Developing a typology of female sex work, South India, with special reference to Karnataka

The thesis is premised on the fact that India's National AIDS Control Organization (NACO) employs the typology of female sex work in outreach and other components of the HIV programme in order to identify high-risk female sex workers (FSWs). However, the current typology – distinguishing between FSWs based on their main place of solicitation – may not adequately reflect the variation in HIV risk. Using data from integrated biological and behavioural assessment surveys among FSWs from three south Indian states, I propose a method for devising evidence-based typologies of sex work which prioritizes place of solicitation and explores other factors potentially helpful for targeted interventions by indicating which FSWs are at high risk. For Karnataka state, the analysis suggests that the typology should distinguish between women based on the main place of solicitation and the main place of sex; this typology identifies street to lodge and brothel to brothel FSWs as being at highest risk for HIV. The strongest HIV/STI risk factor among FSWs from Andhra Pradesh is marital status, while among Tamil Nadu FSWs it is marital status and alcohol consumption respectively. Of the three states, Karnataka typology has the highest outreach applicability, as the main place of sex is linked to a geographical location. In addition, a qualitative study was conducted in Belgaum district, Karnataka to understand what it is about the mode of operation in different sex work settings that may help explain why some FSW categories are at higher risk for HIV compared to others. The qualitative data identified a number of factors which might help explain why brothel to brothel, lodge to lodge, street to lodge, dhaba to dhaba and highway to highway FSWs are likely at highest HIV risk, with different vulnerability factors applying to different modes. (abstract author's own)