 9 12.0

Escort (%) 7 9.3 2 2.7 5 6.7

Londa (%) 55 73.3 23 30.7 32 42.7

---

---

---

---

Dancer (%) 58 77.3 21 28.0 36 48.0

According to the data presented in Table -12, awareness of MSW on various types and subtypes of MSW genre based on their occupation is analysed. It may be observed that most MSW employed in full-time employment are aware of the various groups followed by a large percentage of unemployed MSW who engage in sex for exchange of money, gifts, etc. A closer examination of the data reveals that among full-time employed MSW, 56 percent are aware of Koti, followed by 51 percent aware of Dubli, 49 percent knowing Hijra, 48 percent Dancer and 43 percent Londa. Only 32 percent reportedly knew of Panthi and very few MSW heard of Gigolo, Masseur and Escort. A similar pattern is observed among MSW who are unemployed though the percentage comprise only about a third of the total respondents, around 30 percent. Table – 13 Awareness of Male Sex Workers Genre by MSW by Income Awareness Average Income PM TOTAL

Male Sex Worker Subtypes (N=75) Koti (%) 67 89.3

Panthi (%) 38 50.7

Dubli (%) 64 85.3

Hijra (%) 64 85.3

Gigolo (%) 17 22.7

Masseur (%) 32 42.7

Escort (%) 7 9.3

Londa (%) 55 73.3

Dancer (%) 58 77.3

43 57.3 22 29.3 2 2.7

25 33.3 12 16.0 1 1.3

39 52.0 23 30.7 2 2.7

41 54.7 21 28.0 2 2.7

9 12.0 8 10.7

16 21.3 14 18.7 2 2.7

3 4.0 4 5.3

33 44.0 20 18.7 2 2.7

35 66.7 21 28.0 2 2.7

34 45.3 27 36.0 6 8.0

18 24.0 19 25.3 1 1.3

30 40.0 28 37.3 6 8.0

32 42.7 26 34.7 6 8.0

5 6.7 11 14.7 1 1.3

25 33.3 24 32.0 6 8.0

30 40.0 22 29.3 6 8.0

Income (all sources) < Rs.2500 Rs.2501 – Rs.5000 > Rs.5001

---

---

Income (sex work) < Rs.1500 Rs.1501 – Rs.3000 > Rs.3001

15 20.0 12 16.0 5 6.7

--7 9.3 ---

Table - 13 presents the awareness of respondents on various types and subtypes of MSW in Kolkata City with regard to their monthly income. An overview of the data reveals that a majority of MSW aware of their genre and subtypes earn a lower average monthly income

NIMSW

50

Pilot Study on MSW in India (from all sources) of up to Rs.2500 a month. While a higher number, 67 percent identified Dancers first, other known MSW groups included Koti, Hijra and Dubli followed by Londa and Panti. A comparatively higher awareness on part of poorer paid MSW may be an indication of the fact that those with lower incomes engage in commercial sexual activity more often and hence are better aware of such subtypes. A similar trend is observed across those who earned lesser from sex work of up to Rs.1500 a month.

Type of Male Sex Workers as identified by MSW The following analysis describes the manner in which Male Sex Workers define or identify themselves. It also emphasises on their sexual orientation and gender. From the data, it may be inferred that majority of the MSW in Kolkata, 61 percent identify themselves as Koti, while 32 percent opine that they are typically masseurs working either in massage parlours or independently followed by a similar number, 31 percent who consider themselves as Dubli or those who engage in sex with other males or females as active or passive sexual partners. While 20 percent stated they are Dancers, 15 percent identified themselves as Londa and 11 percent as Hijras. Only 5 MSW said they are Panthis and one each identified themselves as Gigolo and Escort. This indicates that in Kolkata, Koti are very common and so are Dubli. Further, it can be seen that Masseurs are also common in Kolkata and many are male sex workers. Dancers and Londa are also common though they may also pose as Koti, Dubli or Panthi. Table – 14 Type of Male Sex Workers by MSW by Age Group MSW Type Age TOTAL < 18 19-25 26-32 33-39 40 & >

Male Sex Worker Subtypes (N=75) Koti (%) 46 61.3 3 4.0 24 32.0 12 16.0 6 8.0 1 1.3

Panthi (%) 5 6.7

Dubli (%) 23 30.7

Hijra (%) 8 10.7

Gigolo (%) 1 1.3

Masseur (%) 24 32.0

Escort (%) 1 1.3

---

---

---

---

---

---

1 1.3 4 5.3

12 16.0 9 12.0 2 2.7

2 2.7 3 4.0 3 4.0

1 1.3

13 17.3 11 14.7

1 1.3

---

---

---

---

---

---

---

---

-----

---

---

Londa (%) 11 14.7 1 1.3 4 5.3 3 4.0 3 4.0

Dancer (%) 15 20.0 1 1.3 5 6.7 7 9.3 2 2.7

---

---

From Table-14 given above, MSW identity and orientation with regard to age-wise categorisation may be ascertained. It is observed that majority of MSW who indicate they are Koti, 32 percent Masseur, 17 percent and Dubli, 16 percent are in the 19 to 25 age group. This is followed by many MSW, 16 percent Koti, Masseur, 15 percent and Dubli, 12 percent who are older, aged between 26 and 32 years of age. Hence it may be concluded that younger MSW and very old MSW are either not aware of their identity or switch roles often or do not conform to such categorisation but prefer to engage in sex activity in exchange of money, gifts, etc. on a casual basis.

NIMSW

51

Pilot Study on MSW in India Table – 15 Type of Male Sex Workers by MSW by Occupation MSW Type Occupation TOTAL Unemployed Full-time Part-time

Male Sex Worker Subtypes (N=75) Koti (%) 46 61.3 18 24.0 27 36.0 1 1.3

Panthi (%) 5 6.7 3 4.0 2 2.7 ---

Dubli (%) 23 30.7 10 13.3 11 14.7 2 2.7

Hijra (%) 8 10.7 4 5.3 4 5.3

Gigolo (%) 1 1.3

---

---

--1 1.3

Masseur (%) 24 32.0 9 12.0 14 18.7 1 1.3

Escort (%) 1 1.3 --1 1.3 ---

Londa (%) 11 14.7 5 6.7 5 6.7 1 1.3

Dancer (%) 15 20.0 2 2.7 11 14.7 2 2.7

The occupational classification of MSW with respect to their identity is examined in Table-15. It may be observed that majority of the MSW who are employed in full-time jobs are also Koti, 36 percent, Masseur, 19 percent and an equal number as Dubli and Dancers, 15 percent. It is also however interesting to note that a significant number of unemployed male sex workers also identify them as typical Koti, 24 percent Dubli, 13 percent and Masseur, 12 percent who usually don the role of Panthi.

Comment It may thus be concluded that majority of the Male Sex Workers understand the dynamics of MSW industry and terminology as well as classification. They are able to identify individually based on their role in sexual activities as Koti, Panthi, Hijra or Masseur and as observed in discussions with respondents, their perception of their identity and placing into a particular subtype also depends on how others (people in society in general) view them, through their actions, gesticulations and behaviour.

Understanding Sex Industry Network (SIN) – Place of soliciting/ pickup/ aggregating by Male Sex Workers. The following analysis provides an understanding into the Sex Industry Network by pinpointing the locations or places where Male Sex Workers solicit their clientele, pickup them for sexual activities or indicates where such MSW aggregate to attract clients and engage in sex for exchange of money, gifts, etc. It is important to identify such ‘hotspots’ as that would provide vital clues in approaching this otherwise hidden community for long-term healthcare interventions around HIV/ AIDS.

NIMSW

52

Pilot Study on MSW in India Table – 16 Place of soliciting/ pickup/ aggregating by MSW by Age Group

33-39 40 & >

12 16.0 11 14.7 -----

23 30.7 14 18.7 7 9.3 1 1.3

---

---

4 5.3 4 5.3 1 1.3

10 13.3 13 17.3 2 2.7

---

---

32 42.7 3 4.0 17 22.7 10 13.3 1 1.3 1 1.3

25 33.3 --15 20.0 10 13.3 -----

Chat room (%)

25 33.3

Telephone (%)

9 12.0

Internet (%)

48 64.0 4 5.3 27 36.0 12 16.0 4 5.3 1 1.3

Advt. (%)

---

Park (%)

Railway Stn. (%) 45 60.0

6 8.0 ---

1 1.3

4 5.3

---

---

Pimp (%)

26-32

39 52.0 3 4.0 18 24.0 9 12.0 7 9.3 2 2.7

House (%)

19-25

23 30.7 ---

Hotel (%)

< 18

50 66.7 5 6.7 21 28.0 12 16.0 10 13.3 2 2.7

Brothel (%)

TOTAL

Bus stand (%)

Age

Massage parlour (%)

Male Sex Worker soliciting/ pickup/ aggregating points (N=75)

Street (%)

Pickup point

27 36.0 --17 22.7 10 13.3 ---

1 1.3 5 6.7 ---

---

---

1 1.3

2 2.7 2 2.7

---

---

---

---

---

Table - 16 describes the age-wise classification of places where MSW solicit and pickup their clients or places where they aggregate to attract clients for sex work. From the data, it can be seen that most MSW soliciting, picking and aggregating in public places are younger in the 19 to 25 years age group compared to a lesser number who are 26 to 32 years old. A further detailed analysis reveals that among MSW who operate on the streets, 28 percent are younger in the 19-25 age group followed by 16 percent in the 26-32 years age group and 13 percent in the 33-39 age range. Similarly, among those who solicit/ pickup clients in the park, many MSW, 36 percent are in the young age group of 19-25 years compared to 16 percent aged between 26 and 32 years of age. In railway stations, bus stands and massage parlours too, a similar pattern emerges. Table – 17 Place of soliciting/ pickup/ aggregating by MSW by Occupation

NIMSW

25 33.3 13 17.3 12 16.0

32 42.7 14 18.7 18 24.0

25 33.3 11 14.7 14 18.7

---

---

---

---

---

---

27 36.0 9 12.0 18 24.0 ---

6 8.0 3 4.0 3 4.0 ---

1 1.3 1 1.3

Chat room (%)

9 12.0 6 8.0 3 4.0

Internet (%)

Telephone (%)

48 64.0 16 21.3 32 42.7

Advt. (%)

House (%)

45 60.0 19 25.3 26 34.7

Pimp (%)

Hotel (%)

39 52.0 14 18.7 24 32.0 1 1.3

Brothel (%)

Part-time

23 30.7 10 13.3 12 16.0 1 1.3

Park (%)

Full-time

50 66.7 18 24.0 30 40.0 2 2.7

Railway Stn. (%)

Unemployed

Bus stand (%)

TOTAL

Massage parlour (%)

Occupation

Male Sex Worker soliciting/ pickup/ aggregating points (N=75)

Street (%)

Pickup point

4 5.3 ---

---

4 5.3

---

---

53

Pilot Study on MSW in India According to the data in Table - 17 the occupation-wise classification of place of soliciting/ picking up clients by MSW is analysed. It is observed that in the street, railway station, park, bus stand, house, telephone and pimp, the number of MSW engaged in full-time jobs is higher than unemployed. However, in the case of soliciting, picking up or aggregating for sex work, hotels are preferred by unemployed MSW than full-time employed ones. It is important to note that many MSW employed in industries, hotels, petty trade, vendors, drivers and massage parlours use the premises to pick clients and even have sex with peers and others. Table – 18 Place of soliciting/ pickup/ aggregating by MSW by Income

---

---

25 33.3 9 12.0 15 20.0 1 1.3

27 36.0 12 16.0 13 17.3 2 2.7

6 8.0 3 4.0 2 2.7 1 1.3

1 1.3 1 1.3

4 5.3 3 4.0 1 1.3

---

---

---

The income-wise classification of pickup points for sex work is presented in Table 18. From the above table, it is evident that while MSW earning up to Rs.2500/- per month solicit clients in streets, 48 percent park, 40 percent bus stand, 39 percent and railway station, 35 percent, MSW earning between Rs.2501/- and Rs.5000/- a month solicit customers more through telephone, 20 percent pimp, 17 percent, massage parlours, 15 percent and close to 10 percent through brothels.

Comment This indicates that the sex industry has two modus operandi – indoors network and outdoors network. The indoors network is popular among more affluent MSW who earn more through full-time employment as well as through sex work, are younger in age (in the 19-25 age bracket), and operate through network of pimps, contacts over phone, e-mail and chatting, as well as brothels and houses. On the other hand, economically poorer MSW stalk parks, railway stations, bus stands, theatres, parks, public toilets and other public places looking for clients.

NIMSW

Chat room (%)

Internet (%)

32 42.7 19 25.3 13 17.3

Advt. (%)

25 33.3 13 17.3 11 14.7 1 1.3

Pimp (%)

9 12.0 2 2.7 7 9.3

Telephone (%)

48 64.0 30 40.0 17 22.7 1 1.3

House (%)

45 60.0 26 34.7 18 24.0 1 1.3

Hotel (%)

39 52.0 29 38.7 10 13.3 ---

Brothel (%)

> Rs.5001

23 30.7 11 14.7 11 14.7 1 1.3

Park (%)

Rs.2501 – Rs.5000

50 66.7 36 48.0 13 17.3 1 1.3

Railway Stn. (%)

< Rs.2500

Bus stand (%)

TOTAL

Massage parlour (%)

Income (all sources)

Male Sex Worker soliciting/ pickup/ aggregating points (N=75)

Street (%)

Pickup point

54

Pilot Study on MSW in India 5.0 SEXUALITY, SEXUAL PRACTICES AND VULNERABILITY 5.1 Sexual encounters, partners, commercial sex Sexual practices, behaviour and client profile of MSW The tables presented below describe the sexual practices in terms of encounters with clients, sexual behaviour including condom use and seek to capture client profile as seen by Male Sex Workers. A bird’s eye view of the sexual practices among MSW reveals that MSW had paid sex consistently over the last 6 months. More specifically, a large number, 88 percent reported engaging in sex in exchange for money, gifts, etc., during the last time they had sex. This relates to increased sex activity on commercial basis. Data also points out that a large number in Kolkata City, 71 percent reportedly used condoms consistently over the last 6 months when they had paid sex. Further, 63 percent reported using a condom during the last time they had sex in exchange for money, gifts, etc. Finally, a question posed on who their sexual partner was on their last paid sexual encounter revealed a rough profile of the clients of MSW. While it is assumed that 63 percent clients are of high class – defined thus as being either equal to or economically better than MSW themselves. To this group belong mostly peers, students, teachers, office goers, blue collared workers, petty businessmen and the like. On the other hand, 33 percent reported that their clients are low class – meaning those hailing from lower socioeconomic strata – mainly rickshaw pullers, boatmen, unorganised workers, construction labour, unemployed youth, slum populations and so on. This reinforces the fact that not all men who have sex with men (MSM) do so only for physical or psychological stimulation. Observations from the field validate the fact that many MSW started as MSM but in due course, on pressing economic grounds they engage in sex on commercial basis for sheer survival. Hence is visible both survival sex and recreational sex in most cities though it is very difficult to differentiate the two. MSW have also reiterated that there is a huge potential for male sex partners among both men and women and demand for young boys cannot be underestimated. The mixed clientele of MSW makes it an ardent task in identifying specific client groups. Overall, however, it is seen that two distinct levels operate. One male sex work circuit caters to the economically richer segment in society and operate in houses, brothels, hotels and massage parlours while the other sex circuit is carried on at the street level and public places, demanding the sexual needs of people in the lower socio-economic milieu such as those in slums and poor housing colonies operating in parks, railway stations, bus stands, public toilets, and roadside shanties. Table – 19 Sexual practices, behaviour and client profile of MSW by Age group Sexual history

Age group

Sexual practices, behaviour and client profile (N=75) Sex for money/ gifts (Last time)

TOTAL < 18

NIMSW

(%) 66 88.0 5 6.7

Condom use

Condom use

(6 months)

(Last time)

(%) 53 70.7 2 2.7

Clientele

(%)

High class (%)

Low class (%)

47 62.7 2 2.7

47 62.7 3 4.0

25 33.3 1 1.3

55

Pilot Study on MSW in India 19-25 26-32 33-39 40 & >

29 38.7 19 25.3 11 14.7 2 2.7

25 33.3 17 22.7 7 9.3 2 2.7

24 32.0 15 20.0 6 8.0 ---

23 30.7 16 21.3 4 5.3 1 1.3

11 14.7 6 8.0 6 8.0 1 1.3

An analysis of the data in Table - 19 provides insight into the sexual practices and behaviour of MSW with respect to their age. It is evident from the data that majority of the MSW, 39 percent who had sex in exchange for money during the last sexual encounter were 19-25 years of age followed by 25 percent who were older between 26 and 32 years old. A sizeable number of 15 percent were also in the age range of 33 to 39 years of age. This indicates that though MSW are generally younger, many middle-aged MSW too are engaged in paid sex activities. Condom use consistently in the last 6 months has been reported by majority of MSW, 33 percent in the same 19-25 age group followed by 23 percent in the older 26-32 age group. The trend is similar pertaining to condom use during last sexual encounter where 32 percent in 19-25 age range reported condom use and 20 percent between 26 and 32 years said they used condoms during their last sexual encounter. It is interesting to note that more clients of MSW, 31 percent are reported to belong to high class and are younger in the 19-25 age group. Table – 20 Sexual practices, behaviour and client profile of MSW by Education Sexual history

Education

Sexual practices, behaviour and client profile (N=75) Sex for money/ gifts (Last time)

TOTAL Illiterate Primary Middle Hr. Sec. Technical Hr. Education Others

(%) 66 88.0 5 6.7 18 24.0 20 18.7 11 14.7 6 8.0 5 6.7 1 1.3

Condom use

Condom use

(6 months)

(Last time)

(%) 53 70.7 3 4.0 14 18.7 16 21.3 12 16.0 5 6.7 2 2.7 1 1.3

Clientele

(%)

High class (%)

Low class (%)

47 62.7 3 4.0 10 13.3 14 18.7 12 16.0 5 6.7 2 2.7 1 1.3

47 62.7 3 4.0 10 13.3 17 22.7 7 9.3 5 6.7 4 5.3 1 1.3

25 33.3 1 1.3 9 12.0 5 6.7 8 10.7 1 1.3 1 1.3 ---

Table 20 describes the sexual practices, behaviour and client profile of MSW by education status. It is important to note from the above table that though involvement in sex for exchange of money, gifts, etc., is high by educated MSW, that may be a result of rising unemployment and resulting ‘survival sex’, higher education also indicates consistent condom use, 21 percent by

NIMSW

56

Pilot Study on MSW in India those educated up to middle school (majority of respondents in the study) and a high 16 percent by those who studied up to higher secondary. Similarly, larger number of educated MSW, 19 percent educated up to middle school and 16 percent up to higher secondary reported condom use during last sexual encounter compared to only 13 percent who studied up to primary level and 4 percent illiterate MSW. The educational profile of clients indicates that they are similar to that of the MSW and sex workers prefer clients of equal educational and economic status or better that ensures more earning through sex work. Though safe sex practices adoption among those engaging in recreational sex has not been directly recorded, indications are that even among such male sex workers, condom use is high and depends on education status of sex worker as well as client. This therefore indicates that education is an important factor in determining safe sex practices among male sex workers. Uneducated MSW are neither aware of safe sexual practices nor have the appropriate perception of risk. This also points to the fact that educated MSW are in a better position to read and understand HIV/ AIDS related prevention messages and one-to-one rapport with educated clients and NGO/ community workers that reflects on better adoption of safe sex practices. Table – 21 Sexual practices, behaviour and client profile of MSW by Marital status Sexual history

Marital status

Sexual practices, behaviour and client profile (N=75) Sex for money/ gifts (Last time)

TOTAL Unmarried Married living with spouse Married living without spouse Separated/ Divorced

(%) 66 88.0 49 65.3 6 8.0 6 8.0 5 6.7

Condom use

Condom use

(6 months)

(Last time)

(%) 53 70.7 38 50.7 8 10.7 3 4.0 4 5.3

Clientele

(%)

High class (%)

Low class (%)

47 62.7 37 48.3 5 6.7 1 1.3 4 5.3

47 62.7 34 45.3 7 9.3 4 5.3 2 2.7

25 33.3 17 22.7 2 2.7 3 4.0 3 4.0

According to the data presented in Table – 21, the sexual behaviour and practices of MSW are highlighted based on their marital status. The data reveals that 65 percent of MSW who engaged in sex in exchange for money, gifts, etc. are unmarried while the remaining 23 percent were ever-married. Condom use data indicates that 51 percent of unmarried respondents reportedly used condoms consistently during the last 6 months and a similar number, 48 percent reported condom use during their last sexual encounter. Data on client profile reveals that among so-called high class clients, majority are unmarried, 45 percent though a good number, 18 percent are also ever-married. However, among low class clients, a majority, 23 percent are unmarried indicating that MSW get clients who are unmarried. Marital status does not appear to be an important variable in accepting or adopting safe sex practices though it is viewed as important in the case of bisexual MSW.

NIMSW

57

Pilot Study on MSW in India Table – 22 Sexual practices, behaviour and client profile of MSW by Occupation Sexual history

Occupation

Sexual practices, behaviour and client profile (N=75) Sex for money/ gifts (Last time)

TOTAL Unemployed Full-time Part-time

Condom use

Condom use

(6 months)

(Last time)

(%)

(%)

53 70.7 22 29.3 30 40.0 1 1.3

47 62.7 22 29.3 25 33.3

(%) 66 88.0 24 32.0 39 52.0 3 4.0

Clientele High class (%)

Low class (%)

47 62.7 15 20.0 30 40.0 2 2.7

25 33.3 9 12.0 15 20.0 1 1.3

---

The occupation-wise classification of sexual practices of clients may be observed in Table - 22 given above. It may be observed that as majority MSW are employed in full-time jobs, larger number among such MSW, 52 percent said they had sex in exchange for money, gifts, etc., followed by 32 percent who are unemployed who said they had such paid sex. Condom use, both consistent use over 6 months and use during last time are reportedly high by full-time employed MSW, 40 percent and 33 percent respectively compared to unemployed MSW, an equal 30 percent reporting condom use (consistent use as well as use during last time). Among clients of MSW, larger numbers of both high and low class clients are employed in full-time jobs. Table – 23 Sexual practices, behaviour and client profile of MSW by Income Sexual history

Average Income PM

Sexual practices, behaviour and client profile (N=75) Sex for money/ gifts

Condom use

(6 months)

(Last time)

Clientele

(%) 66 88.0

(%)

(%)

High class (%)

53 70.7

47 62.7

47 62.7

25 33.3

41 54.7 23 30.7 2 2.7

34 45.3 18 24.0 1 1.3

28 37.3 18 24.0 1 1.3

34 45.3 12 16.0 1 1.3

12 16.0 12 16.0 1 1.3

33 44.0 28 37.3 5 6.7

27 36.0 21 28.0 5 6.7

22 29.3 20 26.7 5 6.7

24 32.0 19 25.3 4 5.3

15 20.0 8 10.7 2 2.7

(Last time)

TOTAL

Condom use

Low class (%)

Income (all sources) < Rs.2500 Rs.2501 – Rs.5000 > Rs.5001 Income (sex work) < Rs.1500 Rs.1501 – Rs.3000 > Rs.3001

NIMSW

58

Pilot Study on MSW in India

According to the data presented in Table – 23, the sexual practices, behaviour and client profile of MSW by income is analysed. The data reveals that majority of MSW, 54.7 percent who had sex in exchange for money during last time earn below Rs.2500/- a month and 30 percent of those reporting similar behaviour earn between Rs.2501 and Rs.5000/- per month. It is also important to note that larger number of MSW, 44 percent who engaged in paid sex during last sexual encounter earn up to Rs.1500/- from sex work. A high 37 percent who earned between Rs.2501 and Rs.5000/- per month had sex in exchange for money, gifts etc. A similar pattern is observed with regard to condom use. Income levels of clients match those of MSW and therefore they may be said to be of the same economic class. It is noteworthy that those MSW who earn higher incomes adopt safer sex practices as they can afford them. With respect to condoms, discussions revealed that MSW are not satisfied with cheap or freely distributed condoms that tear or break on use. MSW prefer to use well lubricated condoms especially during anal sex. Condom use during oral sex is not popular as risk perception of spread of infection through the mouth is reportedly unheard of among MSW though a few insist that their clients use condoms during oral sex too. MSW know about and prefer flavoured condoms for oral sex but are concerned about the cost of use. (A pack of 3’s of good lubricated/ flavoured condoms costs at least Rs.15/- that cannot be afforded by all MSW). Many reportedly carry condoms at all times (powdered/ jelly filled) and are known to negotiate condom use with clients. However, it has been noticed that intimacy of relationships (especially recreational sex) may lead to increased instances of unprotected sex.

