Commercial sex work and sexual health : an ethnographic study of HIV prevention among female commercial sex workers in Calcutta
This thesis presents the results of ethnographic research conducted from 1995 to 1997 among sex workers in two Calcutta redlight areas where a STD/HIV Intervention Project (SHIP) is being implemented. The thesis provides an in-depth study of sex workers' lives, their concepts of sexual health and their relationship to the SHIP. This material is used to critically consider a number of key concepts currently informing HIV prevention practice, specifically, sexual health, community participation, empowerment and behaviour change. Initial chapters set the background to the study and describe the complex world of the Calcutta sex trade and sex workers' struggle to construct a meaningful social identity. Subsequent chapters consider sex workers' and other actors' varying responses to, and interpretations of, the SHIP. These are related to an analysis of the process of project implementation, revealing the context-dependent, strategic, meaningful and contested nature of community, identity, participation and empowerment, and also highlighting the significance of different constructions of agency for the ways in which these concepts are expressed by different actors. The thesis goes on to examine sex workers' own (vis a vis biomedical) perceptions of sexual health and, drawing upon the SHIP as an example, analyses the representations, meanings and strategic uses of different kinds of knowledge and its perceived role in behaviour change. The next chapter looks at the varying meanings that sexual practices take on for sex workers in the context of their social and occupational position. It examines women's strategies around safer sex and uses this material to critique conventional theories of behaviour change, arguing for a perspective that acknowledges sex workers' agency yet recognizes the ways in which its expression is shaped and constrained by micro and macro level socio-cultural and economic forces. The thesis concludes by arguing that in-depth ethnographic research on sex workers' lives combined with a contextually embedded analysis of the processes and meanings of an intervention yields important insights for understanding, developing and replicating effective HIV prevention initiatives among this group.