The dramatic changes in Mumbai’s urban landscape attributed to urban restructuring has led to the dwindling number of sex workers in traditional brothel areas. Mumbai may be seeing a declining number of visible sex workers, however, there is an increasing prevalence of HIV in sex workers and increasing levels of HIV among “new” sex workers, according to a report “Considering risk contexts in explaining the paradoxical HIV increase among female sex workers in Mumbai and Thane, India” published in BioMed Central.
The paper states that there has been a dispersal of sex work with the sex-trade management adapting by becoming more hidden and mobile, leading to increased vulnerability. It adds that affordable mobile phone technology enabled independent sex workers to trade in more hidden ways and there was an increased dependence on lovers for support. The risk context has become ever more challenging with animosity against sex work amplified since the scale-up of targeted interventions.
“Surveys monitoring HIV prevalence among ‘visible’ street and brothel-bases sex workers are increasingly un-representative of all women selling sex and self-reported condom use is no longer a valid measure of risk reduction,” the report says. The report states that among female sex workers in the state of Maharashtra, HIV prevalence increased slightly between 2006 and 2009 from 26% to 27.5%, despite an increase in intervention coverage from 28% to 66% and a reported rise in condom use from 76% to 95%.
The increase in HIV prevalence was statistically significant in the two neighbouring districts of the metropolis, Mumbai and Thane, where it rose sharply from 24% in 2006 to 31% in 2009. Among women, who reported entering sex work within the last year, HIV increased from 8% to 16% in Thane, while remaining at 19% in both rounds in Mumbai. “It is time to re-evaluate the way HIV prevalence is estimated in rapidly changing contexts. The HIV prevalence among the various hidden subgroups of sex workers is indeed unknown, but the risk context has become ever more challenging, with animosity against sex work amplified since the scale up of targeted interventions. Reaching the increasing proportion of sex workers who intentionally avoid HIV prevention programmes has become the main challenge,” the paper states.