Downtown Kolkata, where one can bump into a male sex worker

NIMSW

59

Pilot Study on MSW in India 5.2 Type of sex, condom use and risk Sexual practices The tables given below provide an analysis of the type of sex popular among MSW in Kolkata City. An overview of the type of sex indicates that a large number of MSW, 88 percent engage in anal sex followed by 79 percent in oral sex and 36 percent ‘thigh’ sex where clients use the thighs of MSW to have sex. Further, 21 percent reported having vaginal sex (presumably bisexuals) and 15 percent engage in other sex acts (‘rolling sex’ where two sexual partners roll on the cot or ground while having sex, ‘body sex’, also involving licking the whole body of the sexual partner and ‘group sex’ where more than three to four sex partners fondle and have sex together). Other sexual practices include ‘Rimming’ or licking the anal portions of sex partners that is reportedly popular among MSW. Table – 24 Type of sex by MSW by Age Group Type of sex Age TOTAL < 18 19-25 26-32 33-39 40 & >

Type of Sex (N=75) Oral (%) 59 78.7 4 5.3 30 40.0 17 22.7 8 10.7 1 1.3

Anal (%) 66 88.0 5 6.7 18 24.0 9 12.0 2 2.7

Vaginal (%) 16 21.3

Thigh (%) 27 36.0

Others (%) 11 14.7

---

---

---

5 6.7 10 13.3 1 1.3

13 17.3 10 13.3 4 5.3

7 9.3 4 5.3

---

---

---

---

The age-wise distribution of type of sex by MSW is depicted in Table –24. It is observed that a majority of those involved in oral sex, 40 percent are in the 19-25 age group followed by 23 percent who are 26 to 32 years old. A similar pattern is visible in the case of MSW engaging in anal sex with 24 percent in the 19-25 age group and around half that number, 12 percent having anal sex are older (26-32 years of age) and 17 percent involved in thigh sex also are in the younger age group compared to 13 percent in the older age range. However, in the case of vaginal sex, more number of MSW, 13 percent belonged to the older age group of 26-32 years while only half that number, 7 percent who had vaginal sex were 19 to 25 years of age. This indicates that oral and anal sex is very popular among MSW. This has also to be seen in the light of the identity that they perceive. As observed earlier, many MSW view themselves as Koti (playing a passive role and receiving sex) and this may explain for higher preference for anal sex.

NIMSW

60

Pilot Study on MSW in India Table – 25 Type of sex by MSW by Marital Status Type of sex Marital status TOTAL Unmarried Married living with spouse Married living without spouse Separated/ Divorced

Type of Sex (N=75) Oral (%) 59 78.7 43 57.3 8 10.7 6 8.0 2 2.7

Anal (%) 66 88.0 47 62.7 8 10.7 8 10.7 5 6.7

Vaginal (%) 16 21.3 9 12.0 3 4.0 2 2.7 2 2.7

Thigh (%) 27 36.0 18 24.0 3 4.0 5 6.7 1 1.3

Others (%) 11 14.7 6 8.0 --5 6.7 ---

Table -25 given above describes the type of sex activity preferred by MSW in relation to their marital status. Expectedly, larger number of unmarried MSW, 57 percent reportedly engage in anal and oral sex compared to ever-married respondents, 22 percent. Further, it is observed that MSW who also have sex with their female sex partners, up to 27 percent evermarried MSW have anal sex engage in anal and or oral sex. This is important from the prevention point of view as unprotected anal sex with male partner may lead to chances of infection on subsequent unprotected sex with spouse.

Comment The type of sex that is popular among male sex workers is definitely anal sex though a large number also engage in oral sex, especially the transgender community. Moreover, the younger age group are known to enjoy variations in different kinds of sex though there is a preference for anal sex. As mentioned earlier, anal sex activity may be attributed to more number of MSW identifying themselves as Koti. Bisexual partners are known to engage in both anal and vaginal sex and the need to educate them on having protected sex always is key to prevention of HIV among this risk group. Owing to the fact that majority of MSW are unmarried, it is important they are informed about risks in anal sex as many are of marriageable age and many are mere ‘hustlers’ who may go back into mainstream sex life after a brief spell of commercial sex activity. It has also been observed that MSW do not consider having sex with other males (predominantly anal sex) as posing risk of HIV infection reflected in poor condom use. Therefore prevention efforts need to be directed at making MSW realise appropriate perception of risk.

5.3 Violence, criminalisation Violence and criminal assault The following tables depict the extent of sex-related violence that MSW faced from their clients and others as a result of engaging in sex work. It is important to note that around half the number of MSWs interviewed, 45 percent experienced acts of violence committed against them and so did a similar number, 47 percent face criminal assault – booked by police and law enforcing authorities on false charges of being public nuisance, petty theft cases and the like and harassed in custody.

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Pilot Study on MSW in India Table – 26 Violence and criminal assault against MSW by Age group Violence, etc. Age group TOTAL < 18 19-25 26-32 33-39 40 & >

Forced sex, violence and criminal assault (N=75) Forced sex Criminal & violence assault (percent)

(percent)

34 45.3 1 1.3 13 17.3 11 14.7 8 10.7 1 1.3

35 46.7 1 1.3 16 21.3 10 13.3 7 9.3 1 1.3

The age-wise distribution of forced sex and violence as well as criminal assault is described in Table – 26. From the above table, it may be observed that a majority of the younger MSW, 17 percent in the age group of 19 to 25 years were forced to have sex with their clients and acts of violence were perpetrated against them. Comparatively, 15 percent in the 26 to 32 age group said they faced such sex-related violence. Moreover, 11 percent of older respondents in the 33-39 age group also reported such violence. This indicates that age is not a factor and sex related violence occurs among all MSW for which they have no recourse as they are unorganised and most instances go unreported. Many described about being burnt over the body with cigarette buts, thrashed and beaten on their backs and sex organs, made to indulge in painful sex acts, gagged and forced to have sex. Many MSW however view such acts as rare instances by a few clients whom they consider facing a psychological problem. It is also seen that clients who pay more indulge in such harsh treatment while having sex. With regard to criminal assault too, a similar pattern is visible with majority of younger MSW in the 19-25 years age group reporting such experiences more often than 13 percent of those in the 26 to 32 years age group. Around 10 percent of older MSW in the 33-39 age group also faced criminal charges piled against them. Table – 27 Violence and criminal assault against MSW by Income Violence, etc. Income (all sources) TOTAL < Rs.2500 Rs.2501 – Rs.5000

NIMSW

Forced sex, violence and criminal assault (N=75) Criminal Forced sex assault & violence (percent)

(percent)

34 45.3 21 28.0 13 17.3

35 46.7 23 30.7 12 16.0

62

Pilot Study on MSW in India According to the data given in Table - 27 above, violence and criminal assault against MSW with respect to their average monthly income from all sources is analysed. It may be noticed from the above data that incidence of forced sex and sexual violence is higher among more number of the MSW, 28 percent earning lower income of up to Rs.2500/- a month, compared to that of MSWs earning between Rs.2501 and Rs.5000 a month, 17 percent. Similar trends can be witnessed in the case of criminal assault by police and goondas whereby 31 percent of MSW earning lower monthly incomes are victimised compared to 16 percent who earn higher income.

Comment Discussions indicated that MSW earning more are considered to be hailing from better socioeconomic backgrounds and hence clients as well as others fear from harming them. However, poorer MSW have to face the brunt of physical violence and assault. With regard to criminal cases, MSW opine that first-timers always face problems from police. Many are forced to have sex with policemen and their henchmen. However, in due course when they become acquaintances, police only harass them and demand money. They then go after younger or new entrants into the sex trade. Many hijras maintain good rapport with police personnel and though they are caught initially in a raid, on the way to the police station or even in the police jeep, they have sex or demand money and release the sex workers.

Old Railway station in Kolkata, an important hotspot for male sex work activity

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Pilot Study on MSW in India 6.0 HIV/ AIDS PREVENTION, TREATMENT, CARE AND SUPPORT SERVICES

6.1 Awareness, sources and sexual behaviour The tables given below provide information on the extent of awareness of MSW on HIV/ AIDS, source of awareness and resultant sexual behaviour. Indications are that there is good awareness with 83 percent of respondents stating they are aware about HIV/AIDS. Table – 28 Awareness on HIV/AIDS of MSW by Age group Awareness

Age group TOTAL < 18 19-25 26-32 33-39 40 & >

Awareness on HIV/ AIDS (N=75) Age in Average completed age of years client (Percent) (Percent) 62 62 82.7 82.7 4 2 5.3 2.7 31 21 41.3 28.0 18 20 24.0 18.7 8 17 10.7 22.7 1 2 1.3 2.7

The age-wise distribution of HIV/AIDS awareness among MSW and their clients is described in Table - 28 above. It may be seen that while majority of the MSW, 41 percent in the 19-25 years age group are aware of HIV/ AIDS, only 24 percent in the 26-32 year age group are aware of the same and only 11 percent of those in the 33-39 years are range are aware of HIV/ AIDS. Among clients, a different pattern emerges. Though majority of clients, 28 percent aware of HIV/ AIDS are in the 19-25 year age group, 23 percent of older clients in the 33-39 age group are aware of HIV/ AIDS compared to only 19 percent of clients in the 26-32 years age group.

Table – 29 Awareness on HIV/AIDS of MSW by Education Education status of MSW (N = 75) Education TOTAL Illiterate Primary Middle school

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Responses (Percent) 62 82.7 4 5.3 14 18.7 19

64

Pilot Study on MSW in India 25.3 13 17.3 6 8.0 5 6.7 1 1.3

Higher Secondary Technical Higher Education No Response

The data presented in Table - 29 above describes the awareness of MSW on HIV/ AIDS with respect to their educational status. It may be observed from the data that education plays an important role to play in increased awareness on HIV/ AIDS. As evident from the table, majority of the respondents, 25 percent who were aware of HIV/ AIDS were educated up to middle school level followed by 19 percent who had primary education and 17 percent who were educated up to higher secondary level. Awareness among MSW with technical and higher education is high with almost all respondents being aware of HIV/ AIDS. Hence, education is an important factor in enhancing knowledge and awareness, more so because educated MSW are able to read and respond to IEC and prevention or behaviour change communication messages displayed by grassroots level HIV/AIDS interventions. Figure – 11 Sources of Awareness on HIV/AIDS of MSW

Sources of awareness on HIV/AIDS 90

88

80 70

66.7 58.7

60 50

53.3 54.7

45.3 42.7

69.3

42.7

40 30 20 10

0

Sources of aw areness Television Poster NGO/ CBO

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Radio Pamphlet Friends

Newspaper Doc tor Ot her sources

65

Pilot Study on MSW in India The main sources of awareness of HIV/ AIDS messages is depicted in Figure-11 given above. From the same, it may be observed that Television is an important media, 88 percent followed by friends, peers or colleagues, 69 percent and NGO/ CBO, 68 percent. Other important sources of awareness include Radio, 59 percent Posters, hoarding and messages displayed in public places followed by newspapers, 53 percent. Around 42 to 45 percent MSW also mentioned pamphlets, doctors and other sources as sources of awareness on HIV/ AIDS. Hence, in disseminating prevention messages, it is important to focus on the popular mass and electronic as well as print media such as Television, Radio, Newspapers, Posters and Pamphlets. Besides oneto-one communication by NGO/CBO workers, doctors and peers are also seen as important channels to provide vital information to the hidden male sex worker community. Table – 30 Awareness on HIV/AIDS and sexual behaviour of MSW Awareness on HIV/AIDS and behaviour of MSW (N = 75) Sexual behaviour Last time had sex for money/ gifts, etc. (MSW) Last time used condoms while having sex

Responses (Percent) 53 70.7 41 54.7

Awareness of MSW on HIV/AIDS and resultant sexual behaviour is analysed in Table -30 given above. From the table, it may be observed that among MSW who are aware of HIV/ AIDS, a high 71 percent reportedly had sex in exchange for money, gifts, etc. during the last time and among MSW aware of HIV/ AIDS, 55 percent reported using condoms during the last time they had sex. This indicates that though awareness on HIV/ AIDS is high and engaging in sex in exchange for money is prevalent (indicating high level of multi-partner sexual activity) such knowledge is not translated into changed behaviour as unprotected sex is high. This points at the need to strengthen Behaviour Change Communication measures among the target audience – MSW in order to enhance knowledge and awareness and result in adoption of safe sex methods to prevent HIV infection. As seen earlier, MSW do not also perceive risk of infection as a result of anal or oral sex. (Many simply have the misconception that HIV infection can be spread only through vaginal sex with female commercial sex workers).

The Kolkata tram, an important mode of transport and a landmark

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6.2 Availability and access to services Awareness, Availability and Access to services by MSW The following tables provide an understanding of the awareness on HIV/ AIDS related services provided by NGOs/ CBOs by the Male Sex Workers in Kolkata city, availability of such services and accessibility of such services by MSW. The overall scenario on service awareness, availability and access reveals that a large number of MSW in the city are aware of such services, 65 percent though fewer numbers are aware of the range of services offered such as condoms, medicines, clinical facilities (testing and treatment), counselling and referral services and are neither aware where such services are offered and by whom (NGO/ CBO/ Government/ private/ traditional systems). Hence, overall access to available services is a low 20 percent among all MSW. Table – 31 Awareness, Availability and Access to services by MSW by Age Group Service access Age TOTAL < 18 19-25 26-32 33-39 40 & >

Awareness, Availability and Access to services (N=75) Aware (%) 49 65.3 3 4.0 24 32.0 14 18.7 7 9.3 1 1.3

NGO (%) 48 64.0 3 4.0 24 32.0 14 18.7 6 8.0 1 1.3

Range of services Condom Clinic Drugs (%) (%) (%) 6 7 3 8.0 9.3 4.0 --5 6.7 --1 1.3 ---

---

---

3 4.0 3 4.0 1 1.3

--2 2.7 1 1.3

---

---

Jelly (%) 2 2.7 ----1 1.3 1 1.3 ---

Access (%) 15 20.3 1 1.3 6 8.0 4 5.3 3 4.0 1 1.3

Table -31 provides an insight into the awareness, availability and access to health and related services for MSW with respect to their age. It may be seen that majority of MSW aware of such services, 32 percent are in the 19-25 age group followed by older MSW in the 26-32 age group, 19 percent. Almost all aware of services said they knew only of NGO/ CBO providing such services. The range of services is not known to many respondents and only few mentioned of condoms, clinical services, drugs and provision of jelly as part of treatment services available to MSW in the city. Accessibility to services is very low even among those who are aware of such services and is proportionately spread across age groups that are aware of such services, though data indicates that older respondents aware of such services are more likely to use such services.

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Pilot Study on MSW in India Table – 32 Awareness, Availability and Access to services by MSW by Education Service access Education TOTAL Illiterate Primary Middle school Higher Secondary Technical Higher Education No Response

Awareness, Availability and Access to services (N=75) Aware (%) 49 65.3 1 1.3 11 14.7 14 18.7 13 17.3 6 8.0 3 4.0 1 1.3

NGO (%) 48 64.0 1 1.3 12 16.0 14 18.7 11 14.7 6 8.0 3 4.0 1 1.3

Range of services Condom Clinic Drugs (%) (%) (%) 6 7 3 8.0 9.3 4.0

Jelly (%) 2 2.7

Access (%) 15 20.3

---

---

---

---

---

---

---

2 2.7 4 5.3

2 2.7 1 1.3 1 1.3 1 1.3 2 2.7

---

---

1 1.3 1 1.3 1 1.3

1 1.3 1 1.3

---

---

---

---

---

---------

5 6.7 5 6.7 4 5.3 1 1.3

---

From the above Table – 32, the education-wise distribution of service awareness, availability and access may be ascertained. It is evident from the above data that more educated MSW, 19 percent educated up to middle school level and 17 percent with higher secondary education are aware of treatment services and also access such services. Though the numbers indicate that service access is poor despite good awareness, among those who have accessed such services, it is observed that they are more educated and therefore education and increased awareness is an important variable in improving service access. Table – 33 Awareness, Availability and Access to services by MSW by Marital status Service access Marital status TOTAL Unmarried Married, living with spouse Married, living without spouse Separated/ Divorced

NIMSW

Awareness, Availability and Access to services (N=75) Aware (%) 49 65.3 36 48.0 8 10.7 3 4.0 2 2.7

NGO (%) 48 64.0 32 46.7 8 10.7 3 4.0 2 2.7

Range of services Condom Clinic Drugs (%) (%) (%) 6 7 3 8.0 9.3 4.0 4 4 2 5.3 5.3 2.7 1 1 --1.3 1.3 1 2 1 1.3 2.7 1.3 ---

---

---

Jelly (%) 2 2.7 2 2.7 ---

Access (%) 15 20.3 12 16.0 3 4.0

---

---

---

---

68

Pilot Study on MSW in India The data in Table -33 presented above describes the awareness, availability and access to services with respect to marital status of the MSW in Kolkata City. It may be seen that as more number of respondents are unmarried, so are more unmarried MSW aware of such services, around half the respondents, 48 percent and many know only of NGOs offering such services. It may however be observed that most married respondents know of such services. However, access to such services is poor even among bisexual MSW.

6.3 Barriers in accessing services and suggestions Only few respondents were able to directly mention various barriers faced in accessing services in the quantitative study. However, from the discussions and qualitative phase, inputs reveal that there are several barriers that male sex workers need to overcome to access services even if awareness levels are high. The key issue is availability of such services. Not all range of services are offered that are needed by MSW. The only services that MSW seem to know include condoms, clinics, drugs and provision of jelly for pain in sex organs. However, they opine that services not available readily are counselling, diagnosis and testing and provision of free medicines for all sex-related diseases (including STI and HIV infection). Moreover, such services are not easily accessible, as they are located in inconvenient locations where respondents have to cover long distances for access. Respondents have complained of illequipped centres with poor infrastructure and non-availability of personnel. Male sex workers would prefer services that are within reach for cheap and easy reach – availability of cheap public transport is also important to access such services. The next issue is regarding timing of service centres. Many services are available only between 10:00 a.m. and 6:00 p.m. in clinics, hospitals or NGO outreach centres. These timings are inconvenient for majority of the MSW who are employed full-time or even may be engaged in sex work during these hours. MSW preferred clinics that are open late in the evenings or even early in the day that they could access. Another important concern is the non-availability of qualified medical personnel as doctors or para-medical staff. Where there are few personnel, their attitude puts the MSW away and hence MSW shy away from accessing these centres. Other important barriers in accessing services include cost of treatment and medicines that are provided by private and supported medical centres and where free treatment is available, quality of services is reportedly very poor. Hence MSW prefer that medical, psychological and referral services be affordable, easily available at all places and at convenient times and of good quality. Many MSWs also preferred that condoms be distributed free of cost and there is a need for a ‘safe space’ for MSW to share their experiences with others and also cater to their recreational needs. Other factors for poor access besides lack of knowledge and information mentioned include stigma and discrimination in accessing such services located in populous surroundings or fear of identification by known persons.

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6.4 Problems faced by Male Sex Workers Figure – 12 Problems faced by MSW

Problems faced by MSW 80

68

60

54.7 57.3

40

57.3

50.7 37.3

32

49.3 52

42.7 32

20 0

Problems faced

Jealousy

Robbing clients

Police harassment

Blackmailing

Cheating/ free sex

Switching loyalty

Hiding from family

Fear of disclosure

No consent to open

Exposure

Other problems

According to Figure-12 portrayed above, the problems faced by MSW in Kolkata City is examined. The data indicates that Male Sex Workers face a host of problems. The most pressing problems that surface are jealousy between sex workers themselves, 68 percent that points out to intra-community (among Kotis, Dublis, Masseurs for clients and money) and intercommunity (between hijras and others for control of areas/ leadership) conflicts prevalent among male sex workers. Most of the other problems identified are on an individual basis such as harassment and forced sex by police, 57 percent cheating by customers or not paying agreed sum after sex, 57 percent and robbing of clients from friends/ other MSW. Here, it is important to note that older MSW see younger MSW as their rivals as clients prefer younger (stronger) male sex workers. This also indicates that younger sex workers are paid better than older ones and hence this develops into conflict between sex workers. Other reasons for concern among MSW include hiding their behaviour from family members, 51 percent as many carry on the sex work without knowledge of the family with sisters of marriageable age and younger siblings whom they have to support economically. Many are worried about being ostracised when discovered that they are sex workers. Another 49 percent opined that it is difficult to hide their behaviour and are under constant threat of being exposed in society by friends/ peers or even clients in public. While 43 percent feared that they might disclose their sex-related behaviour to their families, 32 percent said they were afraid that others would reveal their involvement in sex activity without their consent. Around 52 percent MSW said they faced other problems as being betrayed by own community, threats from relatives and fear of goondas or rowdies.

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7.0 MALE SEX WORKERS IN INDIA AHMEDABAD CITY

Mahatma Gandhi Ashram, the most significant landmark in Ahmedabad city Ahmedabad is known for its rich past and its association with the Mahatma Gandhi. The city offers the traveler a unique style of architecture, which is a blend of Hindu and Islamic styles. Ahmedabad has been known for its industry since medieval times. It is famous for its textile mills and for this reason is often referred to as the 'Manchester of the East'. The city is located in the state of Gujarat, in the western part of India. It lies along the Sabarmati River and is 440 km north of Mumbai. The climate of Ahmedabad is hot and moist. Winters are cool and pleasant (November-February) but summers (April-June) are extremely dry, hot with the mercury rising above 46°C at times. With a population of over 60,48,000 people, spread over 236 sq. km., the city attracts thousands of workers from nearby towns and villages. Gujarati, Hindi and English are the main languages and is famed for the Gandhi Ashram, Kankaria lake, Shaking Minarets, Jama Masjid and Akshardham temple which are major tourist attractions. The analysis of the quantitative data begins with the socio-demographic profile of Male Sex Workers in Ahmedabad in order to understand the physical and environmental conditions that affect MSW and also lead to a better understanding of the respondents through a macro perspective. An analysis of the socio-demographic profile of the MSW reveals that 41 percent are between 19 and 25 years of age, and 93 percent reported having their first sexual experience when they were below 18 years of age. However, in the case of involving in sex first in exchange for money, gifts, etc., it is seen that majority of the respondents, 50 percent had done it when they were between 19 and 25 years of age. Interestingly, 45 percent opined that the average age of their clients is below 18 years. Education status indicates that 36 percent have studied only up to middle school, and a majority comprising 60 percent are unmarried. Occupational status data shows that 80 percent are employed in part-time jobs, with 93 percent earning below Rs.2500 a month from all sources with 55 percent earning up to Rs.1500 from engaging in sex work. Statistics also reveal that 92 percent view television and 82 percent read the newspapers and that 27 percent are smokers and 44 percent have the habit of consuming alcohol.

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7.1 Socio-demographic characteristics Figure – 1 Age of Male Sex Workers (MSW) Age in completed years

1.3

13.3 17.3

41.3

18.7 < 18 Years 33-39 Years

19-25 Years Above 40 Yrs.

26-32 Years

According to the data presented in Figure-1 given above, the age of Male Sex Workers in Ahmedabad City has been described.

It may be observed that a majority of the MSW, 41 percent are between 19 and 25 years of age, followed by 19 percent who are older in the 26 to 32 years age group. While 17 percent of the MSW interviewed in the study are between 33 and 39 years, 13 percent are above 40 years of age and the remaining only 1 percent are below 18 years of age. Hence, it may be concluded that a majority of the Male Sex Workers are in the middle aged category. However, Ahmedabad city points out at a higher average age and even older MSWs can be found. Hence the need to target all ages of MSW for any health or HIV/ AIDS related initiatives. Figure – 2 Age at first sex and Age at first Commercial Sex of Male Sex Workers (MSW) Age at first sex & first commercial sex 93.3

100 80 44

60 40

49.3

6.7

0

20

6.7

0 < 18 Years

19-25 Years

26-32 Years

Age at 1st sex

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Age at 1st com. Sex

73

Pilot Study on MSW in India Figure-2 above portrays the age at first sex and age when MSW first had sex in exchange for money, gifts, etc., of Male Sex Workers in Ahmedabad City. It is seen from Figure-2 that a high 93 percent reported having their first sexual experience below 18 years of age while the remaining 7 percent said their first sex experience occurred when they were between 19 and 25 years old. However, a different trend is observed with respect to the age at which the MSW had sex for the first time in exchange for money, gifts, etc. While around 50 percent reported such experience when they were 19 to 25 years of age, 44 percent reported engaging in paid sex first below 18 years of age. Figure – 3 Average Age of the clients of Male Sex Workers (MSW)

Average Age of clients of MSW 50

45.3

42.7

40 30 20

10.7

10

1.3

0

< 18

0

Avg. age of client

19-25

26-32

33-39

40 & >

Figure-3 analyses the average age of the clients of the Male Sex Workers in Ahmedabad City. It is seen that majority of the MSW, 45 percent opined that the average age of the clients is below 18 years while 43 percent said that the average age of their clients was between 26 to 32 years, only 11 percent said their clients were 26 to 32 years old and according to the remaining 1 percentage, their clients were older at 33 to 39 years of age. This indicates that in Ahmedabad, a large number of younger clients are there and they prefer other males of their age.

A typical street in Ahmedabad

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Pilot Study on MSW in India Figure – 4 Educational status of Male Sex Workers (MSW) Education status of MSW 36

40 29.3

30 20

13.3

13.3

10 0

0

2.7

5.3

Education

Illiterate

Primary

Middle school

Hr. Sec.

Technical

Hr. Edu.

No Resp.

The educational status of the MSW is indicated in Figure-4 above. It is noticed that majority of the MSW interviewed, 36 percent have completed only up to middle school followed by 29 percent who have had only primary education. An equal percentage of respondents, 13 percent are illiterate or are educated up to higher secondary. This indicates extremely low level of education among male sex workers here that points out to the need to cater to information and education needs of respondents with respect to health/ HIV/ AIDS efforts. Figure – 5 Marital status of Male Sex Workers (MSW) Marital Status of MSW 60

60 40

34.7

20 1.3

0

4

0

Marital status

Unmarried Married, living with spouse Married, living without spouse Separated/ Divorced No Response

Figure-5 describes the marital status of the MSW covered in the study. With a predominantly large younger group, expectedly a large 60 percent are unmarried. Among ever-married MSW, 35 percent are living with their spouse and only 1 percent are living without their spouse. This shows that there may be large number of bisexuals in Ahmedabad and sex with males is also

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Pilot Study on MSW in India common among married partners. Marriage is a crucial factor as it determines risk and vulnerability to HIV infection during unprotected sex. Thus the need to ensure that risk of infection is not transmitted to the married spouse. Figure – 6 Occupational status of Male Sex Workers (MSW)

Occupation Status of MSW 80

80 60 40 6.7

20 0

13.3

Occupation

Unemployed Full-time employed Part time employed

From Figure-6, the occupational status of the MSW may be ascertained. The data reveals that majority of the respondents, 80 percent are employed in part-time jobs while 13 percent are engaged in full-time jobs and remaining 7 percent are unemployed. The type of occupations that have been observed include rickshaw pullers, vendors, drivers, boatmen and those belonging predominantly to lower rungs of the socio-economic ladder. A few have taken up working with NGO/ CBO as peers and volunteers and continue to engage in sex work. Figure – 7 Average monthly income of Male Sex Workers (MSW) (All sources) Age in completed years 2.7 4

93.3 < Rs.2500

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Rs.2501 – Rs.5000

> Rs.5001

76

Pilot Study on MSW in India According to Figure-7, the gross Average Monthly Income of the MSW has been recorded. This indicates that almost all respondents, 93 percent earn below Rs.2500 a month from all sources while for only 3 percent the monthly income ranges between Rs.2501 and Rs.5000. Only 4 percent reportedly earn more than Rs.5001 a month. It may therefore be concluded that the economic condition of MSW is comparatively very poor and many are forced to take up sex work as an alternative for a living. Poor earnings also have an effect on expenditure on health care and prevention methods as purchase of condoms, testing and treatment. Figure – 8 Average monthly income of Male Sex Workers (MSW) (Sex work)

Age in completed years 10.7

54.7

34.7


Rs.1501-3000

>Rs.3001

The average monthly income of MSW from sex work is described in Figure-8. From the table, it may be inferred that a large number, 55 percent earn up to Rs.1500 from engaging in sex work followed by a sizeable percentage, 35 percent who earn between Rs.1501 and Rs.3000 from sex work. This is done to augment their meagre income they earn from their full-time employment. As observed in other studies and in qualitative phase of the study, many MSW are forced to engage in sex work on commercial basis to support the family or need to earn more to lead a better quality of life. It is also observed that in certain instances, clients offer money willingly and when satisfied with sexual experience are reported to pay extra to MSW in gratitude.

Men and women in a ‘Dandiya dance’

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7.2 Lifestyle, environmental influences Figure - 9 Media habits of Male Sex Workers (MSW) Media habits of MSW 92

100 80

82 61.3

60 40 17.3

20 0

9.3

Media channels

Television

Radio

Magazines

Cinema

Newspaper

The media habits of the MSW in this study may be gauged from the multiple response Figure-9 given above. It is observed that majority of the MSW, 92 percent view television and 82 percent read the newspapers. A large percentage, 61 percent also reportedly listen to the radio and an equal percentage of 17 percent read magazines and watch movies. It may thus be concluded that MSW are exposed to both electronic and print mass media and hence these may be used for getting messages on prevention, education, treatment, care and support in relation to HIV/ AIDS. Figure – 10 Other habits of Male Sex Workers (MSW) Other habits of MSW 70

68

60 44

50

40

40

25.3

30

18.7

20 10 0

Smoking Drugs Other habits

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Other habits

Alcoholism Consuming tobacco

78

Pilot Study on MSW in India Figure-10 presented above describes the other habits of MSW. It may be seen from the above table that a large number of respondents 44 percent consume tobacco chewing tobacco (local ‘paan’) and many are addicted to locally available tobacco and ‘masalas’ with intoxicants and 27 percent have the habit of smoking. A large number, 13 percent also reported to consume alcohol regularly. Though habits as alcoholism and drugs are known to induce to poor adoption of protective measures leading to increased risk of HIV infection, in Ahmedabad it does not seem to be significant and probably owing to much poorer economic conditions, respondents do not take alcohol/ drugs and consume tobacco.

Comment Profile of a typical MSW in Ahmedabad City From a study of the overall socio-demographic profile of Male Sex Workers in Ahmedabad City, a typical profile of an MSW may be constructed. Overall, it may be seen that an average Male Sex Worker in this city is between 26 to 32 years, has had his first sexual experience below 18 years of age, experienced first sexual encounter in exchange for money, gifts, etc, when he was between 19 and 25 years of age and the average age of his client is below 18 years though many may also have clients between 19 to 25 years of age. The other socio-demographic characteristics reveal that the Male sex worker here is educated up to the middle school level, mostly unmarried and employed mainly in part-time occupations – petty jobs such as daily wage labour/ construction and so on. This poor occupational status induces him into sex work as an alternative source of income. A typical MSW earns reportedly less than Rs.2500/- a month from all sources and less than Rs.1500/- from sex work. The media habits of MSW reveal that television is the most influential media followed by newspaper and the radio. He also is a smoker and probably an occasional drinker.

Old buildings line the streets in the city

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Pilot Study on MSW in India

7.3 Identity and sub-types Awareness of MSW on types and subtypes of Male Sex Workers in Ahmedabad City Table – 9 Awareness of Male Sex Workers Genre by MSW by Age Group Awareness Age TOTAL < 18 19-25 26-32 33-39 40 & >

Male Sex Worker Subtypes (N=75) Koti (%) 75 100.0 1 1.3 31 41.3 20 26.7 13 17.3 10 13.3

Panthi (%) 63 64.0

Dubli (%) 58 77.3

---

---

25 33.3 17 22.7 11 14.7 10 13.3

21 28.0 17 22.7 12 16.0 8 10.7

Hijra (%) 74 98.7 4 5.3 31 41.3 20 26.7 12 16.0 10 13.3

Gigolo (%) 10 13.3

Masseur (%) 11 14.7

Escort (%) 2 2.7

Londa (%) 21 28.0

Dancer (%) 63 84.0

---

---

---

---

---

2 2.7 5 6.7 2 2.7 1 1.3

3 4.0 4 5.3 2 2.7 2 2.7

7 9.3 4 5.3 5 6.7 5 6.7

25 33.3 15 20.0 13 17.3 10 13.3

--1 1.3 --1 1.3

The data in table - 9 presented above describes the Male Sex Workers awareness of the various types and sub-types of MSW that are reportedly existing in society in various proportions with respect to their age. It is seen that majority of the MSW know about groups such as ‘Koti’ (which in common parlance means a person (biologically male) who is a recipient during a sexual act also termed passive partner). Similarly ‘Panthi’ denotes a person who plays a dominant or active role (read penetrative) during sexual act. ‘Dubli’ is a colloquial term (in Ahmedabad also) used to describe a person who performs both an active and passive role. It is observed that they are also popularly called ‘Double Decker’ or ‘DD’. ‘Hijra’ are transgender or transsexual population and ‘Londa’ a group popular in eastern parts of the country – mainly West Bengal and Bihar are mainly transsexuals or males who attire in female clothing and dance during specific cultural festivities. After the fair or festival, they engage in sex with other men or women and earn a living through sex work. ‘Dancer’ is a term describing a typical dancer (usually entertaining people in public). After or during the dance programme, he is approached by clients and negotiates an agreement for paid sex. Masseur is a male ‘body massager’ who works in a massage parlour. Many massage parlours are reportedly known to also provide sexual services for an additional sum and masseurs engage in sex with clients who visit massage parlours. Some masseurs also service clients for massage in the clients houses. A ‘Gigolo’ is a commercial male sex worker who caters to mainly to women alone. An ‘Escort’ is a male sex partner who is usually kept by the client in his house/ workplace and is used for sexual activity when desired by the client. Escorts are known to accompany clients on outstation trips and frequent travel. Comment The overall analysis of MSW on awareness pertaining to MSW genre indicates that a majority of the MSW in Ahmedabad City is aware of predominantly main groups in the MSW network in the city. All respondents knew about Koti, 100 percent and a large number heard of Hijra, 99 percent followed by Dancer, 84 percent Dubli, 77 percent and Panthi, 64 percent.

NIMSW

80

Pilot Study on MSW in India Comparatively very few, 28 percent heard about Londa and Masseur, 15 percent Gigolo, 14 percent and Escort, 3 percent as a subtype of MSW in Ahmedabad City. An analysis of the age-wise classification of data reveals that majority of the MSW in the 19 to 25 age group are aware of the various types and sub-types of MSW existing in society. Within this group, an equal number, 41 percent are aware of Koti and Hijra while another equal number of respondents, 33 percent are aware of Panthi and Dancer. Only 28 percent in this age group knew about Dubli and numbers aware of other subtypes are insignificant. Next, most MSW in the 26 to 32 age group are aware of various types and sub-types of MSW. The trends in knowledge about various sub-types is similar to the younger age group seen with around 27 percent aware of Koti, and Hijra. However, fewer MSW knew about ‘Panthi’, and Dubli, 23 percent. While 20 percent in this age group were aware of Dancers, knowledge of other sub-groups is very poor. In the older age group of 33 to 39 years too, knew 16 percent to 20 percent of the respondents had heard about Koti, Dubli, Hijra, Panthi, and Dancer. Similarly, among respondents aged above 40 years, there is knowledge on only these sub-types. However, many MSW in the young age group of less than 18 years do not seem to know about the various types and sub-types within MSW. It is observed that no clear definitions demarcate the various types and sub-types and there is overlapping of context and meaning that leads to confusion among MSW in defining their genre. Table – 10 Awareness of Male Sex Workers Genre by MSW by Education Awareness Education TOTAL Illiterate Primary Middle Hr. Sec. Technical Hr. Education Others

Male Sex Worker Subtypes (N=75) Koti (%) 75 100.0 10 13.3 22 29.3 27 36.0 10 13.3

Panthi (%) 63 64.0 8 10.7 19 25.3 24 32.0 7 9.3

Dubli (%) 58 77.3 7 9.3 15 20.0 24 32.0 7 9.3

Hijra (%) 74 98.7 10 13.3 22 29.3 26 34.7 10 13.3

Gigolo (%) 10 13.3

Escort (%) 2 2.7

2 2.7 5 6.7 1 1.3

Masseur (%) 11 14.7 1 1.3 3 4.0 4 5.3 1 1.3

---

---

---

---

---

---

---

2 2.7 4 5.3

1 1.3 4 5.3

2 2.7 3 4.0

2 2.7 4 5.3

---

--2 2.7

1 1.3 1 1.3

----2 2.7 ---

-----

Londa (%) 21 28.0 3 4.0 7 9.3 7 9.3 2 2.7

Dancer (%) 63 64.0 9 12.0 20 26.7 22 29.3 7 9.3

---

---

1 1.3 1 1.3

1 1.3 4 5.3

Table - 10 depicts the Male Sex Worker’s understanding of the various types and sub-types prevalent with respect to their education. It may be deduced from the above data that majority of the respondents aware of various types and sub-types within MSW are educated up to middle school, followed by those educated up to primary, then higher secondary level. This is followed by MSW who are illiterate. More MSW may be aware of types as a majority of the respondents are educated only up to some level. It is also seen that MSW with primary, higher education and those who are illiterate are not very conversant with various types and subtypes.

NIMSW

81

Pilot Study on MSW in India Responses from the field indicate that higher educated MSW are engaged in such activity only occasionally or do so to fulfil immediate economic needs, and hence do not understand nor are they keen on knowing various types and sub-types. On the other hand, illiterate MSW neither know nor understand the dynamics of the MSW genre in society. Table – 11 Awareness of Male Sex Workers Genre by MSW by Marital status Awareness

Male Sex Worker Subtypes (N=75)

Marital status TOTAL Unmarried Married living with spouse Married living without spouse Separated/ Divorced

Koti (%) 75 100.0 45 60.0 26 34.7 1 1.3 3 4.0

Panthi (%) 63 64.0 38 50.7 23 30.7 1 1.3 1 1.3

Dubli (%) 58 77.3 35 66.7 21 28.0 1 1.3 1 1.3

Hijra (%) 74 98.7 44 58.6 26 34.7 1 1.3 3 4.0

Gigolo (%) 10 13.3 6 8.0 4 5.3

Masseur (%) 11 14.7 7 9.3 3 4.0

Escort (%) 2 2.7 2 2.7

---

---

---

---

---

1 1.3

---

2 2.7

---

Londa (%) 21 28.0 10 13.3 9 12.0

Dancer (%) 63 64.0 37 49.3 23 30.7 1 1.3 2 2.7

Table - 11 provides an analysis of awareness of MSW genre in relation to their marital status. The statistics reveals that most unmarried respondents are aware of various types and sub-types among MSW, as majority of respondents are unmarried. Among MSW, majority of the respondents aware of Koti are unmarried, 60 percent followed by those married and living with spouse, 35 percent. Similar trends can be witnessed among those aware of Panthi, 51 and 31 percent Dubli 68 and 28 percent and Hijra 59 and 35 percent as well as Dancer, 49 and 31 percent. This indicates that larger number of unmarried MSW are aware of various sub-types among MSW. However, it is also to be noted that majority of the respondents are unmarried. Thus, an analysis of awareness among married respondents indicates that awareness among both married as well as unmarried MSWs is significant. Table – 12 Awareness of Male Sex Workers Genre by MSW by Occupation Awareness Occupation TOTAL Unemployed Full-time Part-time

NIMSW

Male Sex Worker Subtypes (N=75) Koti (%) 75 100.0 5 6.7 10 13.3 60 80.0

Panthi (%) 63 64.0 5 6.7 10 13.3 48 64.0

Dubli (%) 58 77.3 5 6.7 10 13.3 43 57.3

Hijra (%) 74 98.7 5 6.7 10 13.3 59 78.7

Gigolo (%) 10 13.3

Masseur (%) 11 14.7

Escort (%) 2 2.7

---

---

---

2 2.7 8 10.7

3 4.0 8 10.7

1 1.3 1 1.3

Londa (%) 21 28.0 2 2.7 5 6.7 14 18.7

Dancer (%) 63 64.0 5 6.7 10 13.3 48 64.0

82

Pilot Study on MSW in India

According to the data presented in Table -12, awareness of MSW on various types and subtypes of MSW genre based on their occupation is analysed. It may be observed that in Ahmedabad, most MSW are employed in part-time employment and they are aware of the various groups followed by a large percentage of full-time employed MSW who also engage in sex for exchange of money, gifts, etc. A closer examination of the data reveals that among those respondents aware of Koti, Panthi, Dubli, Hijra and Dancer, constituting roughly 64 to 80 percent of the respondents are employed in part-time jobs compared to only around 14 percent of the respondents aware of these major sub-types who are engaged in full-time employment. This indicates that occupation is an important factor in the sense that as more MSW are found to be in part-time employment, their awareness on the various sub-types is better than those engaged in full-time or unemployed respondents. Table – 13 Awareness of Male Sex Workers Genre by MSW by Income Awareness Average Income PM TOTAL

Male Sex Worker Subtypes (N=75) Koti (%) 75 100.0

Panthi (%) 63 64.0

Dubli (%) 58 77.3

Hijra (%) 74 98.7

Gigolo (%) 10 13.3

Masseur (%) 11 14.7

Escort (%) 2 2.7

Londa (%) 21 28.0

Dancer (%) 63 64.0

41 54.7 26 34.7 8 10.7

32 42.7 23 30.7 8 10.7

27 36.0 23 30.7 8 10.7

41 54.7 26 34.7 7 9.3

3 4.0 4 5.3 3 4.0

4 5.3 5 6.7 2 2.7

1 1.3 1 1.3

8 10.7 9 12.0 4 5.3

33 44.0 23 30.7 7 9.3

70 93.3 2 2.7 3 4.0

58 77.3 2 2.7 3 4.0

30 40.0 2 2.7 3 4.0

69 92.0 2 2.7 3 4.0

10 13.3

11 14.7

2 2.7

---

---

---

---

---

---

18 24.0 1 1.3 2 2.7

59 78.6 2 2.7 2 2.7

Income (all sources) < Rs.2500 Rs.2501 – Rs.5000 > Rs.5001

---

Income (sex work) < Rs.1500 Rs.1501 – Rs.3000 > Rs.3001

Table - 13 presents the awareness of respondents on various types and subtypes of MSW in Ahmedabad City with regard to their monthly income. An overview of the data reveals that a majority of MSW aware of their genre and subtypes earn a lower average monthly income (from all sources) of up to Rs.2500 a month. The data reveals that among those who are aware of Koti and Hijra, 55 percent earn below Rs.2500 a month while 35 percent earn a month. Among those who know about dancers, 44 percent are in the low income category while 31 percent earn Rs.2501 to Rs.5000. A similar trend may be observed among respondents who are aware of Panthi 43 and 31 percent and Dubli 36 and 31 percent respectively. Overall, even among other groups it may be seen that those aware of major sub-types earn lesser than the others. This may also point to the fact that majority of the respondents earn lower incomes.

NIMSW

83

Pilot Study on MSW in India Type of Male Sex Workers as identified by MSW The following analysis describes the manner in which Male Sex Workers define or identify themselves. It also emphasises on their sexual orientation and gender. From the data, it may be inferred that majority of the MSW in Ahmedabad, almost all respondents identify thenselves as Panthi, 100 percent, while 87 percent also identify themselves as Koti, and 31 percent opine that they are typically Hijras followed by a smaller number, 12 percent who consider themselves as Dubli or those who engage in sex with other males or females as active or passive sexual partners. MSW who consider themselves as Londa, Escorts and Gigolo are very few and no MSW consider themselves as Masseur or Dancer. This indicates that in Ahmedabad, Panthi are very common and so are Koti. However, Hijras can also be found and many consider themselves as Dubli. Table – 14 Type of Male Sex Workers by MSW by Age Group MSW Type Age TOTAL < 18 19-25 26-32 33-39 40 & >

Male Sex Worker Subtypes (N=75) Koti (%) 65 86.7 1 1.3 26 34.7 17 22.7 12 16.0 9 12.0

Panthi (%) 75 100.0 1 1.3 31 41.3 20 18.7 13 17.3 10 13.3

Dubli (%) 9 12.0

Hijra (%) 23 30.7

Gigolo (%) 1 1.3

Masseur (%)

---

---

---

---

4 5.3 1 1.3 4 5.3

9 12.0 5 6.7 4 5.3 5 6.7

1 1.3

---

---

---

-----

---

Escort (%) 2 2.7

Londa (%) 2 2.7

Dancer (%)

---

---

---

1 1.3 1 1.3

1 1.3 1 1.3

---

---

---

---

---

---

---

---

---

---

-----

From Table-14 given above, MSW identity and orientation with regard to age-wise categorisation may be ascertained. It is observed from the data that among those who identify as Koti, majority, 35 percent are in the 19-25 age group followed by 23 percent in the 26-32 age group and 16 percent in the 33-39 age group. A similar trend is seen among respondents who consider themselves as Panthi with 41 percent in the younger age group of 19-25 years followed by 19 percent in 26-32 age group and 17 percent in 33-39 age range. Among Hijras though, it is observed that while 12 percent are in the 19–25 age group, 7 percent are in 26-32 age group and above 40 years age group followed by 5 percent who are in the 33-39 age group. Table – 15 Type of Male Sex Workers by MSW by Occupation MSW Type Occupation TOTAL Unemployed

NIMSW

Male Sex Worker Subtypes (N=75) Koti (%) 65 86.7 5 6.7

Panthi (%) 75 100.0 5 6.7

Dubli (%) 9 12.0 ---

Hijra (%) 23 30.7 1 1.3

Gigolo (%) 1 1.3

Masseur (%)

---

---

---

Escort (%) 2 2.7

Londa (%) 2 2.7

Dancer (%)

---

---

---

---

84

Pilot Study on MSW in India Full-time Part-time

10 13.3 50 60.7

10 13.3 65 86.7

2 2.7 7 9.3

1 1.3 21 28.0

---

---

---

---

---

1 1.3

---

2 2.7

2 2.7

---

The occupational classification of MSW with respect to their identity is examined in Table-15. It may be observed that majority of the MSW who identified themselves as Panthi, Koti, Hijra and Dubli are employed in part-time work compared to those in full-time employment. Thus, it may be seen that 87 percent of Panthi, 61 percent Koti and 28 percent Hijras are employed in part-time jobs compared to 13 percent Koti and Panthi and 1 percent Hijra in fulltime jobs. This indicates that majority of the MSW are not economically well off and hence take to sex work in order to enhance their incomes. Comment It may be observed in Ahmedabad that MSW are aware of only the main traditional types and sub-types of MSW such as Koti, Panthi, Hijra and Dubli. They are aware of the complexity governing each of these sub-types and also identify typically with one or more groups. Predominantly however, many consider themselves as Panthi and a large hijra population also exists in Gujarat with their typical hierarchical structure and norms. Most of the well informed Male Sex Workers are in the younger age group and earn less and hence have to take up multiple jobs including sex work to augment their incomes. Education does not seem to be a critical factor in becoming a Male Sex worker but more educated sex workers are aware of various dynamics and are able to attract richer clients.

Main Market Street in Ahmedabad where one can find ‘hustlers’

NIMSW

85

Pilot Study on MSW in India Understanding Sex Industry Network (SIN) – Place of soliciting/ pickup/ aggregating by Male Sex Workers. The following analysis provides an understanding into the Sex Industry Network by pinpointing the locations or places where Male Sex Workers solicit their clientele, pickup them for sexual activities or indicates where such MSW aggregate to attract clients and engage in sex for exchange of money, gifts, etc. It is important to identify such ‘hotspots’ as that would provide vital clues in approaching this otherwise hidden community for long-term healthcare interventions around HIV/ AIDS. The overall analysis of the place of soliciting/ picking up clients and places of aggregating of MSW in Ahmedabad City reveals that majority of the MSW operate in the street, 87 percent followed by those in Bus stand, 81 percent and Park, 73 percent. The other prominent places of contact are railway station, 60 percent, public toilet, 51 percent, 47 percent brothel and hotel and 35 percent houses. It has been observed that in most instances, the places where clients are solicited are also the places where they have sex in exchange for money. It is seen that in Ahmedabad city, outdoor sex among MSW groups is more common and majority of the MSW and clientele interviewed belong to the lower socio-economic ladder. Table – 16 Place of soliciting/ pickup/ aggregating by MSW by Age Group

3 4.0 1 1.3 ---

Chat room (%)

19 25.3 16 21.3 5 6.7 5 6.7

Internet (%)

25 33.3 17 22.7 9 12.0 10 13.3

---

Public toilet (%)

---

Pimp (%)

---

55 73.3 1 1.3 22 29.3 14 18.7 9 12.0 9 12.0

Telephone (%)

---

Park (%)

45 60.0

House (%)

40 & >

61 81.3

Hotel (%)

33-39

4 5.3

Brothel (%)

26-32

Railway Stn. (%)

19-25

65 86.7 1 1.3 28 37.3 16 21.3 12 16.0 8 10.7

Bus stand (%)

TOTAL

Massage parlour (%)

Age

< 18

Male Sex Worker soliciting/ pickup/ aggregating points (N=75)

Street (%)

Pickup point

35 46.7

35 46.7

26 34.7

6 8.0

1 1.3

38 50.7

1 1.3

1 1.3

---

---

---

---

---

---

---

---

16 21.3 10 13.3 5 6.7 4 5.3

15 20.0 10 13.3 6 8.0 4 5.3

9 12.0 7 9.3 7 9.3 3 4.0

4 5.3

1 1.3

1 1.3

1 1.3

---

---

---

---

2 2.7

---

---

---

---

---

17 22.7 11 14.7 5 6.7 5 6.7

---

---

Table - 16 describes the age-wise classification of places where MSW solicit and pickup their clients or places where they aggregate to attract clients for sex work. From the data, it can be seen that most MSW soliciting, picking and aggregating in public places are younger in the 19 to 25 years age group compared to a lesser number who are 26 to 32 years old. A further detailed analysis reveals that among MSW who operate on the streets, 37 percent are younger in the 19-25 age group followed by 21 percent in the 26-32 years age group and 16 percent in the 33-39 age range. In the bus stands, 33 percent are in the 19-25 age group followed by 23 percent in the 26 – 32 years age group and 13 percent in the above 40 years age group. Similarly, among those who solicit/ pickup clients in the park, many MSW, 29 percent are in the young age group of 19-25

NIMSW

86

Pilot Study on MSW in India years compared to 19 percent aged between 26 and 32 years of age and 12 percent in the older age group. In public toilets, brothels, hotels and houses too, a similar pattern emerges. Table – 17 Place of soliciting/ pickup/ aggregating by MSW by Occupation

35 46.7 3 4.0 8 10.7 24 32.0

35 46.7 3 4.0 7 9.3 25 33.3

26 34.7 1 1.3 8 10.7 17 22.7

--3 4.0

6 8.0

1 1.3

---

---

2 2.7 4 5.3

1 1.3

Chat room (%)

55 73.3 4 5.3 9 12.0 42 56.0

Internet (%)

45 60.0 2 2.7 9 12.0 34 45.3

Public toilet (%)

House (%)

61 81.3 5 6.7 10 13.3 46 61.3

Pimp (%)

Hotel (%)

4 5.3 1 1.3

65 86.7 5 6.7 7 9.3 53 70.7

Telephone (%)

Brothel (%)

Part-time

Park (%)

Full-time

Railway Stn. (%)

Unemployed

Bus stand (%)

TOTAL

Massage parlour (%)

Occupation

Male Sex Worker soliciting/ pickup/ aggregating points (N=75)

Street (%)

Pickup point

1 1.3

1 1.3

---

---

---

---

1 1.3

1 1.3

38 50.7 2 2.7 4 5.3 32 42.6

---

According to the data in Table - 17 the occupation-wise classification of place of soliciting/ picking up clients by MSW is analysed. It is observed that in the street, bus stand, park, railway station, Public toilet, brothel, hotel and house, the number of MSW engaged in part-time jobs is higher than those in full-time followed by unemployed MSWs. It is important to note that though many MSW may be employed in petty trades, mostly in Ahmedabad city as construction workers, load carriers, in transport industry, as drivers, truckers, vendors and agricultural labour, they use the pick up points also to have sex which may not be the place of work. It is seen that MSWs here prefer public places such as toilets, bus stands, railway stations and parks to get the attention of clients as well as to escape law enforcing authorities including local police. Table – 18 Place of soliciting/ pickup/ aggregating by MSW by Income

NIMSW

55 73.3 32 42.6 19 25.3 4 5.3

35 46.7 19 25.3 12 16.0 4 5.3

35 46.7 18 24.0 12 16.0 5 6.7

26 34.7 10 13.3 13 17.3 3 4.0

6 8.0 1 1.3 2 2.7 3 4.0

---

1 1.3 --1 1.3 ---

38 50.7 25 33.3 11 14.7 2 2.7

Chat room (%)

Telephone (%)

45 60.0 25 33.3 14 18.7 6 8.0

Internet (%)

House (%)

61 81.3 33 44.0 22 29.3 6 8.0

Public toilet (%)

Hotel (%)

4 5.3 3 4.0 1 1.3

Pimp (%)

Brothel (%)

> Rs.5001

Park (%)

Rs.2501 – Rs.5000

Railway Stn. (%)

< Rs.2500

65 86.7 34 45.3 24 32.0 7 9.3

Bus stand (%)

TOTAL

Massage parlour (%)

Income (all sources)

Male Sex Worker soliciting/ pickup/ aggregating points (N=75)

Street (%)

Pickup point

1 1.3

1 1.3

---

---

---

---

1 1.3

1 1.3

87

Pilot Study on MSW in India

The income-wise classification of pickup points for sex work is presented in Table 18. From the above table, it is evident that while MSW earning up to Rs.2500/- per month mostly solicit clients in streets, 45 percent bus stand, 44 percent park, 43 percent and railway station, 33 percent, majority of MSW soliciting in other places also have lower incomes. However, proportionately, it may be seen that those earning between Rs.2501 and Rs.5000 a month also solicit and have sex with customers in brothels, houses and hotels, roughly 16 percent of the respondents.

Comment The Male Sex Work industry in Ahmedabad is not organised on the lines that are in other cities – such as commercial sex activity through pimps and in brothels/ houses. Here such a system is either non-existent or not popular. Sex workers prefer to contact their clients directly than through networks. In Ahmedabad the profile of sex workers is very low and therefore soliciting and having sex in streets, public places such as toilets and railway stations or bus stands during nights is very common. Neither MSW nor their clients can afford to go to a brothel or engage in sex at homes/ other places. Moreover, their occupational profile indicates that many are engaged in petty jobs and during their leisure time, especially in evenings and nights, they visit parks, toilets for younger boys who are willing to pay them for sexual favours. This explains the lower age of majority of the clients in Ahmedabad. Overall, it may be seen that sex industry in Ahmedabad is very unorganised and operates more on an individual basis. Many hijras have their exclusive clients and prefer to go back to same clients. MSW have mentioned that they face competition from younger persons who enter the field as clients prefer younger and stronger male sex workers.

The banks of the Sabarmati River, which is also a hotspot for MSWs

NIMSW

88

Pilot Study on MSW in India

8.0 SEXUALITY, SEXUAL PRACTICES AND VULNERABILITY 8.1 Sexual encounters, partners, commercial sex Sexual practices, behaviour and client profile of MSW The tables presented below describe the sexual practices in terms of encounters with clients, sexual behaviour including condom use and seek to capture client profile as seen by Male Sex Workers. A bird’s eye view of the sexual practices among MSW reveals that MSW had paid sex consistently over the last 6 months. More specifically, a large number, 95 percent reported engaging in sex in exchange for money, gifts, etc., during the last time they had sex. This relates to increased sex activity on commercial basis. Data also points out that a large number in Ahmedabad City, 88 percent reportedly used condoms consistently over the last 6 months when they had paid sex. Further, 84 percent reported using a condom during the last time they had sex in exchange for money, gifts, etc. Finally, a question posed on who their sexual partner was on their last paid sexual encounter revealed a rough profile of the clients of MSW. While it is assumed that 32 percent clients are of high class – defined thus as being either equal to or economically better than MSW themselves. To this group belong mostly peers, students, teachers, office goers, blue collared workers, petty businessmen and the like. On the other hand, 48 percent reported that their clients are low class – meaning those hailing from lower socioeconomic strata – mainly rickshaw pullers, boatmen, unorganised workers, construction labour, unemployed youth, slum populations and so on. Ahmedabad city witnesses MSW activity predominantly at the street level and public places, catering to the economic as well as sexual needs of people in the lower socio-economic milieu such as those in slums and poor housing colonies operating in parks, railway stations, bus stands, public toilets, and roadside shanties. Observations from the field validate the fact that many MSW started as MSM but in due course, on pressing economic grounds they engage in sex on commercial basis for sheer survival. Therefore, compared to other cities where survival sex is to be found with recreational sex, in Ahmedabad, only survival sex may be found. Table – 19 Sexual practices, behaviour and client profile of MSW by Age group Sexual history

Age group

Sexual practices, behaviour and client profile (N=75) Sex for money/ gifts (Last time)

TOTAL < 18 19-25 26-32 33-39 40 & >

NIMSW

(%) 71 94.7 1 1.3 30 40.0 19 25.3 13 17.3 8 10.7

Condom use

Condom use

(6 months)

(Last time)

(%)

(%)

66 88.0 1 1.3 27 36.0 20 18.7 11 14.7 7 9.3

63 84.0 1 1.3 26 35.7 18 24.0 10 13.3 8 10.7

Clientele High class (%)

Low class (%)

24 32.0

36 48.0 7 9.3 13 17.3 10 13.3 7 9.3 5 6.7

--14 18.7 3 4.0 4 5.3 3 4.0

89

Pilot Study on MSW in India

An analysis of the data in Table - 19 provides insight into the sexual practices and behaviour of MSW with respect to their age. It is evident from the data that majority of the MSW, 40 percent who had sex in exchange for money during the last sexual encounter were 19-25 years of age followed by 25 percent who were older between 26 and 32 years old. A sizeable number of 17 percent were also in the age range of 33 to 39 years of age. This indicates that though MSW are generally younger, many middle-aged MSW too are engaged in paid sex activities. Condom use consistently in the last 6 months has been reported by majority of MSW, 36 percent in the same 19-25 age group followed by 19 percent in the older 26-32 age group. The trend is similar pertaining to condom use during last sexual encounter where 36 percent in 19-25 age range reported condom use and 24 percent between 26 and 32 years said they used condoms during their last sexual encounter. It is interesting to note that an almost equal number of clients of MSW, 18 percent who may be considered belonging to high class or low class and are younger in the 19-25 age group. However, it is also noticed that many MSW considered low class are in the older age group of 26-32 years. Table – 20 Sexual practices, behaviour and client profile of MSW by Education Sexual history

Education

Sexual practices, behaviour and client profile (N=75) Sex for money/ gifts

Illiterate Primary Middle Hr. Sec. Technical Hr. Education Others

Condom use

(6 months)

(Last time)

Clientele Low class (%)

(%) 71 94.7 8 10.7 20 18.7 27 36.0 10 13.3

(%)

(%)

High class (%)

66 88.0 8 10.7 20 18.7 22 29.3 10 13.3

63 84.0 8 10.7 19 25.3 22 29.3 10 13.3

24 32.0 2 2.7 8 10.7 11 14.7 1 1.3

36 48.0 7 9.3 11 14.7 9 12.0 6 8.0

---

---

---

---

---

2 2.7 4 5.3

2 2.7 4 5.3

2 2.7 2 2.7

1 1.3 1 1.3

(Last time)

TOTAL

Condom use

--3 4.0

Table 20 describes the sexual practices, behaviour and client profile of MSW by education status. It is important to note from the above table that though involvement in sex for exchange of money, gifts, etc., is high by educated MSW, that may be a result of rising unemployment and resulting ‘survival sex’, higher education also indicates consistent condom use, 29 percent by those educated up to middle school (majority of respondents in the study) and a high 13 percent by those who studied up to higher secondary. Similarly, larger number of educated MSW, 29 percent educated up to middle school and 13 percent up to higher secondary reported condom use during last sexual encounter. Interestingly, better condom use is being reported by respondents educated up to primary level compared to those with higher secondary education. This may be

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Pilot Study on MSW in India attributed to the intervention efforts of grassroots NGO/ CBO in prevention and control activities through effective behaviour change communication programmes and other interventions. This therefore indicates that education is an important factor in determining safe sex practices among male sex workers. Uneducated MSW are neither aware of safe sexual practices nor have the appropriate perception of risk. This also points to the fact that educated MSW are in a better position to read and understand HIV/ AIDS related prevention messages and one-to-one rapport with educated clients and NGO/ community workers that reflects on better adoption of safe sex practices. All the same, grassroots interventions can also help in enhancing condom adoption and lesser risk taking by Male Sex Workers. Table – 21 Sexual practices, behaviour and client profile of MSW by Marital status Sexual practices, behaviour and client profile (N=75) Sex for Condom Condom money/ use use gifts (6 months) (Last time)

Sexual history

Marital status

(Last time)

(%) 71 94.7 44 58.6 23 30.7 1 1.3 3 4.0

TOTAL Unmarried Married living with spouse Married living without spouse Separated/ Divorced

(%)

(%)

66 88.0 40 53.3 22 29.3 1 1.3 3 4.0

63 84.0 39 52.0 21 28.0 1 1.3 2 2.7

According to the data presented in Table – 21, the sexual behaviour and practices of MSW are highlighted based on their marital status. The data reveals that 59 percent of MSW who engaged in sex in exchange for money, gifts, etc. are unmarried while 36 percent were evermarried. Condom use data indicates that 53 percent of unmarried respondents reportedly used condoms consistently during the last 6 months and a similar number, 52 percent reported condom use during their last sexual encounter. This may be due to the fact that majority of the respondents are unmarried. However, it is also of concern to note that only about half the respondents use condoms and this needs to be scaled up to reduce risk of HIV infection. Table – 22 Sexual practices, behaviour and client profile of MSW by Occupation Sexual history

Occupation

Sexual practices, behaviour and client profile (N=75) Sex for Condom Condom money/ use use gifts (6 months) (Last time)

(Last time)

TOTAL

NIMSW

(%) 71 94.7

(%)

(%)

66 88.0

63 84.0

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Pilot Study on MSW in India Unemployed Full-time Part-time

5 6.7 10 13.3 56 77.9

4 5.3 10 13.3 52 69.3

5 6.7 9 12.0 49 65.3

The occupation-wise classification of sexual practices of clients may be observed in Table - 22 given above. It may be observed that as majority MSW are employed in part-time jobs, larger number among such MSW, 78 percent said they had sex in exchange for money, gifts, etc., followed by 13 percent who are in full-time jobs who said they had such paid sex. Condom use, both consistent use over 6 months and use during last time are reportedly high by part-time employed MSW, 69 percent and 65 percent respectively compared to MSW with fulltime jobs, around 12 to 13 percent reporting condom use (consistent use as well as use during last time). Table – 23 Sexual practices, behaviour and client profile of MSW by Income Sexual history

Average Income PM

Sexual practices, behaviour and client profile (N=75) Sex for Condom Condom money/ use use gifts (6 months) (Last time)

(Last time)

TOTAL

(%) 71 94.7

(%)

(%)

66 88.0

63 84.0

37 49.3 26 34.7 6 8.0

35 46.7 23 30.7 8 10.7

35 46.7 22 29.3 6 8.0

66 88.0 2 2.7 3 4.0

62 82.7 1 1.3 3 4.0

58 77.4 2 2.7 3 4.0

Income (all sources) < Rs.2500 Rs.2501 – Rs.5000 > Rs.5001 Income (sex work) < Rs.1500 Rs.1501 – Rs.3000 > Rs.3001

According to the data presented in Table – 23, the sexual practices, behaviour and client profile of MSW by income is analysed. The data reveals that majority of MSW, 50 percent who had sex in exchange for money during last time earn below Rs.2500/- a month and 35 percent of those reporting similar behaviour earn between Rs.2501/- and Rs.5000/- per month. It is also important to note that larger number of MSW, 88 percent who engaged in paid sex during last sexual encounter earn up to Rs.1500/- from sex work. A similar pattern is observed with regard to condom use. Income levels of clients match those of MSW and therefore they may be said to be of the same economic class. Consistent condom use and condom use during last encounter are reportedly high among those earning low incomes though the same may be as mentioned earlier

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Pilot Study on MSW in India due to better interventions at grassroots by NGO/ CBO. MSW with higher incomes too, exhibit better condom use patterns that point out to affordability of condoms. It is noteworthy that those MSW who earn higher incomes adopt safer sex practices as they can afford them. With respect to condoms, discussions revealed that MSW are not satisfied with cheap or freely distributed condoms that tear or break on use. MSW prefer to use well lubricated condoms especially during anal sex. Condom use during oral sex is not popular as risk perception of spread of infection through the mouth is reportedly unheard of among MSW though a few insist that their clients use condoms during oral sex too. MSW know about and prefer flavoured condoms for oral sex but are concerned about the cost of use. (A pack of 3’s of good lubricated/ flavoured condoms costs at least Rs.15/- that cannot be afforded by all MSW). Many reportedly carry condoms at all times (powdered/ jelly filled) and are known to negotiate condom use with clients. However, it has been noticed that intimacy of relationships (especially recreational sex) may lead to increased instances of unprotected sex.

8.2 Type of sex, condom use and risk Sexual practices The tables given below provide an analysis of the type of sex popular among MSW in Ahmedabad City. An overview of the type of sex indicates that all MSW, 100 percent engage in anal sex followed by 96 percent in oral sex and 67 percent ‘thigh’ sex where clients use the thighs of MSW to have sex. Further, 9 percent reported having vaginal sex (presumably bisexuals) and 1 percent engage in other sex acts (‘rolling sex’ where two sexual partners roll on the cot or ground while having sex, ‘body sex’, also involving licking the whole body of the sexual partner and ‘group sex’ where more than three to four sex partners fondle and have sex together). Other sexual practices include ‘Rimming’ or licking the anal portions of sex partners that is reportedly popular among MSW. Table – 24 Type of sex by MSW by Age Group Type of sex Age TOTAL < 18 19-25 26-32 33-39 40 & >

Type of Sex (N=75) Oral (%) 72 96.0 1 1.3 28 37.3 20 18.7 13 17.3 10 13.3

Anal (%) 75 100.0 1 1.3 31 41.3 20 18.7 13 17.3 10 13.3

Vaginal (%) 7 9.3 --1 1.3 3 4.0 3 4.0 ---

Thigh (%) 50 66.7 1 1.3 17 22.7 17 22.7 9 12.0 6 8.0

Others (%) 1 1.3 ----1 1.3 -----

The age-wise distribution of type of sex by MSW is depicted in Table –24. It is observed that a majority of those involved in oral sex, 37 percent are in the 19-25 age group followed by 19 percent who are 26 to 32 years old. A similar pattern is visible in the case of MSW engaging in

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Pilot Study on MSW in India anal sex with 41 percent in the 19-25 age group and around half that number, 19 percent having anal sex are older (26-32 years of age) and an equal number of 23 percent involved in thigh sex also are in the age group of 19-25 years and 26-32 years However, in the case of vaginal sex, more number of MSW, 4 percent belonged to the older age group of 26-32 years and an equal percent in the 33-39 age group. This indicates that oral and anal sex is very popular among MSW. In Ahmedabad city, many MSW perceive themselves as Panthi and hence play the role of the penetrative partner during sex act. Thus, they may have a preference for anal sex compared to other sexual types though oral and thigh sex are also very popular. Table – 25 Type of sex by MSW by Marital Status Type of sex Marital status TOTAL Unmarried Married living with spouse Married living without spouse

Type of Sex (N=75) Oral (%) 72 96.0 5 6.7 10 13.3 57 82.0

Anal (%) 75 100.0 5 6.7 10 13.3 60 80.0

Vaginal (%) 7 9.3 ----7 9.3

Thigh (%) 50 66.7 4 5.3 8 10.7 38 50.7

Others (%) 1 1.3 ----1 1.3

Table -25 given above describes the type of sex activity preferred by MSW in relation to their marital status. It is interesting to note from the data that among MSW engaging in oral sex, 82 percent are married but living without spouse compared to 13 percent married with spouse and 7 percent unmarried respondents. Similar patterns can be observed in other sex type of MSW – 80 percent engaging in anal sex are married living without spouse, in contrast to 13 percent married and with spouse and 7 percent unmarried. Among respondents engaging in thigh sex, 51 percent are married living without spouse, 11 percent married living with spouse and only 5 percent unmarried. Comment The type of sex that is popular among male sex workers is definitely anal sex though a large number also engage in oral sex, especially the transgender community. Moreover, the younger age group are known to enjoy variations in different kinds of sex though there is a preference for anal sex. As mentioned earlier, anal sex activity may be attributed to more number of MSW identifying themselves as panthi. Ahmedabad may not have classic ‘hustlers’ and many men having sex with men in lower socio-economic strata engage in sex work when employed in parttime jobs.

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8.3 Violence, criminalisation Violence and criminal assault The following tables depict the extent of sex-related violence that MSW faced from their clients and others as a result of engaging in sex work. It is important to note that around half the number of MSWs interviewed, 48 percent experienced acts of violence committed against them and so did a similar number, 44 percent reportedly faced criminal assault – booked by police and law enforcing authorities on false charges of being public nuisance, false petty cases and the like and harassed in custody. Table – 26 Violence and criminal assault against MSW by Age group Violence, etc. Age group TOTAL < 18 19-25 26-32 33-39 40 & >

Forced sex, violence and criminal assault (N=75) Criminal Forced sex assault & violence (percent)

(percent)

36 48.0 1 1.3 12 16.0 10 13.3 7 9.3 6 8.0

33 44.0 --9 12.0 11 14.7 8 10.7 5 6.7

The age-wise distribution of forced sex and violence as well as criminal assault is described in Table – 26. From the above table, it may be observed that a majority of the younger MSW, 16 percent in the age group of 19 to 25 years were forced to have sex with their clients and acts of violence were perpetrated against them. Comparatively, 13 percent in the 26 to 32 age group said they faced such sex-related violence. Moreover, 9 percent of older respondents in the 33-39 age group also reported such violence. This indicates that age is not a factor and sex related violence occurs among all MSW for which they have no recourse as they are unorganised and most instances go unreported. Many described about being burnt over the body with cigarette buts, thrashed and beaten on their backs and sex organs, made to indulge in painful sex acts, gagged and forced to have sex. Many MSW however view such acts as rare instances by a few clients whom they consider facing a psychological problem. It is also seen that clients who pay more indulge in such harsh treatment while having sex. With regard to criminal assault however, majority of the respondents, 15 percent were in the 26 to 32 years age group followed by 12 percent in the younger age group of 19-25 years. Around 11 percent of older MSW in the 33-39 age group also faced criminal charges against them.

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Pilot Study on MSW in India Table – 27 Violence and criminal assault against MSW by Income Forced sex, violence and criminal assault (N=75) Criminal Forced sex assault & violence

Violence, etc. Income (all sources) TOTAL < Rs.2500 Rs.2501 – Rs.5000 > Rs.5001

(percent)

(percent)

36 48.0 21 28.0 10 13.3 5 6.7

33 44.0 15 20.0 13 17.3 5 6.7

According to the data given in Table - 27 above, violence and criminal assault against MSW with respect to their average monthly income from all sources is analysed. It may be noticed from the above data that incidence of forced sex and sexual violence is higher among more number of the MSW, 28 percent earning lower income of up to Rs.2500/- a month, compared to that of MSWs earning between Rs.2501 and Rs.5000 a month, 13 percent. Similar trends can be witnessed in the case of criminal assault by police and goondas whereby 20 percent of MSW earning lower monthly incomes are victimised in contrast to 17 percent who earn comparatively higher income.

Comment Male Sex Workers in Ahmedabad acknowledge that many are harassed, forced to have sex and unwanted sexual acts as well as face false criminal charges levelled against them by the police and public. Hence, their self-esteem is very low and they are not confident of facing such problems as others brand them as morally wrong doers. Male sex workers are known to be especially dejected when they face problems by people they move with very closely -–such as clients and their own mates. Economic concerns precede over other issues and MSW are left to face problems by themselves. It is also observed that because of such disorganisation among them, it is very difficult to target them or organise them to fight for their rights. Similarly, targeting them for interventions thus becomes a Herculean task and only through community based organisations of MSW themselves can succeed in outreach activities. Moreover, proper sensitisation among police force and law enforcing authorities, media and general public is viewed as critical to the betterment of conditions of MSW in Ahmedabad.

Unique Ahmedabad!

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9.0 HIV/ AIDS Prevention, Treatment, Care and Support Services 9.1 Awareness, sources and sexual behaviour The tables given below provide information on the extent of awareness of MSW on HIV/ AIDS, source of awareness and resultant sexual behaviour. Indications are that there is total awareness with all 100 percent of respondents stating they are aware about HIV/AIDS. Statistics also reveals that awareness on HIV/ AIDS is 100 percent among clients of MSW in Ahmedabad City. Table – 28 Awareness on HIV/AIDS of MSW by Age group Awareness

Age group TOTAL < 18 19-25 26-32 33-39 40 & >

Awareness on HIV/ AIDS (N=75) Average Age in age of completed client years (Percent) (Percent) 75 75 100.0 100.0 1 --1.3 31 34 41.3 45.3 20 32 18.7 46.7 13 8 17.3 10.7 10 1 13.3 1.3

The age-wise distribution of HIV/AIDS awareness among MSW and their clients is described in Table - 28 above. It may be seen that while majority of the MSW, 41 percent in the 19-25 years age group are aware of HIV/ AIDS, only 19 percent in the 26-32 year age group are aware of the same and only 17 percent of those in the 33-39 years are range are aware of HIV/ AIDS. Among clients, a different pattern emerges. Though majority of clients, 45 percent aware of HIV/ AIDS are in the 19-25 year age group, 47 percent of older clients in the 26-32 years age group are aware of HIV/ AIDS. Table – 29 Awareness on HIV/AIDS of MSW by Education Education status of MSW (N = 75) Education TOTAL Illiterate Primary

NIMSW

Responses (Percent) 75 100.0 10 13.3 22

97

Pilot Study on MSW in India 29.3 27 36.0 10 13.3 2 2.7 4 5.3

Middle school Higher Secondary Technical Higher Education

The data presented in Table - 29 above describes the awareness of MSW on HIV/ AIDS with respect to their educational status. It may be observed from the data that education plays an important role to play in increased awareness on HIV/ AIDS. As evident from the table, majority of the respondents, 36 percent who were aware of HIV/ AIDS were educated up to middle school level followed by 29 percent who had primary education and 13 percent who were educated up to higher secondary level. Awareness among MSW with technical and higher education is high with almost all respondents being aware of HIV/ AIDS. Hence, education is an important factor in enhancing knowledge and awareness, more so because educated MSW are able to read and respond to IEC and prevention or behaviour change communication messages displayed by grassroots level HIV/AIDS interventions. Figure – 11 Sources of Awareness on HIV/AIDS of MSW

Sources of awareness on HIV/AIDS 98.7

100 80

88 72

60

66.7 45.3

52

56 53.3

40 20 1.3

0

Sources of awareness Television Poster NGO/ CBO

Radio Pamphlet Friends

Newspaper Doctor Other sources

The main sources of awareness of HIV/ AIDS messages is depicted in Figure-11 given above. From the same, it may be observed that NGO/ CBO, is an important media, 74 percent followed by friends, peers or colleagues, 66 percent Television 54 percent and Posters, hoarding and messages displayed in public places 50 percent. Other important sources of awareness on HIV/ AIDS include Pamphlets, 42 percent, Doctor, 40 percent, Newspapers, 39 percent and Radio, 34 percent Posters. Hence, in disseminating prevention messages, it is important to focus one-to-one communication by NGO/CBO workers, doctors and peers are also

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Pilot Study on MSW in India seen as important channels to provide vital information to the hidden male sex worker community. Besides popular mass and electronic as well as print media such as Television, Radio, Newspapers, Posters and Pamphlets may be effectively used to improve awareness on HIV/ AIDS. Table – 30 Awareness on HIV/AIDS and sexual behaviour of MSW Awareness on HIV/AIDS and behaviour of MSW (N = 75) Sexual behaviour Last time had sex for money/ gifts, etc. (MSW) Last time used condoms while having sex

Responses (Percent) 71 94.7 63 84.0

Awareness of MSW on HIV/AIDS and resultant sexual behaviour is analysed in Table -30 given above. From the table, it may be observed that among MSW who are aware of HIV/ AIDS, a high 95 percent reportedly had sex in exchange for money, gifts, etc. during the last time and among MSW aware of HIV/ AIDS, 84 percent reported using condoms during the last time they had sex. This indicates that though awareness on HIV/ AIDS is high and engaging in sex in exchange for money is prevalent (indicating high level of multi-partner sexual activity) such knowledge is not translated into changed behaviour as unprotected sex is high. This points at the need to strengthen Behaviour Change Communication measures among the target audience – MSW in order to enhance knowledge and awareness and result in adoption of safe sex methods to prevent HIV infection. As seen earlier, MSW do not also perceive risk of infection as a result of anal or oral sex. (Many simply have the misconception that HIV infection can be spread only through vaginal sex with female commercial sex workers).

Transvestite dancing with boy during a cultural festival that is very popular during specific seasons

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9.2 Availability and access to services Awareness, Availability and Access to services by MSW The following tables provide an understanding of the awareness on HIV/ AIDS related services provided by NGOs/ CBOs by the Male Sex Workers in Ahmedabad city, availability of such services and accessibility of such services by MSW. The overall scenario on service awareness, availability and access reveals that all MSW in the city are aware of such services, 100 percent though fewer numbers are aware of the range of services offered such as condoms, 75 percent medicines, 72 percent clinical facilities (testing and treatment), 51 percent counselling and referral services and are neither aware where such services are offered and by whom, 25 percent (NGO/ CBO/ Government/ private/ traditional systems). However, overall access to available services among those who are aware is high with all MSW stating that they access services they are aware of. Table – 31 Awareness, Availability and Access to services by MSW by Age Group Service access Age TOTAL < 18 19-25 26-32 33-39 40 & >

Awareness, Availability and Access to services (N=75) Aware (%) 75 100.0 1 1.3 31 41.3 20 18.7 13 17.3 10 13.3

NGO (%) 19 25.3 --6 8.0 14 18.7 6 8.0 4 5.3

Range of services Condom Clinic Drugs (%) (%) (%) 56 38 54 74.7 50.7 72.0 1 1 --1.3 1.3 5 3 6.7 4.0 --3 2 4.0 2.7 --6 1 6 8.0 1.3 8.0 6 6 --8.0 8.0

Jelly (%) 55 73.3 1 1.3 --1 1.3 6 8.0 6 8.0

Access (%) 75 100.0 1 1.3 31 41.3 20 18.7 13 17.3 10 13.3

Table -31 provides an insight into the awareness, availability and access to health and related services for MSW with respect to their age. It may be seen that majority of MSW aware of such services, 41 percent are in the 19-25 age group followed by older MSW in the 26-32 age group, 19 percent and those in 33-39 age group, 17 percent. However, only 25 percent said they knew only of NGO/ CBO providing such services. The entire range of services is not known to many respondents and only few mentioned of condoms, clinical services, drugs and provision of jelly as part of treatment services available to MSW in the city. Accessibility to services is high among those who are aware of such services and is proportionately spread across age groups that are aware of such services, and data indicates that information or increased awareness of availability of services is more likely to enhance use of such available services.

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Pilot Study on MSW in India Table – 32 Awareness, Availability and Access to services by MSW by Education Service access Education TOTAL Illiterate Primary Middle school Higher Secondary Higher Education No Response

Awareness, Availability and Access to services (N=75) Aware (%) 75 100.0 10 13.3 22 29.3 27 36.0 10 13.3 2 2.7 4 5.3

Range of services Condom Clinic Drugs (%) (%) (%) 56 38 54 74.7 50.7 72.0 5 3 4 6.7 4.0 5.3 17 11 17 22.7 14.7 22.7 21 15 21 28.0 20.0 28.0 9 6 9 12.0 8.0 12.0 2 1 1 2.7 1.3 1.3 2 2 2 2.7 2.7 2.7

NGO (%) 19 25.3 5 6.7 6 8.0 5 6.7 1 1.3 --2 2.7

Jelly (%) 55 73.3 5 6.7 17 22.7 20 18.7 9 12.0 2 2.7 2 2.7

Access (%) 75 100.0 10 13.3 22 29.3 27 36.0 10 13.3 2 2.7 4 5.3

From the above Table – 32, the education-wise distribution of service awareness, availability and access may be ascertained. It is evident from the above data that more educated MSW, 36 percent educated up to middle school level and 13 percent with higher secondary education are aware of treatment services and also access such services. It is also evident that many respondents educated only up to primary level, 29 percent are aware of services and all those who access services access the same. Though the numbers indicate that service access is poor despite good awareness, among those who have accessed such services, it is observed that they are more educated and therefore education and increased awareness is an important variable in improving service access. Table – 33 Awareness, Availability and Access to services by MSW by Marital status Service access Marital status TOTAL Unmarried Married, living with spouse Married, living without spouse Separated/ Divorced

Awareness, Availability and Access to services (N=75) Aware (%) 75 100.0 45 60.0 26 34.7 1 1.3 3 4.0

NGO (%) 19 25.3 9 12.0 10 13.3 -----

Range of services Condom Clinic Drugs (%) (%) (%) 56 38 54 74.7 50.7 72.0 36 26 34 48.0 34.7 45.3 16 10 16 21.3 13.3 21.3 1 1 1 1.3 1.3 1.3 3 1 3 4.0 1.3 4.0

Jelly (%) 55 73.3 36 48.0 15 20.0 1 1.3 3 4.0

Access (%) 75 100.0 45 60.0 26 34.7 1 1.3 3 4.0

The data in Table -33 presented above describes the awareness, availability and access to services with respect to marital status of the MSW in Ahmedabad City. It may be seen that as more number of respondents are unmarried, so are more unmarried MSW aware of such services,

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Pilot Study on MSW in India more than half the respondents, 60 percent and all who know of such services access the same. It may also be observed that proportionately most married respondents know of such services and knowledge is equal to access of services.

9.3 Barriers in accessing services and suggestions Only few respondents were able to directly mention various barriers faced in accessing services in the quantitative study. However, from the discussions and qualitative phase, inputs reveal that there are several barriers that male sex workers need to overcome to access services even if awareness levels are high. The key issue is availability of such services. Not all range of services are offered that are needed by MSW. The only services that MSW seem to know include condoms, clinics, drugs and provision of jelly for pain in sex organs. However, they opine that services not available readily are counselling, diagnosis and testing and provision of free medicines for all sex-related diseases (including STI and HIV infection). Moreover, such services are not easily accessible, as they are located in inconvenient locations where respondents have to cover long distances for access. Respondents have complained of illequipped centres with poor infrastructure and non-availability of personnel. Male sex workers in Ahmedabad have mentioned about poor range of services among service providers. The extent of services provided by Non-Governmental Organisations/ CBOs is either not substantial or is unknown to a large target audience. This calls for establishing effective linkages and networking of institutions to disseminate information on available services that may be accessed by MSW in the city. MSW living or working in outer areas and in the suburbs face specific problems in commuting to the main city and accessing prominent health care facilities. They are also concerned about issues such as stigma and discrimination or identification by known friends/ family members. Thus such issues need to be addressed to provide services at convenient locations where MSW aggregate, work or solicit clients. With regard to services, they also prefer to access free services and would like to receive even drugs and medicines free of charge for sexually transmitted infections (STIs), HIV prevention and Opportunistic Infections (OIs). This is because many of the MSW hail from weaker socio-economic strata and therefore are unable to afford money for drugs and medicines. Many are known to take self-medication and seek medical help from friends/ peers as well as in the pharmacy. Many MSW are known to access free treatment at government hospitals and clinics but are unhappy with the quality of services and attention given to them by the personnel. Not many are aware of the numerous NGOs/ CBOs and services they offer in the city. Besides, interventions focussing on condom promotion are lacking explaining for poor condom use among many MSW. This enhances risk but many MSW do not perceive appropriate risk in engaging in unprotected sex mainly with other men or women.

Kankaria Lake, at the heart of Ahmedabad City that is also an MSW hotspot

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9.4 Problems faced by Male Sex Workers Figure – 12 Problems faced by MSW

Problems faced by MSW 100 80

85.3

74

60

65.4 53.3 50.7

58.6

56

40

41.3

20 0 Jealousy Blackmailing Hiding from family Exposure

48

53.3

4

Problems faced Robbing clients Cheating/ free sex Fear of disclosure Other problems

Police harassment Switching loyalty No consent to open

According to Figure-12 portrayed above, the problems faced by MSW in Ahmedabad City is examined. The data indicates that Male Sex Workers face a host of problems. The most pressing problems that surface are jealousy between sex workers themselves, 85 percent that points out to intra-community (among Kotis, Dublis, Masseurs for clients and money) and intercommunity (between hijras and others for control of areas/ leadership) conflicts prevalent among male sex workers, such as robbing of clients from friends/ other MSW, 74 percent. Most of the other problems identified are on an individual basis such as cheating by customers or not paying agreed sum after sex, 65 percent, switching customers/ clients. Here, it is important to note that older MSW see younger MSW as their rivals as clients prefer younger (stronger) male sex workers. This also indicates that younger sex workers are paid better than older ones and hence this develops into conflict between sex workers. Other reasons for concern among MSW include hiding their behaviour from family members, 56 percent as many carry on the sex work without knowledge of the family with sisters of marriageable age and younger siblings whom they have to support economically, harassment and forced sex by police, 53 percent and constant threat of being exposed in society by friends/ peers or even clients in public, an equal 53 percent. Many are worried about being ostracised when discovered that they are sex workers, being blackmailed, 50 percent. While 41 percent feared that they might disclose their sex-related behaviour to their families, 48 percent said they were afraid that others would reveal their involvement in sex activity without their consent. Around 4 percent MSW said they faced other problems as being betrayed by own community, threats from relatives and fear of goondas or rowdies.

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10.0

MALE SEX WORKERS IN INDIA VIJAYAWADA CITY

A bird’s eye view of Vijayawada City from atop the hill Vijayawada, in Andhra Pradesh is located at the head of the Krishna delta, 70km from the sea. Earlier known as Bezwada it has a long and glorious history and is famous for traditional handcrafted wooden toys. The present name is derived from the presiding deity, Kanakdurga also called Vijaya. The city, a major railway Junction is picturesquely surrounded by hills on three sides, with the swiftly flowing waters of the Krishna river on the south. Today it is a thriving business centre and a convenient base from which to visit varied historical sites. With a population of over 8,45,300 people, it is a growing city and is one of the important cities after the capital Hyderabad in Andhra Pradesh. Telugu, Hindi and English are the main languages though one can find many people speaking Tamil and Kannada as these are languages of neighbouring states. The analysis of the quantitative data begins with the socio-demographic profile of Male Sex Workers in Vijayawada in order to understand the physical and environmental conditions that affect MSW and also lead to a better understanding of the respondents through a macro perspective. An analysis of the socio-demographic profile of the MSW reveals that 51 percent are between 19 and 25 years of age, and 79 percent reported having their first sexual experience and 69 percent reportedly involved in sex first in exchange for money, gifts, etc., when they were below 18 years of age. Further, 55 percent opined that the average age of their clients is between 19 and 25 years. Education status indicates that 41 percent have studied only up to middle school, and a majority comprising 56 percent are unmarried. Occupational status data shows that 45 percent are employed in full-time jobs, with 52 percent earning below Rs.2500 a month from all sources and 81 percent earning up to Rs.1500 from engaging in sex work. Statistics also reveal that 84 percent view television and 33 percent listen to the radio and 29 percent read the newspapers and that 73 percent have the habit of consuming alcohol and 47 percent are smokers.

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10.1

Socio-demographic characteristics Figure – 1 Age of Male Sex Workers (MSW) Age in completed years 2.7 2.7

10.7

50.7

33.3

26-32 Years

19-25 Years Above 40 Yrs.

< 18 Years 33-39 Years

According to the data presented in Figure-1 given above, the age of Male Sex Workers in Vijayawada City has been described. It may be observed that a majority of the MSW, 51 percent are between 19 and 25 years of age, followed by 33 percent who are older in the 26 to 32 years age group. While 11 percent of the MSW interviewed in the study are between 33 and 39 years, 3 percent are below 18 years of age. An equal 3 percent are above 40 years of age. Hence, it may be concluded that a majority of the Male Sex Workers in Vijayawada are younger.

Figure – 2 Age at first sex and Age at first Commercial Sex of Male Sex Workers (MSW)

78.7

Age in completed years 69.3

80 60 40

26.7 20

1.3

20 0

< 18 19-25 26-33 Years Years Years Age at 1st sex

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Age at 1st com. Sex

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Figure-2 above portrays the age at first sex and age when MSW first had sex in exchange for money, gifts, etc., of Male Sex Workers in Vijayawada City. It is seen from Figure-2 that 79 percent reported having their first sexual experience below 18 years of age while 20 percent said their first sex experience occurred when they were between 19 and 25 years old. However with respect to the age at which the MSW had sex for the first time in exchange for money, gifts, etc., it is seen that while 69 percent reported such experience when they were were between 19 and 25 years of age, 27 percent reported engaging in paid sex first when they were below 18 years of age. Figure – 3 Average Age of the clients of Male Sex Workers (MSW) Average Age of clients of MSW 54.7

60 50

36

40 30 20 10

8

0

< 18

0

1.3

Avg. age of client

19-25

26-32

33-39

40 & >

Figure-3 analyses the average age of the clients of the Male Sex Workers that reveals a different pattern. While majority of the MSW, 55 percent opined that the average age of the clients is between 19 to 25 years, a sizeable number, 36 percent said their clients were old 26 to 32 years of age. Only 8 percent reported that their clients were older in the 33 to 39 years age group. This indicates that older clients prefer younger persons as their partners and there is a large demand for young boys.

The deity at Kanaka Durga Temple

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Figure – 4 Educational status of Male Sex Workers (MSW)

Education status of MSW

50

41.3

40 30

21.3

20

20

9.3

6.7

10

1.3

0

0

Education

Illiterate

Primary

Middle school

Hr. Sec. No Resp.

Technical

Hr. Edu.

The educational status of the MSW is indicated in Figure-4 above. It is noticed that majority of the MSW interviewed, 41 percent have completed only up to middle school followed by 22 percent who are educated up to higher secondary and 20 percent have had only primary education. This indicates poor education levels among male sex workers that points out to the need to cater to information and education needs of respondents with respect to health/ HIV/ AIDS efforts. Figure – 5 Marital status of Male Sex Workers (MSW)

Marital Status of MSW 60 50 40

56

37.3

30 20 10 0

2.7

4

0

Marital status

Unmarried Married, living with spouse Married, living without spouse Separated/ Divorced No Response

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Pilot Study on MSW in India Figure-5 describes the marital status of the MSW covered in the study. With a predominantly large younger group, expectedly a large 56 percent are unmarried. Among ever-married MSW, a high 37 percent are living with their spouse and only 3 percent are living without their spouse. Marriage is a crucial factor as it determines risk and vulnerability to HIV infection during unprotected sex. Figure – 6 Occupational status of Male Sex Workers (MSW)

Occupation Status of MSW 45.3

50

36

40 30

18.7

20 10 0

Occupation

Unemployed Full-time employed Part time employed

From Figure-6, the occupational status of the MSW may be ascertained. The data reveals that majority of the respondents, 45 percent are employed in full-time jobs while 36 percent are engaged in part-time jobs and 19 percent are unemployed. The type of occupations that have been observed include petty traders, rickshaw pullers, male commercial sex workers, vendors, drivers, and the like. A few have taken up working with NGO/ CBO as peers and volunteers and continue to engage in sex work. Figure – 7 Average monthly income of Male Sex Workers (MSW) (All sources) Average Monthly Income - all sources 8

40

52 < Rs.2500

Rs.2501 – Rs.5000

> Rs.5001

According to Figure-7, the gross Average Monthly Income of the MSW has been recorded. This indicates that abouth half the number of respondents, 52 percent earn between Rs.2501 and Rs.5000 from all sources while 40 percent earn below Rs.2500 a month. Only 8 percent reportedly earn more than Rs.5001 a month. It may therefore be concluded that the economic condition of MSW is not very good and many are forced to work hard for a living. This may be a motivating factor for MSW to take up sex work as alternate means of income generation.

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Pilot Study on MSW in India Figure – 8 Average monthly income of Male Sex Workers (MSW) (Sex work)

Average Monthly Income - sex work 4 14.7

81.3
Rs.1501-3000

>Rs.5001

The average monthly income of MSW from sex work is described in Figure-8. From the table, it may be inferred that a large number, 81 percent earn up to Rs.1500 from engaging in sex work followed by only 15 percent who earn between Rs.1501 and Rs.3000 from sex work alone. This is done to augment their meagre income they earn from their full-time employment It is also observed that in certain instances, clients offer money willingly and when satisfied with sexual experience are reported to pay extra to MSW in gratitude. In Vijayawada typically, many MSW hail from middle class or lower middle class families, live with parents and siblings but engage in sex work too in addition to regular employment without the knowledge of the family.

10.2

Lifestyle, environmental influences Figure - 9 Media habits of Male Sex Workers (MSW)

Media habits of MSW 100

84

80 60 40

33.3

29.3

20 0

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6.7

0

Media channels

Television

Radio

Magazines

Cinema

Newspaper

110

Pilot Study on MSW in India The media habits of the MSW in this study may be gauged from the multiple response Figure-9 given above. It is observed that majority of the MSW, 84 percent view television and 33 percent listen to the radio. A lesser number, 29 percent also reportedly read the newspapers. Only 7 percent read magazines and none keenly watch movies. It may thus be concluded that MSW are exposed to both electronic and print mass media and hence these may be used for getting messages on prevention, education, treatment, care and support in relation to HIV/ AIDS. Figure – 10 Other habits of Male Sex Workers (MSW)

Other habits of MSW 73.3

80 70 60 50

46.7 36

40 30 13.3

20

1.3

10 0 Other habits

Smoking Drugs Other habits

Alcoholism Consuming tobacco

Figure-10 presented above describes the other habits of MSW. It may be seen from the above table that 73 percent have the habit of consuming alcohol and 47 percent are smokers. A large number, 36 percent also reported chewing tobacco (local ‘paan’) and many are addicted to locally available tobacco and ‘masalas’ with intoxicants. A good number, 13 percent also reported taking drugs. Such habits as alcoholism and drugs are known to induce to poor adoption of protective measures leading to increased risk of HIV infection.

Comment Profile of a typical MSW in Vijayawada City From a study of the overall socio-demographic profile of Male Sex Workers in Vijayawada City, a typical profile of an MSW may be constructed. Thus, a male Sex Worker in this city is young, say around 22 years of age, who had his first sexual experience below the age of 18 years, and had sex in exchange of money, gifts, etc., for the first time when between 19 and 25 years of age. This MSW caters to most clients in the age group of 26-32 years. The typical MSW is educated up to middle school, unmarried, employed in some full-time occupation and also engages in sex work on a part-time basis. The average gross monthly income from all sources is between Rs.2501/- to Rs.5000/- and to augment income earns up to Rs.1500/- through sex work. The typical MSW is a keen TV viewer, listens to the radio and also reads newspaper regularly. Other

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Pilot Study on MSW in India habits include taking alcohol, smoking, and usually chewing tobacco in various forms. The MSW exhibits a casual attitude and is always looking for new clients and engaging in sex in exchange for money whenever possible.

The Bridge spanning the Krishna River

10.3

Identity and sub-types

Awareness of MSW on types and subtypes of Male Sex Workers in Vijayawada City

Table – 9

Awareness of Male Sex Workers Genre by MSW by Age Group Awareness Age TOTAL < 18 19-25 26-32 33-39 40 & >

Male Sex Worker Subtypes (N=75) Koti (%) 75 100.0 2 2.7 38 50.7 25 33.3 8 10.7 2 2.7

Panthi (%) 75 100.0 2 2.7 38 50.7 25 33.3 8 10.7 2 2.7

Dubli (%) 75 100.0 2 2.7 34 45.3 25 33.3 7 9.3 2 2.7

Hijra (%) 69 92.0 2 2.7 34 45.3 24 32.0 7 9.3 2 2.7

Gigolo (%) 10 13.3

Masseur (%) 43 57.3

Escort (%)

Londa (%)

---

---

---

---

---

---

4 5.3 5 6.7 1 1.3

22 29.3 16 21.3 4 5.3 1 1.3

---

---

---

---

---

---

---

---

---

---

---

Dancer (%) 8 10.7 --4 5.3 4 5.3

The data in table - 9 presented above describes the Male Sex Workers awareness of the various types and sub-types of MSW that are reportedly existing in society in various proportions with respect to their age.

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Pilot Study on MSW in India Comment The overall analysis of MSW on awareness pertaining to MSW genre indicates that a majority of the MSW in Vijayawada City is aware of predominantly main groups in the MSW network in the city. While all respondents, 100 percent know about Koti, Panthi and Dubli. A lesser number, 92 percent knew of Hijra and 57 hear about Masseurs. However, only 13 percent knew about Gigolo and 11 percent heard reportedly heard of Dancer as a subtype of MSW in Vijayawada City. An analysis of the age-wise classification of data reveals that among those aware of Koti and Panthi, an identical 51 percent are in the 19 to 25 years age group, followed by 33 percent in the 26 to 32 years age group. 11 percentage of respondents aware of Koti were between 33 and 39 years of age. A similar trend is observed in the case of those aware of Dubli, with 45 percent in the 19 to 25 years age group, followed by 33 percent in the 26 to 32 years age group and 9 percent between 33 and 39 years of age. Among those aware of Hijra, 45 percent are in the 19 to 25 years age group, followed by 32 percent in the 26 to 32 years age group and 9 percent between 33 and 39 years of age. Table – 10 Awareness of Male Sex Workers Genre by MSW by Education Awareness Education TOTAL Illiterate Primary Middle Hr. Sec. Technical Hr. Education

Male Sex Worker Subtypes (N=75) Koti (%) 75 100.0 5 6.7 15 20.0 31 41.9 16 21.3 7 9.3 1 1.3

Panthi (%) 75 100.0 5 6.7 15 20.0 31 41.9 16 21.3 7 9.3 1 1.3

Dubli (%) 75 100.0 4 5.3 12 16.0 35 66.7 16 21.3 7 9.3 1 1.3

Hijra (%) 69 92.0 3 4.0 15 20.0 30 40.6 14 18.7 6 8.0 1 1.3

Gigolo (%) 10 13.3

Masseur (%) 43 57.3

Escort (%)

Londa (%)

---

---

---

---

---

---

3 4.0 3 4.0 4 5.3

8 10.7 18 24.0 13 17.3 4 5.3

---

---

---

---

---

---

---

---

---

---

---

---

-----

---

Dancer (%) 8 10.7 --1 1.3 2 2.7 5 6.7

Table - 10 depicts the Male Sex Worker’s understanding of the various types and sub-types prevalent with respect to their education. It may be deduced from the above data that majority of the respondents aware of various types and sub-types within MSW are educated up to middle school. The data indicates that majority of the respondents aware of Koti, Panthi, Dubli and Hijra are educated up to middle school, 42 percent, 42 percent, 68 percent, 41 percent respectively. Comparatively, a lesser number aware of the same subtypes are educated up to higher secondary level, 18 to 21 percent of all respondents aware of such categories. It is also observed that around 20 percent of respondents aware of these major groups are educated up to 20 percent. It may be observed from the data that educated respondents are more aware of the major types and sub-types of MSW than uneducated respondents.

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Pilot Study on MSW in India Table – 11 Awareness of Male Sex Workers Genre by MSW by Marital status Awareness

Male Sex Worker Subtypes (N=75)

Marital status TOTAL Unmarried Married living with spouse Married living without spouse

Separated/ Divorced No Response

Koti (%) 75 100.0 42 55.0 28 37.3 2 2.7 2 2.7 1 1.3

Panthi (%) 75 100.0 42 55.0 28 37.3 2 2.7 2 2.7 1 1.3

Dubli (%) 75 100.0 40 53.3 26 34.7 1 1.3 2 2.7 6 8.0

Hijra (%) 69 92.0 39 52.0 26 34.7 2 2.7 1 1.3 1 1.3

Gigolo (%) 10 13.3 6 8.0 4 5.3 -------

Masseur (%) 43 57.3 23 30.7 16 21.3 1 1.3 2 2.7 1 1.3

Escort (%)

Londa (%)

Dancer (%) 8 10.7 6 8.0 1 1.3

---

---

---

---

---

---

---

---

---

---

---

1 1.3

---

---

---

Table - 11 provides an analysis of awareness of MSW genre in relation to their marital status. The statistics reveals that most unmarried respondents are aware of various types and sub-types among MSW, as majority of respondents are unmarried. Overall,it may be seen that 52 to 55 percent of the respondents aware of the major sub-types – Koti, Panthi, Dubli and Hijra are unmarried while around 35 to 37 percent aware of the same are married and living with spouse. Table – 12 Awareness of Male Sex Workers Genre by MSW by Occupation Awareness Occupation TOTAL Unemployed Full-time Part-time

Male Sex Worker Subtypes (N=75) Koti (%) 75 100.0 14 18.7 34 45.3 27 36.0

Panthi (%) 75 100.0 14 18.7 34 45.3 27 36.0

Dubli (%) 75 100.0 14 18.7 36 48.0 25 33.3

Hijra (%) 69 92.0 14 18.7 32 42.7 23 30.7

Gigolo (%) 10 13.3 1 1.3 4 5.3 5 6.7

Masseur (%) 43 57.3 7 9.3 20 18.7 16 21.3

Escort (%)

Londa (%)

---

---

---

---

---

---

---

---

Dancer (%) 8 10.7 3 4.0 2 2.7 3 4.0

According to the data presented in Table -12, awareness of MSW on various types and subtypes of MSW genre based on their occupation is analysed. It may be observed that most MSW employed in full-time employment are aware of the various groups followed by a large number who are occupied in part-time occupations. This is followed by those who are unemployed. Thus, on an average, 40 to 45 percent of MSW aware of Koti, Panthi, Dubli and Hijra are employed in full-time jobs followed by 30 to 36 percent aware of the same having parttime jobs. Around 19 percent of respondents equally knowing of the main subtypes are unemployed.

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Pilot Study on MSW in India Table – 13 Awareness of Male Sex Workers Genre by MSW by Income Awareness Average Income PM TOTAL

Male Sex Worker Subtypes (N=75) Koti (%) 75 100.0

Panthi (%) 75 100.0

Dubli (%) 75 100.0

Hijra (%) 69 92.0

Gigolo (%) 10 13.3

Masseur (%) 43 57.3

30 40.0 39 52.0 6 8.0

30 40.0 39 52.0 6 8.0

27 36.0 42 55.0 6 8.0

28 37.3 36 48.0 5 6.7

3 4.0 7 9.3

16 21.3 22 29.3 5 6.7

61 81.3 11 14.7 3 4.0

61 81.3 11 14.7 3 4.0

62 82.6 11 14.7 3 4.0

55 73.4 11 14.7 3 4.0

9 12.0

Escort (%)

Londa (%)

Dancer (%) 8 10.7

---

---

---

---

---

---

---

---

---

---

7 9.3

---

---

---

---

---

1 1.3

Income (all sources) < Rs.2500 Rs.2501 – Rs.5000 > Rs.5001

---

5 6.7 1 1.3 2 2.7

Income (sex work) < Rs.1500 Rs.1501 – Rs.3000 > Rs.3001

--1 1.3

36 48.0 5 6.7 2 2.7

Table - 13 presents the awareness of respondents on various types and subtypes of MSW in Vijayawada City with regard to their monthly income. An overview of the data reveals that a majority of MSW aware of their genre and subtypes earn a monthly income (from all sources) of between Rs.2501 to Rs.5000 a month. A closer look at the data reveals that around half the respondents aware of Koti, 52 percent Panthi, 52 percent Dubli 55 percent Hijra, 48 percent and Masseur 29 percent earn between Rs.2501 to Rs.5000 a month (from all sources). A lesser number of respondents aware of the same major subtypes, Koti, 40 percent Panthi, 40 percent Dubli 36 percent Hijra, 37 percent and Masseur 21 percent earn below Rs.2500 a month from all sources. However, in relation to the income of the respondents from sex work, it is seen that a majority of the respondents aware of the major subtypes reportedly earn less than Rs.1500 a month from sex work (75 to 81 percent).

Type of Male Sex Workers as identified by MSW The following analysis describes the manner in which Male Sex Workers define or identify themselves. It also emphasises on their sexual orientation and gender. From the data, it may be inferred that majority of the MSW in Vijayawada, 36 percent identify themselves as Koti, while 32 percent consider that they are Dubli and according to 24 percent they are Panthi. Comparatively only 8 percent said they are Hijras. MSW do not identify themselves as other categories here. This indicates that in Vijayawada, one can find typically Koti, Pnthi or Dubli or Hijras and they are clearly distinguished by their orientation – signs and symbols used by each of these groups to identify and attract clientele, as well as clothing and other physical gestures as poise, walking style and speech.

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Table – 14 Type of Male Sex Workers by MSW by Age Group MSW Type Age TOTAL < 18 19-25 26-32 33-39 40 & >

Male Sex Worker Subtypes (N=75) Koti (%) 27 36.0 --10 13.3 10 13.3 6 8.0 1 1.3

Panthi (%) 18 24.0 1 1.3 14 18.7 2 2.7 1 1.3

Dubli (%) 24 32.0

---

---

--11 14.7 12 16.0 1 1.3

Hijra (%) 6 8.0 1 1.3 3 4.0 1 1.3

Gigolo (%)

Masseur (%)

Escort (%)

Londa (%)

Dancer (%)

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

1 1.3

---

---

---

---

---

From Table-14 given above, MSW identity and orientation with regard to age-wise categorisation may be ascertained. It is observed that majority of MSW who indicate they are Koti, 13 percent Panthi, 19 percent and Hijra, 4 percent are in the 19 to 25 age group. This is followed by many MSW, 13 percent Koti, Panthi, 3 percent and Hijra, 1 percent who are older, aged between 26 and 32 years of age. However, among Dubli, majority, 16 percent are 26 to 32 years old followed by 15 percent who are younger in the 19 to 25 years age group. This shows that while Kotis, Panthis and Hijras are younger, those who consider themselves as Dubli are older. Table – 15 Type of Male Sex Workers by MSW by Occupation MSW Type Occupation TOTAL Unemployed Full-time Part-time

Male Sex Worker Subtypes (N=75) Koti (%) 27 36.0 3 4.0 15 20.0 9 12.0

Panthi (%) 18 24.0 2 2.7 11 14.7 5 6.7

Dubli (%) 24 32.0 5 6.7 7 9.3 12 16.0

Hijra (%) 6 8.0 4 5.3 1 1.3 1 1.3

Gigolo (%)

Masseur (%)

Escort (%)

Londa (%)

Dancer (%)

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

The occupational classification of MSW with respect to their identity is examined in Table-15. It may be observed that majority of the MSW who consider themselves as Koti are employed in full-time jobs, 20 percent followed by those in part-time jobs, 12 percent. Further 4 percent of Koti are unemployed. A similar trend may be observed among those MSW considering themselves as Panthi with 15 percent in full-time jobs, 7 percent in part-time jobs and 3 percent unemployed. However, among Dubli, majority, 16 percent are employed in part-time jobs followed by 9 percent in full-time employment and 7 percent are unemployed. Among Hijras, a

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Comment It may thus be concluded that majority of the Male Sex Workers in Vijayawada are able to distinguish only the major classical types and sub-types of sex workers and orientation. There don’t seem to be specific regional classifications and an important feature is that there is little distinction between one group and the other and unlike other places, MSW here more frequently change roles and therefore distinction can become very difficult. Another important factor is that the sex market in Vijayawada is pretty large and potential for earning through sex is therefore proportionately higher. This increased demand also has lead to larger number of unemployed youth into the sex industry.

Understanding Sex Industry Network (SIN) – Place of soliciting/ pickup/ aggregating by Male Sex Workers. The following analysis provides an understanding into the Sex Industry Network by pinpointing the locations or places where Male Sex Workers solicit their clientele, pickup them for sexual activities or indicates where such MSW aggregate to attract clients and engage in sex for exchange of money, gifts, etc. It is important to identify such ‘hotspots’ as that would provide vital clues in approaching this otherwise hidden community for long-term healthcare interventions around HIV/ AIDS.

It is observed from the data that in Vijayawada City, the most popular places to solicit/ pickup clients and aggregate among MSW are the park, 89 percent, street, 85 percent, and bus stand, 83 percent followed by telephone, 77 percent, and railway station, 55 percent. Comparatively, the work areas for fewer MSW are the hotel, 37 percent or house, 36 percent. Besides, sex workers are also known to meet at brothels, chat rooms, through pimps, internet, Massage Parlours and Godown. Table – 16 Place of soliciting/ pickup/ aggregating by MSW by Age Group Pickup point

NIMSW

--10 13.3 2 2.7

Chat room (%)

27 36.0 1 1.3 14 18.7 5 6.7

Internet (%)

2 2.7 1 1.3

28 37.3 1 1.3 17 22.7 5 6.7

Godown. (%)

---

13 17.3

Pimp (%)

67 89.3 1 1.3 34 45.3 24 32.0

Telephone (%)

41 54.7 1 1.3 21 28.0 13 17.3

House (%)

62 82.7 1 1.3 31 41.3 23 30.7

Hotel (%)

6 8.0

Brothel (%)

Park (%)

26-32

Railway Stn. (%)

19-25

64 85.3 2 2.7 31 41.3 22 29.3

Bus stand (%)

TOTAL

Massage parlour (%)

Street (%)

Age

< 18

Male Sex Worker soliciting/ pickup/ aggregating points (N=75)

58 77.3

10 13.3

4 5.3

7 9.3

9 12.0

---

---

---

---

---

28 37.3 21 28.0

7 9.3 1 1.3

1 1.3 2 2.7

4 5.3 1 1.3

5 6.7 2 2.7

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8 10.7 1 1.3

3 4.0

6 8.0 1 1.3

---

4 5.3 2 2.7

7 9.3 1 1.3

1 1.3

4 5.3 1 1.3

---

6 8.0 1 1.3

8 10.7 1 1.3

2 2.7

1 1.3

---

---

1 1.3 1 1.3

1 1.3 1 1.3

Table - 16 describes the age-wise classification of places where MSW solicit and pickup their clients or places where they aggregate to attract clients for sex work. From the data, it can be seen that most MSW soliciting, picking and aggregating in public places are younger in the 19 to 25 years age group compared to a lesser number who are 26 to 32 years old. A further detailed analysis reveals that among MSW who operate on the streets, 41 percent are younger in the 19-25 age group followed by 29 percent in the 26-32 years age group and 11 percent in the 33-39 age range. Similarly, among those who solicit/ pickup clients in the park, many MSW, 45 percent are in the young age group of 19-25 years compared to 32 percent aged between 26 and 32 years of age. In railway stations, bus stands and massage parlours too, a similar pattern emerges. Table – 17 Place of soliciting/ pickup/ aggregating by MSW by Occupation

58 77.3 9 12.0 27 36.0 22 29.3

---

10 13.3 3 4.0

10 13.3 ---

8 10.7 2 2.7

Chat room (%)

27 36.0 2 2.7 16 21.3 9 12.0

Internet (%)

28 37.3 6 8.0 16 21.3 6 8.0

Godown. (%)

13 17.3

Pimp (%)

Bus stand (%) y

Telephone (%)

---

67 89.3 11 14.7 30 40.0 26 34.7

House (%)

6 8.0

41 54.7 10 13.3 18 24.0 13 17.3

Hotel (%)

Part-time

---

62 82.7 10 13.3 30 40.0 22 29.3

Brothel (%)

Full-time

6 8.0

Park (%)

Unemployed

64 85.3 10 13.3 31 41.3 23 30.7

Stn. (%)

TOTAL

Massage parlour (%)

Occupation

Male Sex Worker soliciting/ pickup/ aggregating points (N=75) Street (%)

Pickup point

4 5.3 1 1.3

7 9.3 2 2.7 3 4.0 2 2.7

9 12.0 2 2.7 3 4.0 4 5.3

---

3 4.0

According to the data in Table - 17 the occupation-wise classification of place of soliciting/ picking up clients by MSW is analysed. It is observed that in the street, bus stand, park, telephone, railway station, hotel and house, the number of MSW engaged in full-time jobs is higher than those in part-time jobs or unemployed. It is important to note that many MSW employed in industries, hotels, petty trade, vendors, drivers and massage parlours use the premises to pick clients and even have sex with peers and others.

Modern expressway that is also a hotspot

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Pilot Study on MSW in India Table – 18 Place of soliciting/ pickup/ aggregating by MSW by Income

41 54.7 16 21.3 21 28.0 4 5.3

67 89.3 24 32.0 35 46.7 6 8.0

13 17.3 5 6.7 7 9.3 1 1.3

28 37.3 10 13.3 16 21.3 2 2.7

27 36.0 6 8.0 18 24.0 3 4.0

58 77.3 21 28.0 31 41.3 6 8.0

Chat room (%)

Telephone (%)

62 82.7 25 33.3 31 41.3 6 8.0

Internet (%)

House (%)

6 8.0 1 1.3 4 5.3 1 1.3

Godown. (%)

Hotel (%)

64 85.3 25 33.3 33 44.0 6 8.0

Pimp (%)

Brothel (%)

> Rs.5001

Park (%)

Rs.2501 – Rs.5000

Railway Stn. (%)

< Rs.2500

Bus stand (%)

TOTAL

Massage parlour (%)

Income (all sources)

Male Sex Worker soliciting/ pickup/ aggregating points (N=75)

Street (%)

Pickup point

10 13.3 3 4.0 7 9.3

4 5.3 2 2.7 2 2.7

---

---

7 9.3 2 2.7 2 2.7 3 4.0

9 12.0 2 2.7 4 5.3 3 4.0

The income-wise classification of pickup points for sex work is presented in Table 18. From the above table, it is evident that larger number of MSW soliciting clients in park, 47 percent street, 44 percent bus stand 41 percent, telephone, 41 percent and railway station 28 percent earn more – between Rs.2501 and Rs.5000 a month from all sources. Comment This indicates that in Vijayawada city, the sex industry is very unorganised but the numbers of sex workers are large and therefore it has become common in many public places such as parks, railway stations, bus stands, theatres, parks, public toilets and other public places.

One of the fastest growing metropolises in India reporting increased MSW activity

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11.0

SEXUALITY, SEXUAL PRACTICES AND VULNERABILITY 11.1

Sexual encounters, partners, commercial sex

Sexual practices, behaviour and client profile of MSW The tables presented below describe the sexual practices in terms of encounters with clients, sexual behaviour including condom use and seek to capture client profile as seen by Male Sex Workers. A bird’s eye view of the sexual practices among MSW reveals that MSW had paid sex consistently over the last 6 months. More specifically, a large number, 95 percent reported engaging in sex in exchange for money, gifts, etc., during the last time they had sex. This relates to increased sex activity on commercial basis. Data also points out that a large number in Vijayawada City, 73 percent reportedly used condoms consistently over the last 6 months when they had paid sex. Further, 63 percent reported using a condom during the last time they had sex in exchange for money, gifts, etc. Finally, a question posed on who their sexual partner was on their last paid sexual encounter revealed a rough profile of the clients of MSW. While it is assumed that only 19 percent clients are of high class – defined thus as being either equal to or economically better than MSW themselves. To this group belong mostly peers, students, teachers, office goers, blue collared workers, petty businessmen and the like. On the other hand, 77 percent reported that their clients are low class – meaning those hailing from lower socio-economic strata – mainly rickshaw pullers, boatmen, unorganised workers, construction labour, unemployed youth, slum populations and so on.

This reinforces the fact that not all men who have sex with men (MSM) do so only for physical or psychological stimulation. Observations from the field validate the fact that many MSW started as MSM but in due course, on pressing economic grounds they engage in sex on commercial basis for sheer survival. Hence is visible both survival sex and recreational sex in most cities though it is very difficult to differentiate the two. MSW have also reiterated that there is a huge potential for male sex partners among both men and women and demand for young boys cannot be underestimated. The mixed clientele of MSW makes it an ardent task in identifying specific client groups. Overall, however, it is seen that two distinct levels operate. One male sex work circuit caters to the economically richer segment in society and operate in houses, brothels, hotels and massage parlours while the other sex circuit is carried on at the street level and public places, demanding the sexual needs of people in the lower socio-economic milieu such as those in slums and poor housing colonies operating in parks, railway stations, bus stands, public toilets, and roadside shanties.

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Pilot Study on MSW in India Table – 19 Sexual practices, behaviour and client profile of MSW by Age group Sexual history

Age group

TOTAL < 18 19-25 26-32 33-39 40 & >

Sexual practices, behaviour and client profile (N=75) Sex for money/ gifts (Last time) (%) 71 94.7 2 2.7 37 48.3 23 30.7 7 9.3 2 2.7

Condom use (6 months) (%)

Condom use (Last time) (%)

55 73.3 1 1.3 27 36.0 19 25.3 6 8.0 2 2.7

47 62.7 1 1.3 24 32.0 15 20.0 6 8.0 1 1.3

Clientele High class (%)

Low class (%)

14 18.7

58 77.3 2 2.7 32 42.7 16 21.3 7 9.3 1 1.3

--5 6.7 7 9.3 1 1.3 1 1.3

An analysis of the data in Table - 19 provides insight into the sexual practices and behaviour of MSW with respect to their age. It is evident from the data that majority of the MSW, 48 percent who had sex in exchange for money during the last sexual encounter were 19-25 years of age followed by 31 percent who were older between 26 and 32 years old. A sizeable number of 9 percent were also in the age range of 33 to 39 years of age. This indicates that though MSW are generally younger, many middle-aged MSW too are engaged in paid sex activities. Condom use consistently in the last 6 months has been reported by majority of MSW, 36 percent in the same 19-25 age group followed by 25 percent in the older 26-32 age group. The trend is similar pertaining to condom use during last sexual encounter where 32 percent in 19-25 age range reported condom use and 20 percent between 26 and 32 years said they used condoms during their last sexual encounter. It is interesting to note that more clients of MSW, 77 percent are reported to belong to lower class and are younger, in the 19-25 age group 43 percent. Table – 20 Sexual practices, behaviour and client profile of MSW by Education Sexual history

Education

TOTAL Illiterate Primary Middle

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Sexual practices, behaviour and client profile (N=75) Sex for money/ gifts (Last time) (%) 71 94.7 5 6.7 14 18.7 30 40.0

Clientele

Condom use (6 months) (%)

Condom use (Last time) (%)

High class (%)

Low class (%)

55 73.3 5 6.7 7 9.3 24 32.0

47 62.7 1 1.3 6 8.0 22 29.3

14 18.7 2 2.7 1 1.3 5 6.7

58 77.3 3 4.0 13 17.3 26 34.7

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14 18.7 7 9.3 1 1.3

13 17.3 6 8.0

12 16.0 5 6.7

---

---

2 2.7 3 4.0 1 1.3

12 16.0 4 5.3 ---

Table 20 describes the sexual practices, behaviour and client profile of MSW by education status. It is important to note from the above table that though involvement in sex for exchange of money, gifts, etc., is high by educated MSW, that may be a result of rising unemployment and resulting ‘survival sex’, higher education also indicates consistent condom use, 32 percent by those educated up to middle school (majority of respondents in the study) and a high 17 percent by those who studied up to higher secondary. Similarly, larger number of educated MSW, 29 percent educated up to middle school and 16 percent up to higher secondary reported condom use during last sexual encounter compared to only 9 percent who studied up to primary level and 7 percent illiterate MSW. The educational profile of clients indicates that they are similar to that of the MSW and sex workers prefer clients of equal educational and economic status or better that ensures more earning through sex work. Though safe sex practices adoption among those engaging in recreational sex has not been directly recorded, indications are that even among such male sex workers, condom use is high and depends on education status of sex worker as well as client. This therefore indicates that education is an important factor in determining safe sex practices among male sex workers. Uneducated MSW are neither aware of safe sexual practices nor have the appropriate perception of risk. This also points to the fact that educated MSW are in a better position to read and understand HIV/ AIDS related prevention messages and one-to-one rapport with educated clients and NGO/ community workers that reflects on better adoption of safe sex practices. Table – 21 Sexual practices, behaviour and client profile of MSW by Marital status Sexual history

Marital status

TOTAL Unmarried Married living with spouse Married living without spouse Separated/ Divorced

Sexual practices, behaviour and client profile (N=75) Sex for money/ gifts (Last time) (%) 71 94.7 38 50.7 28 37.3 2 2.7 3 4.0

Condom use (6 months) (%)

Condom use (Last time) (%)

55 73.3 30 40.0 23 30.7 1 1.3 1 1.3

47 62.7 27 36.0 18 24.0 1 1.3 1 1.3

Clientele High class (%)

Low class (%)

14 18.7 8 10.7 5 6.7 1 1.3

58 77.3 31 41.3 23 30.7 1 1.3 3 4.0

---

According to the data presented in Table – 21, the sexual behaviour and practices of MSW are highlighted based on their marital status. The data reveals that 51 percent of MSW who engaged in sex in exchange for money, gifts, etc. are unmarried while 44 percent were ever-

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Pilot Study on MSW in India married. Condom use data indicates that 40 percent of unmarried respondents reportedly used condoms consistently during the last 6 months and a similar number, 36 percent reported condom use during their last sexual encounter. Data on client profile reveals that among so-called lowclass clients, majority are unmarried, 41 percent though a good number, 31 percent are also evermarried. Marital status does not appear to be an important variable in accepting or adopting safe sex practices though it is viewed as important in the case of bisexual MSW. Table – 22 Sexual practices, behaviour and client profile of MSW by Occupation Sexual history

Occupation

TOTAL Unemployed Full-time Part-time

Sexual practices, behaviour and client profile (N=75) Sex for money/ gifts (Last time) (%) 71 94.7 14 18.7 32 42.7 25 33.3

Clientele

Condom use (6 months) (%)

Condom use (Last time) (%)

High class (%)

Low class (%)

55 73.3 9 12.0 25 33.3 21 28.0

47 62.7 8 10.7 19 25.3 20 26.7

14 18.7 4 5.3 4 5.3 6 8.0

58 77.3 10 13.3 29 38.6 19 25.3

The occupation-wise classification of sexual practices of clients may be observed in Table - 22 given above. It may be observed that as majority MSW are employed in full-time jobs, larger number among such MSW, 43 percent said they had sex in exchange for money, gifts, etc., followed by 33 percent who are in part-time jobs who said they had such paid sex. Condom use, consistent use over 6 months is reportedly high by full-time employed MSW, 33 percent compared to part-time employed MSW 28 percent. However, with regard to condom use during the last time, more part-time employed MSW 27 percent reported condom use compared to 25 percent employed in full-time jobs. Among clients of MSW, larger numbers of low class clients are employed in full-time jobs or are unemployed however, more number of high-class clients are in part-time jobs. Table – 23 Sexual practices, behaviour and client profile of MSW by Income Sexual history

Average Income PM

TOTAL

Sexual practices, behaviour and client profile (N=75) Sex for money/ gifts (Last time) (%) 71 94.7

Clientele

Condom use (6 months) (%)

Condom use (Last time) (%)

High class (%)

Low class (%)

55 73.3

47 62.7

14 18.7

58 77.3

21 28.0 30

21 28.0 21

4 5.3 7

26 34.7 29

Income (all sources) < Rs.2500 Rs.2501 – Rs.5000

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30 40.0 35

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> Rs.5001

46.7 2 2.7

40.0 4 5.3

28.0 5 6.7

9.3 3 4.0

38.6 3 4.0

58 77.3 10 13.3 3 4.0

45 60.0 9 12.0 1 1.3

40 53.3 5 6.7 2 2.7

10 13.3 3 4.0 1 1.3

48 63.0 8 10.7 2 2.7

Income (sex work) < Rs.1500 Rs.1501 – Rs.3000 > Rs.3001

According to the data presented in Table – 23, the sexual practices, behaviour and client profile of MSW by income is analysed. The data reveals that majority of MSW, 47 percent who had sex in exchange for money during last time earn between Rs.2501 and Rs.5000/per month. Comparatively a lesser number, 40 percent earn below Rs.2500/- a month. It is also important to note that larger number of MSW, 77 percent who engaged in paid sex during last sexual encounter earn up to Rs.1500/- from sex work. A high 13 percent who earned between Rs.2501 and Rs.5000/- per month had sex in exchange for money, gifts etc. A similar pattern is observed with regard to condom use. Income levels of clients match those of MSW and therefore they may be said to be of the same economic class. It is noteworthy that those MSW who earn higher incomes adopt safer sex practices as they can afford them. With respect to condoms, discussions revealed that MSW are not satisfied with cheap or freely distributed condoms that tear or break on use. MSW prefer to use well lubricated condoms especially during anal sex. Condom use during oral sex is not popular as risk perception of spread of infection through the mouth is reportedly unheard of among MSW though a few insist that their clients use condoms during oral sex too. MSW know about and prefer flavoured condoms for oral sex but are concerned about the cost of use. (A pack of 3’s of good lubricated/ flavoured condoms costs at least Rs.15/- that cannot be afforded by all MSW). Many reportedly carry condoms at all times (powdered/ jelly filled) and are known to negotiate condom use with clients. However, it has been noticed that intimacy of relationships (especially recreational sex) may lead to increased instances of unprotected sex.

The placid Krishna River shrouds hectic MSW activity on its banks

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11.2

Type of sex, condom use and risk

Sexual practices The tables given below provide an analysis of the type of sex popular among MSW in Vijayawada City. An overview of the type of sex indicates that a large number of MSW, 87 percent engage in oral sex followed by 78 percent in anal sex and 67 percent ‘thigh’ sex where clients use the thighs of MSW to have sex. Further, 16 percent reported having vaginal sex (presumably bisexuals) and only 5 percent engage in other sex acts (‘rolling sex’ where two sexual partners roll on the cot or ground while having sex, ‘body sex’, also involving licking the whole body of the sexual partner and ‘group sex’ where more than three to four sex partners fondle and have sex together). Other sexual practices include ‘Rimming’ or licking the anus of sex partners that is also reportedly popular among MSW.

Table – 24 Type of sex by MSW by Age Group Type of sex Age TOTAL < 18 19-25 26-32 33-39 40 & >

Type of Sex (N=75) Oral (%) 65 86.7 2 2.7 32 42.7 22 29.3 7 9.3 2 2.7

Anal (%) 59 78.7 2 2.7 30 40.0 20 18.7 6 8.0 1 1.3

Vaginal (%) 12 16.0 1 1.3 10 13.3 1 1.3 -----

Thigh (%) 50 66.7

Others (%) 4 5.3

---

---

26 34.7 18 24.0 5 6.7 1 1.3

--3 4.0 1 1.3 ---

The age-wise distribution of type of sex by MSW is depicted in Table –24. It is observed that a majority of those involved in oral sex, 43 percent are in the 19-25 age group followed by 29 percent who are 26 to 32 years old. A similar pattern is visible in the case of MSW engaging in anal sex with 40 percent in the 19-25 age group and around half that number, 19 percent having anal sex are older (26-32 years of age) and 35 percent involved in thigh sex also are in the younger age group compared to 24 percent in the older age range. In the case of vaginal sex too, more number of MSW, 13 percent belonged to the younger age group of 19 to 25 years. This indicates that oral and anal sex is very popular among MSW. This has also to be seen in the light of the identity that they perceive. As observed earlier, many MSW view themselves as Koti (playing a passive role and receiving sex) and this may explain for higher preference for anal sex.

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Pilot Study on MSW in India Table – 25 Type of sex by MSW by Marital Status Type of sex Marital status TOTAL Unmarried Married living with spouse Married living without spouse Separated/ Divorced

Type of Sex (N=75) Oral (%) 65 86.7 36 48.0 24 32.0 2 2.7 3 4.0

Anal (%) 59 78.7 34 45.3 21 28.0 2 2.7 3 4.0

Vaginal (%) 12 16.0 8 10.7 4 5.3

Thigh (%) 50 66.7 25 33.3 23 30.7

Others (%) 4 5.3 1 1.3 3 4.0

---

---

---

---

2 2.7

---

Table -25 given above describes the type of sex activity preferred by MSW in relation to their marital status. Expectedly, larger number of unmarried MSW, 45 to 48 percent reportedly engage in anal and oral sex compared to ever-married respondents, 35 and 39 percent respectively. Further, it is observed that MSW who also have sex with their female sex partners, and engage in anal and or oral sex. This is important from the prevention point of view as unprotected anal sex with male partner may lead to chances of infection on subsequent unprotected sex with spouse.

Comment The type of sex that is popular among male sex workers is definitely anal sex though a large number also engage in oral sex, especially the transgender community. Moreover, the younger age group are known to enjoy variations in different kinds of sex though there is a preference for anal sex. As mentioned earlier, anal sex activity may be attributed to more number of MSW identifying themselves as Koti. Bisexual partners are known to engage in both anal and vaginal sex and the need to educate them on having protected sex always is key to prevention of HIV among this risk group. Owing to the fact that majority of MSW are unmarried, it is important they are informed about risks in anal sex as many are of marriageable age and many are mere ‘hustlers’ who may go back into mainstream sex life after a brief spell of commercial sex activity. It has also been observed that MSW do not consider having sex with other males (predominantly anal sex) as posing risk of HIV infection reflected in poor condom use. Therefore prevention efforts need to be directed at making MSW realise appropriate perception of risk.

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11.3

Violence, criminalisation

Violence and criminal assault The following tables depict the extent of sex-related violence that MSW faced from their clients and others as a result of engaging in sex work. It is important to note that around half the number of MSWs interviewed, 57 percent experienced acts of violence committed against them and a lesser number, 20 percent faced criminal assault – booked by police and law enforcing authorities on false charges of being public nuisance, petty theft cases and the like and harassed in custody.

Table – 26 Violence and criminal assault against MSW by Age group Violence, etc. Age group TOTAL < 18 19-25 26-32 33-39 40 & >

Forced sex, violence and criminal assault (N=75) Forced sex Criminal & violence assault (percent) (percent) 43 15 57.3 20.0 2 --2.7 24 8 32.0 10.7 11 5 14.7 6.7 6 2 8.0 2.7 ---

---

The age-wise distribution of forced sex and violence as well as criminal assault is described in Table – 26. From the above table, it may be observed that a majority of the younger MSW, 32 percent in the age group of 19 to 25 years were forced to have sex with their clients and acts of violence were perpetrated against them. Comparatively, 15 percent in the 26 to 32 age group said they faced such sex-related violence. Moreover, 8 percent of older respondents in the 33-39 age group also reported such violence. This indicates that age is not a factor and sex related violence occurs among all MSW for which they have no recourse as they are unorganised and most instances go unreported. Many described about being burnt over the body with cigarette buts, thrashed and beaten on their backs and sex organs, made to indulge in painful sex acts, gagged and forced to have sex. Many MSW however view such acts as rare instances by a few clients whom they consider facing a psychological problem. It is also seen that clients who pay more indulge in such harsh treatment while having sex. With regard to criminal assault too, a similar pattern is visible with majority of younger MSW 11 percent in the 19-25 years age group reporting such experiences more often than 7 percent of those in the 26 to 32 years age group. Around 3 percent of older MSW in the 33-39 age group also faced criminal charges filed against them.

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Pilot Study on MSW in India Table – 27 Violence and criminal assault against MSW by Income Violence, etc. Income (all sources) TOTAL < Rs.2500 Rs.2501 – Rs.5000 > Rs.5001

Forced sex, violence and criminal assault (N=75) Forced sex Criminal & violence assault (percent) (percent) 43 15 57.3 20.0 20 7 18.7 9.3 21 7 28.0 9.3 2 1 2.7 1.3

According to the data given in Table - 27 above, violence and criminal assault against MSW with respect to their average monthly income from all sources is analysed. It may be noticed from the above data that incidence of forced sex and sexual violence is higher among more number of the MSW, earning between Rs.2501 and Rs.5000 a month, 28 percent compared to that of MSWs earning lower income of up to Rs.2500/- a month, 19 percent. However, in the case of criminal assault by police and goondas an equal 9 percent of MSW earn lower monthly incomes (up to Rs.2500 a month) as well as between Rs.2501 to Rs.5000.

Comment Discussions indicated that MSW earning more are considered to be hailing from better socioeconomic backgrounds and hence clients as well as others fear from harming them. However, poorer MSW have to face the brunt of physical violence and assault. With regard to criminal cases, MSW opine that first-timers always face problems from police. Many are forced to have sex with policemen and their henchmen. However, in due course when they become acquaintances, police only harass them and demand money. They then go after younger or new entrants into the sex trade. Many hijras maintain good rapport with police personnel and though they are caught initially in a raid, on the way to the police station or even in the police jeep, they have sex or demand money and release the sex workers.

Another view of the massive Krishna Bridge

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Pilot Study on MSW in India 12.0

HIV/ AIDS PREVENTION, TREATMENT, CARE AND SUPPORT SERVICES

12.1

Awareness, sources and sexual behaviour

The tables given below provide information on the extent of awareness of MSW on HIV/ AIDS, source of awareness and resultant sexual behaviour. Indications are that there is good awareness with large number of respondents stating they are aware about HIV/AIDS. . Figure – 11 Sources of Awareness on HIV/AIDS of MSW

Sources of awarene ss on HIV/A IDS 80

77.3

73.3

66.7

70 57.3

60

50.7

54.7

50 40

32

30

14.7

20 10

0

0 Sources of awareness Television Poster NGO/ CBO

Radio Pamphlet Friends

Newspaper Doctor Other sources

The main sources of awareness of HIV/ AIDS messages is depicted in Figure-11 given above. From the same, it may be observed that Posters are an important media, 77 percent followed by Television, 73 percent and Pamphlets, 67 percent. Other significant media include Newspaper, 57 percent followed by friends, peers or colleagues, 55 percent and NGO/ CBO, 51 percent. Other important sources of awareness include Radio, 32 percent. Around 15 percent MSW also mentioned doctors as sources of awareness on HIV/ AIDS. Hence, in disseminating prevention messages, it is important to focus on the popular mass and electronic as well as print media such as Television, Radio, Newspapers, Posters and Pamphlets. Besides one-to-one communication by NGO/CBO workers, doctors and peers are also seen as important channels to provide vital information to the hidden male sex worker community.

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Pilot Study on MSW in India Table – 28 Awareness on HIV/AIDS and sexual behaviour of MSW Awareness on HIV/AIDS and behaviour of MSW (N = 75) Sexual behaviour Last time had sex for money/ gifts, etc. (MSW) Last time used condoms while having sex

Responses (Percent) 59 78.7 44 58.7

Awareness of MSW on HIV/AIDS and resultant sexual behaviour is analysed in Table -28 given above. From the table, it may be observed that among MSW who are aware of HIV/ AIDS, a high 79 percent reportedly had sex in exchange for money, gifts, etc. during the last time and among MSW aware of HIV/ AIDS, 59 percent reported using condoms during the last time they had sex. This indicates that though awareness on HIV/ AIDS is high and engaging in sex in exchange for money is prevalent (indicating high level of multi-partner sexual activity) such knowledge is not translated into changed behaviour as unprotected sex is high. This points at the need to strengthen Behaviour Change Communication measures among the target audience – MSW in order to enhance knowledge and awareness and result in adoption of safe sex methods to prevent HIV infection. As seen earlier, MSW do not also perceive risk of infection as a result of anal or oral sex. (Many simply have the misconception that HIV infection can be spread only through vaginal sex with female commercial sex workers).

12.2

Availability and access to services

Awareness, Availability and Access to services by MSW The following tables provide an understanding of the awareness on HIV/ AIDS related services provided by NGOs/ CBOs by the Male Sex Workers in Vijayawada city, availability of such services and accessibility of such services by MSW. The overall scenario on service awareness, availability and access reveals that only few MSW in the city are aware of such services, 32 percent and fewer numbers are aware of the range of services offered such as condoms, medicines, clinical facilities (testing and treatment), counselling and referral services and are neither aware where such services are offered and by whom (NGO/ CBO/ Government/ private/ traditional systems). However, all MSW who are aware of available services access the same. Yet overall access to services is a poor 32 percent among all MSW. Table – 29 Awareness, Availability and Access to services by MSW by Age Group Service access Age TOTAL

NIMSW

Awareness, Availability and Access to services (N=75) Aware (%) 24 32.0

NGO (%) 18 24.0

Range of services Condom Clinic Drugs (%) (%) (%) 1 ----1.3

Jelly (%) ---

Access (%) 24 32.0

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Pilot Study on MSW in India < 18 19-25 26-32 33-39 40 & >

---

---

---

---

---

---

11 14.7 11 14.7 1 1.3 1 1.3

8 10.7 9 12.0

1 1.3

---

---

---

---

---

---

---

---

---

---

---

---

1 1.3

---

---

---

---

--10 13.3 12 16.0 1 1.3 1 1.3

Table -29 provides an insight into the awareness, availability and access to health and related services for MSW with respect to their age. It may be seen that an equal percent of MSW aware of such services, 15 percent are in the 19-25 age group as well as those in the 26-32 age group, 15 percent. A majority aware of services said they knew only of NGO/ CBO providing such services. The range of services is not known to many respondents and only one respondent mentioned of condoms, as services available to MSW in the city. Accessibility to services is very low with those who are aware of such services accessing such services. Table – 30 Awareness, Availability and Access to services by MSW by Education Service access Education TOTAL Illiterate Primary Middle school Higher Secondary Technical Higher Education

Awareness, Availability and Access to services (N=75) Aware (%) 24 32.0 2 2.7 2 2.7 14 18.7 3 4.0 3 4.0

NGO (%) 18 24.0 2 2.7

---

Range of services Condom Clinic Drugs (%) (%) (%) 1 ----1.3

Jelly (%) ---

---

---

---

---

---

---

---

---

---

8 10.7 5 6.7 3 4.0

1 1.3

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

Access (%) 24 32.0 --5 6.7 13 17.3 4 5.3 1 1.3 ---

From the above Table – 30, the education-wise distribution of service awareness, availability and access may be ascertained. It is evident from the above data that more educated MSW, 19 percent educated up to middle school level and 4 percent with higher secondary education are aware of treatment services and also access such services. Though the numbers indicate that service access is poor despite good awareness, among those who have accessed such services, it is observed that they are more educated and therefore education and increased awareness is an important variable in improving service access.

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Pilot Study on MSW in India Table – 31 Awareness, Availability and Access to services by MSW by Marital status Service access

Awareness, Availability and Access to services (N=75)

Marital status

Aware (%) 24 32.0 9 12.0 14 18.7

NGO (%) 18 24.0 8 10.7 10 13.3

Married, living without spouse

---

Separated/ Divorced

1 1.3

TOTAL Unmarried Married, living with spouse

Range of services Condom Clinic Drugs (%) (%) (%) 1 ----1.3 1 ----1.3

Jelly (%) -----

Access (%) 24 32.0 11 14.7 13 17.3

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

The data in Table -31 presented above describes the awareness, availability and access to services with respect to marital status of the MSW in Vijayawada City. It may be seen that though more number of respondents are unmarried, so are more MSW married and living with spouse are aware of such services, 19 percent than 12 percent unmarried respondents and many know only of NGOs offering such services. Access to services is seen to be better among married MSW living with spouse compared to unmarried respondents.

The famous Mogalrajpuram caves also attracts hustlers

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12.3

Barriers in accessing services and suggestions

Only few respondents were able to directly mention various barriers faced in accessing services in the quantitative study. However, from the discussions and qualitative phase, inputs reveal that there are several barriers that male sex workers need to overcome to access services even if awareness levels are high. The key issue is availability of such services. Not all range of services are offered that are needed by MSW. The only services that MSW seem to know include condoms, clinics, drugs and provision of jelly for pain in sex organs. However, they opine that services not available readily are counselling, diagnosis and testing and provision of free medicines for all sex-related diseases (including STI and HIV infection). Moreover, such services are not easily accessible, as they are located in inconvenient locations where respondents have to cover long distances for access. Respondents have complained of illequipped centres with poor infrastructure and non-availability of personnel.

Male sex workers would prefer services that are within reach for cheap and easy reach – availability of cheap public transport is also important to access such services. The next issue is regarding timing of service centres. Many services are available only between 10:00 a.m. and 6:00 p.m. in clinics, hospitals or NGO outreach centres. These timings are inconvenient for majority of the MSW who are employed full-time or even may be engaged in sex work during these hours. MSW preferred clinics that are open late in the evenings or even early in the day that they could access. Another important concern is the non-availability of qualified medical personnel as doctors or para-medical staff. Where there are few personnel, their attitude puts the MSW away and hence MSW shy away from accessing these centres. Other important barriers in accessing services include cost of treatment and medicines that are provided by private and supported medical centres and where free treatment is available, quality of services is reportedly very poor. Hence MSW prefer that medical, psychological and referral services be affordable, easily available at all places and at convenient times and of good quality. Many MSWs also preferred that condoms be distributed free of cost and there is a need for a ‘safe space’ for MSW to share their experiences with others and also cater to their recreational needs. Other factors for poor access besides lack of knowledge and information mentioned include stigma and discrimination in accessing such services located in populous surroundings or fear of identification by known persons.

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12.4

Problems faced by Male Sex Workers Figure – 12 Problems faced by MSW

Problems faced by MSW

100 80

88 70.7 68

72 60

60 40

29.3

20

20 0 Jealousy Blackmailing Hiding from family Exposure

21.3

16

24 1.3

Problems faced Robbing clients Cheating/ free sex Fear of disclosure Other problems

Police harassment Switching loyalty No consent to open

According to Figure-12 portrayed above, the problems faced by MSW in Vijayawada City is examined. The data indicates that Male Sex Workers face a host of problems. The most pressing problems that surface are jealousy between sex workers themselves, 88 percent that points out to intra-community (among Kotis, Dublis, Masseurs for clients and money) and intercommunity (between hijras and others for control of areas/ leadership) conflicts prevalent among male sex workers. Most of the other problems identified are on an individual basis such as harassment and forced sex by police, 68 percent cheating by customers or not paying agreed sum after sex, 72 percent and robbing of clients from friends/ other MSW. Here, it is important to note that older MSW see younger MSW as their rivals as clients prefer younger (stronger) male sex workers. This also indicates that younger sex workers are paid better than older ones and hence this develops into conflict between sex workers. Other reasons for concern among MSW include hiding their behaviour from family members, 60 percent as many carry on the sex work without knowledge of the family with sisters of marriageable age and younger siblings whom they have to support economically. Many are worried about being ostracised when discovered that they are sex workers. Another 16 percent opined that it is difficult to hide their behaviour and are under constant threat of being exposed in society by friends/ peers or even clients in public. While 21 percent feared that they might disclose their sex-related behaviour to their families, 24 percent said they were afraid that others would reveal their involvement in sex activity without their consent. Around 1 percent MSW said they faced other problems as being betrayed by own community, threats from relatives and fear of goondas or rowdies.

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Pilot Study on MSW in India 13.0

OVERALL RECOMMENDATIONS

13.1

Defining MSW – issues of identity and differentiation from MSM for programmatic interventions

As far as awareness of MSW genre among MSW themselves, many are aware of the predominant types/ sub-types across cities though there is considerable confusion on how each MSW perceives or defines a type/ sub-type. Overall, there is a need to target all MSW irrespective of their types/ sub-types Similarly, many community based organisations/ NGOs work among specific groups (most commonly among Kotis only). They may be targeted to get to the Koti community and similarly other groups may be clustered for better outreach among this hidden population. 13.2

Extensive outreach – Being hidden community, need for enhancement of community-based MSW-peer-based approach to identify new/ hidden groups and networks and extend services

As a majority of the MSW are young persons, they need to be targeted more intensively through various programmes. Focus on school programme, drop-out youth and on unemployed to be stressed. Clients of MSW in all ages must be the target of all grassroots interventions and clients may be segregated based on socio-economic criteria. (As it has been observed that in some cities, clients are older while in others, clients are younger, hence age is not a critical factor). 13.3

Inclusion – combating issues of social stigma and discrimination within their groups/ subgroups as well as by the general population through better awareness/ appropriate media advocacy

There is an immediate need for advocacy among both police as well as law enforcing authorities (such as railway ticket inspectors) and the media. It has been proved in the study that almost all sex workers contacted have sex in exchange for money that shows that ‘survival sex’ is predominant though ‘recreational sex’ may be carried out simultaneously. Thus interventions need to target MSW irrespective of their sexual behaviour based on their needs. The places most frequented by that also serve as the place of actual sex activity in most cities presents a similar picture. Streets, parks, bus stands and railway stations are seen as major hotspots for reaching out to MSW. This is followed by houses (of clients), public toilets, brothels and massage parlours (mainly in Kolkata). Hence a lot of outreach activity can be planned around these areas and should be carried our consistently – over long-term period in order to have better impact. 13.4

Service Information – providing all MSW with adequate information on available resources and services for HIV/ AIDS prevention, treatment, care and support

The television, radio and newspapers are popular media to reach out to MSW as many reportedly access these. However, one-to-one peer group communication, friends and health care givers are also ways that are effective communication channels among MSW. With regard to sources of information on HIV/ AIDS, the TV, NGO and friends are the most important sources followed by posters, newspapers and pamphlets. Thus, an appropriate media mix can target MSW in an effective way.

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Pilot Study on MSW in India 13.5

Improve service access – through intertwining public-private institutional and individual health care givers thereby ensuring expended range of services and easy access with accent on quality and affordability

Though occupational status does not emerge to be significant, unemployed youth and those engaged in sex on part-time basis need more information on safe sex practices and increase in their appropriate perception of risk. MSW with lower incomes are particularly vulnerable to risk of infection as they may be unable to afford safe sex practices and hence they need to be targeted more intensely. Unemployment and underemployment are main problems that MSW face and many are skilled and would like to engage in some economic activity – as turners/ fitters/ electricians or similar small industries but are denied jobs when it is known they are sex workers too. Avenues for training and providing initial inputs for entrepreneurial ventures may be worked out. 13.6

Further empirical research – focus on mapping MSW, sexual behaviour, condom programming, communication, treatment access, training needs assessment of MSW (peers/ programme staff)

In the absence of estimates of Male Sex Workers in different parts of the country, a comprehensive mapping of MSW through NGOs, CBOs and involving MSW themselves. 14.0

SPECIFIC PROGRAMMATIC RECOMMENDATIONS

14.1

Strengthening NGO/ CBO programming exclusively for MSW

Establishing exclusive MSW-centred NGO/CBO networks is seen as important as very few such entities exist. Many programme activities are an extension of MSM projects where MSW are segregated and service access by MSW themselves is low Overall, it has been observed that the range of services offered across all cities is poor, inadequate and not need-based. Thus, whole range of following services may be offered: a)

More number of HIV testing/ diagnosis facilities and motivating MSW for testing to ensure protection against infection b) Better condom programming with an accent on lubricated ones for anal sex/ flavoured condoms for oral sex c) Clinics with staggered timings – open late in the evenings and or early mornings when MSW can access them without disturbing other routine tasks d) Provision of free drugs and medicines for STI/ HIV e) Quality care and specialised services such as counselling, referrals and linkages with an array of service providers – private/ government/ NGO/ others 14.1.1

Adequate infrastructure, funding, scaling up and technical support and materials

NGO/ CBO need to be adequately equipped with infrastructural facilities as well as with qualified, experienced and trained human resources for better service delivery. Timely disbursement of funds and completion of planned project cycle would enable maximum impact as well as feed inputs for further refined interventions. Scaling up of efforts is a dire need if the widening chasm between supply and demand for MSW-oriented services is to be bridged. Materials also need to be provided wherever possible – such as IEC materials, condoms, drugs and medicines and other relevant articles. Technical support is to be provided to new organisations in programme management on financial, managerial and other technical aspects as skill building, behavioural training and so on.

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Pilot Study on MSW in India 14.1.2

Psychosocial services

Forced sex and harassment as well as criminal assault are reportedly common among MSW across cities and this may be rectified through community organisation among MSW so they are able to fight for the protection of their rights. This warrants better networking within MSW as well as extending professional counselling and referral services to all MSW. Such services need to focus on enhancing personality development and self-esteem of young males in the sex industry. Problems faced by MSW indicate that there is considerable inter-community and intra-community rivalry between MSW as there is a lot of confusion on clear cut definitions and that several types and sub-types of MSW are targeting the same clients. Preference for younger clients indicates that they need to be targeted more extensively and fear of exposure and stigma need to be dealt with appropriately through effectively community-based approaches involving peers, care givers, media, family of MSW and key influencers. 14.1.3

Networking and linkages

There is an unmet need of merging multi-sector institutions extending services that include government, private and individual care givers as well as at various levels – at local level (rural/ urban slums), block/ mandal, district, and state (city) level. MSW need to be not only informed of these groups but also be able to access services without trouble. 14.2

Information services

14.2.1

IEC and communication strategy

With regard to awareness about various services offered, the same differs from city to city depending on numerous factors such as: a) b) c) d) e)

extent of dissemination of information by various sources media mix logistics of distributing and obtaining information reach (in terms of geographical area) by CBOs/ NGOs public opinion and community perspective to MSW (stigma)

What is critical though, is the need to increase information about existing services available and offered in each city. This maybe done through developing a database on all services, service providers and places where they can be accessed including cost and other important information which MSW can use and thereby improve service access. Next, among those who are aware, it is observed that access is low, due to various factors such as timing, non-availability of doctors, costly drugs and medicines, inconvenient location and hence poor reach. Therefore a need for Service Centres catering exclusively for MSW that are friendly, cheap, easily accessible at all times and that provide quality services. 14.2.2

Need for Information on specific sexual practices, associated risks and prevention – anal – understood and developed by MSW themselves

It is very important that information is provided on specific sexual practices among MSW – which is currently absent. MSW rely on general information available for other high risk groups that are inappropriate and do not address key issues such as anal sex, etc. More importantly, materials targeted at MSW have to be designed, developed, pre-tested and accepted by MSW themselves thereby catering to their specific needs and being user-friendly, (use of pictures) with increased retention level and facilitate behaviour change.

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Pilot Study on MSW in India As educational status of MSW is rather poor, they need to be targeted with more information on HIV/ AIDS and importance of protected sex that is appropriate, easily understandable and practical and motivated for accepting safe sex behaviours. 14.2.3

Capacity building of peer groups/ networks

The present study witnessed the magical effect of capacity building in managing the quantitative and qualitative survey efficiently and effectively, producing the desired results. Thus, technical support should be in the form of ‘hand holding’ where grassroots level MSW organisations are equipped in project management thereby ensuring ‘ownership’ of the intervention thereby ensuring sustainability. 14.3

STI and condom promotion services

14.3.1

Ensure availability, accessibility of condoms (lubricated) and motivate for consistent use (stock and carry easily)

Probably poor condom use may also be due to preference for anal sex among MSW in which they do not perceive risk of infection even in multi-partner sex. Hence the need for better condom programming including provision of lubricated condoms/ gel for male sex workers. 14.3.2

Enhance dissemination on need for condom use through media/ social marketing

It is also observed that even though MSW may have information and awareness on importance of use of condoms and on the need for protected sex, the same is not translated into behaviour change indicated by poor condom use. This calls for an effective communication strategy for MSW. Smoking, alcohol and tobacco consumption being predominant habits of MSW, places such as paan and bidi shops, wine shops and bars and local street-side shops are places frequented by MSW where they can be reached and where IEC dissemination can also be done effectively. 14.3.3

Partner treatment (both male and female partners)

Unmarried youth need to be targeted vigorously. Among married MSW too, stress needs to be laid on protected sex and partner treatment in the case of STI/ HIV.

Photo courtesy: Srinivas Kurungati

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Pilot Study on MSW in India 15.0

CONCLUSION

In the light of the above study, it is suggested that city-wise Action Plans be prepared pinpointing areas of action – beginning with identification of Sex Industry Networks, planning outreach activities through community-based networks of MSW, outlaying and extending diagnostic and treatment as well as specialised services such as counselling and referrals that are currently very scattered and insufficient across each city and networking care givers, service providers and local community efforts in improving conditions of MSW. Going a step further, there is an unmet need of identifying and prioritising current priorities of the MSW community and working around those priorities. Such needs pertain to Basic needs – provision of food, and shelter (safe space) for MSW where they can meet, enlist support and learn from the experience of others (economic self-reliance and preventive health) Education – basic skills and vocational training besides treatment literacy, knowledge and awareness on care and support. Provision of Medical services – diagnostic and treatment services – as seen from the study, many MSW are unaware of VCTC and HIV testing facilities – neither do they access such services. Where available, MSW complain of non-availability or non-affordability of drugs and medicines, poor quality of services, inconvenient location or reach and poor logistics. Economic Needs – financial support in the wake of unemployment or underpaid employment, vocational training and guidance and support through provision of infrastructure to begin entrepreneurial activities, training and guidance in sustaining economic ventures. Social Acceptance – MSW face untold suffering upon disclosure of their status in public as a result of increasing stigma and discrimination against sex work that is considered taboo and with even more strictures placed on same-sex activities. There is an immediate need to sensitize the general public through various programmes on the prevalence of male sex work activity and preventive measures that need to be adopted to stem HIV infection through this mode. Psychological – Male Sex Workers reportedly face increasing psychological pressure that is projected by their sense of low self-esteem, powerlessness and dejection in society. However, professional counselling services are scattered and few NGO/ CBO provide services to a handful of MSW. Many MSW are unaware of the availability of such services across each city and have no clue as to how to access such services. Targeted Interventions on Male Sex Workers need to be drawn through a well-defined multipronged strategy with specific components such as: i. MSW-centred communications strategy ii. Condom programming iii. Prevention programmes at MSW and general population iv. Care and support initiatives focused at MSW and v. Advocacy among media/ law enforcers on issues facing MSW Barriers and obstacles faced by MSW too need to be identified and broken down.

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Pilot Study on MSW in India ANNEXURE – 1 (KOLKATA) Table – 1 Age of Male Sex Workers (MSW) Age of MSW (N = 75) Age Range < 18 19-25 26-32 33-39 40 & >

Age in completed years (Percent) 5 6.7 35 46.7 22 29.3 11 14.7 2 2.7

Age at first sex (Percent)

Age first sex with money/ gifts (%)

Average age of client (Percent)

61 81.3 14 18.7

41 54.6 30 40.0 ---

3 4.0 23 30.7 25 33.3 19 25.3 5 6.7

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Table – 2 Education status of Male Sex Workers (MSW) Education status of MSW (N = 75) Education Illiterate Primary Middle school Higher Secondary Technical Higher Education No Response

Responses (Percent) 5 6.7 19 25.3 23 30.7 16 21.3 6 8.0 5 6.7 1 1.3

Table – 3 Marital status of Male Sex Workers (MSW) Marital status of MSW (N = 75) Marital status Unmarried Married, living with spouse Married, living without spouse Separated/ Divorced No Response

Responses (Percent) 53 70.7 9 12.0 7 9.3 5 6.7 1 1.3

Table – 4 Nature of occupation of Male Sex Workers (MSW)

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Pilot Study on MSW in India Nature of occupation of MSW (N = 75) Nature of occupation Unemployed Full-time employed Part-time employed

Responses (Percent) 25 33.3 47 62.7 3 4.0

Table – 5 Average monthly income of Male Sex Workers (MSW) (all sources) Average monthly income of MSW from all sources (N = 75) Responses Average Monthly Income (Percent) 48 < Rs.2500 64.0 25 Rs.2501 – Rs.5000 33.3 2 > Rs.5001 2.7 Table – 6 Average monthly income of Male Sex Workers (MSW) (Sex work) Average monthly income of MSW from sex work (N = 75) Responses Average Monthly Income (Percent) 41 < Rs.1500 54.7 28 Rs.1501 – Rs.3000 37.3 6 > Rs.3001 8.0

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Pilot Study on MSW in India Table – 7 Media habits of Male Sex Workers (MSW) Media habits of MSW (N = 75) (multiple responses) Responses Nature of Mass Media (Percent) 71 Television 94.7 49 Radio 65.3 53 Newspaper 76.7 16 Magazines 21.3 17 Cinema 22.7 Table – 8 Other habits of Male Sex Workers (MSW) Other habits of MSW (N = 75) (multiple responses) Responses Other common habits (Percent) 51 Smoking 68.0 33 Alcoholism 44.0 14 Drugs 18.7 30 Consuming tobacco 40.0 19 Other habits 25.3 Table – 9 Sources of Awareness on HIV/AIDS of MSW Sources of Awareness on HIV/AIDS of MSW (N = 75) (multiple response) Responses Sources of awareness (Percent) Television Radio Newspaper Poster Pamphlet Doctor NGO/ CBO Friends Other sources

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66 88.0 44 58.7 40 53.3 41 54.7 32 42.7 34 45.3 50 66.7 52 69.3 32 42.7

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Pilot Study on MSW in India Table – 10 Problems faced by MSW Problems encountered by MSW (N = 75) (multiple response) Sources of awareness Jealousy Robbing clients from peers Police harassment/ sex Blackmailing by clients, others Cheating, being underpaid after sex Switching of loyalty by clients Hiding behaviour from family, friends Fear of disclosure by self to others Unwanted disclosure by others without consent

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Responses (Percent) 51 68.0 41 54.7 43 57.3 24 32.0 43 57.3 28 37.3 38 50.7 32 42.7 24 32.0

Constant fear of being exposed in society

37 49.3

Other problems

39 52.0

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Pilot Study on MSW in India ANNEXURE – 2 (AHMEDABAD) Table –11 Age of Male Sex Workers (MSW) Age of MSW (N = 75) Age Range < 18 19-25 26-32 33-39 40 & >

Age in completed years (Percent) 1 1.3 31 41.3 20 18.7 13 17.3 10 13.3

Age at first sex (Percent)

Age first sex with money/ gifts (%)

Average age of client (Percent)

70 93.3 5 6.7

33 44.0 37 49.3 5 6.7 ---

34 45.3 32 42.7 8 10.7 1 1.3 ---

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Table – 12 Education status of Male Sex Workers (MSW) Education status of MSW (N = 75) Education Illiterate Primary Middle school Higher Secondary Technical Higher Education No Response

Responses (Percent) 10 13.3 22 29.3 27 36.0 10 13.3 --2 2.7 4 5.3

Table – 13 Marital status of Male Sex Workers (MSW) Marital status of MSW (N = 75) Marital status Unmarried Married, living with spouse Married, living without spouse Separated/ Divorced

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Responses (Percent) 45 60.0 26 34.7 1 1.3 3 4.0

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Table –14 Nature of occupation of Male Sex Workers (MSW) Nature of occupation of MSW (N = 75) Nature of occupation Unemployed Full-time employed Part-time employed

Responses (Percent) 5 6.7 10 13.3 60 80.0

Table – 15 Average monthly income of MSW from all sources (N = 75) Responses Average Monthly Income (Percent) 70 < Rs.2500 93.3 2 Rs.2501 – Rs.5000 2.7 3 > Rs.5001 4.0 Table – 16 Average monthly income of Male Sex Workers (MSW) (Sex work) Average monthly income of MSW from sex work (N = 75) Responses Average Monthly Income (Percent) 41 < Rs.1500 54.7 26 Rs.1501 – Rs.3000 34.7 8 > Rs.3001 10.7 Table – 17 Media habits of Male Sex Workers (MSW) Media habits of MSW (N = 75) (multiple responses) Responses Nature of Mass Media (Percent) 69 Television 92.0 46 Radio 61.3 57 Newspaper 82.0 13 Magazines 17.3

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Pilot Study on MSW in India 7 9.3

Cinema

Table – 18 Other habits of Male Sex Workers (MSW) Other habits of MSW (N = 75) (multiple responses) Responses Other common habits (Percent) 20 Smoking 26.6 10 Alcoholism 13.3 1 Drugs 1.3 33 Consuming tobacco 44.0 Other habits

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Table – 19 Sources of Awareness on HIV/AIDS of MSW Sources of Awareness on HIV/AIDS of MSW (N = 75) (multiple response) Responses Sources of awareness (Percent) Television Radio Newspaper Poster Pamphlet Doctor NGO/ CBO Friends Other sources

54 72.0 34 45.3 39 52.0 50 66.7 42 56.0 40 53.3 74 98.7 66 88.0 1 1.3

Table – 20 Problems faced by MSW Problems encountered by MSW (N = 75) (multiple response) Sources of awareness Jealousy Robbing clients from peers

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Responses (Percent) 64 85.3 56 74.7

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Pilot Study on MSW in India Police harassment/ sex Blackmailing by clients, others Cheating, being underpaid after sex Switching of loyalty by clients Hiding behaviour from family, friends Fear of disclosure by self to others Unwanted disclosure by others without consent

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40 53.3 38 50.7 49 65.4 44 58.6 42 56.0 31 41.3 36 48.0

Constant fear of being exposed in society

40 53.3

Other problems

3 4.0

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ANNEXURE – 3 (VIJAYAWADA)

Age Range < 18 19-25 26-32 33-39 40 & >

Table – 21 Age of Male Sex Workers (MSW) Age first sex Age in Age at first with money/ completed sex gifts (%) years (Percent) (Percent) 2 59 20 2.7 78.7 26.7 38 15 52 50.7 20.0 69.3 25 1 3 33.3 1.3 4.0 8 ----10.7 2 ----2.7

Average age of client (Percent) 1 1.3 41 54.7 27 36.0 6 8.0 ---

Table – 22 Education status of Male Sex Workers (MSW) Responses Education (Percent) 5 Illiterate 6.7 15 Primary 20.0 31 Middle school 41.3 16 Higher Secondary 21.3 7 Technical 9.3 1 Higher Education 1.3 Table – 23 Marital status of Male Sex Workers (MSW) Responses Marital status (Percent) 42 Unmarried 56.0 28 Married, living with spouse 37.3 2 Married, living without spouse 2.7 3 Separated/ Divorced 4.0 Table – 24 Nature of occupation of Male Sex Workers (MSW) Nature of occupation Unemployed Full-time employed

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Responses (Percent) 14 18.7 34 45.3

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Pilot Study on MSW in India Part-time employed

27 36.0

Table – 25 Average monthly income of Male Sex Workers (MSW) (all sources) Average monthly income of MSW from all sources (N = 75) 30 < Rs.2500 40.0 39 Rs.2501 – Rs.5000 52.0 6 > Rs.5001 8.0 Table – 26 Average monthly income of Male Sex Workers (MSW) (Sex work) Average monthly income of MSW from sex work (N = 75) 61 < Rs.1500 81.3 11 Rs.1501 – Rs.3000 14.7 3 > Rs.3001 4.0 Table – 27 Media habits of Male Sex Workers (MSW) Media habits of MSW (N = 75) (multiple responses) Responses Nature of Mass Media (Percent) 63 Television 84.0 25 Radio 33.3 22 Newspaper 29.3 5 Magazines 6.7 Table – 28 Other habits of Male Sex Workers (MSW) Responses Other common habits (Percent) 35 Smoking 46.7 55 Alcoholism 73.3 10 Drugs 13.3 27 Consuming tobacco 36.0 1 Other habits 1.3 Table – 29 Sources of Awareness on HIV/AIDS of MSW Responses Sources of awareness (Percent)

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Pilot Study on MSW in India 55 73.3 24 32.0 43 57.3 58 77.3 50 66.7 11 14.7 38 50.7 41 54.7

Television Radio Newspaper Poster Pamphlet Doctor NGO/ CBO Friends Table – 30 Problems faced by MSW

Problems encountered by MSW (N = 75) (multiple response) Sources of awareness Jealousy Robbing clients from peers Police harassment/ sex Blackmailing by clients, others Cheating, being underpaid after sex Switching of loyalty by clients Hiding behaviour from family, friends Fear of disclosure by self to others Unwanted disclosure by others without consent

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Responses (Percent) 66 88.0 53 70.7 51 68 22 29.3 54 72.0 15 20.0 45 60.0 16 21.3 12 16.0

Constant fear of being exposed in society

18 24.0

Other problems

1 1.3

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