Rapid Qualitative Study of Female Sex

Rapid Qualitative Study of Female Sex Workers
in Pokhara
A FOCUSSED ETHNOGRAPHIC STUDY
Submitted to:
Final Report
Family Health International
HIV/AIDS Prevention and Control Program
Kathmandu, Nepal
March 2003
skf
C
REHPA
Center for Research on Environment
Health and Population Activities (CREHPA)
Ekantakuna, Jawalakhel
P.O. Box: 9626, Kathmandu, Nepal
Tel: 5530344, Fax: 5530341
ACKNOWLEDGEMENTS
The successful accomplishment of this study is an outcome of the collective efforts of
CREHPA and many other individuals.
The study team wishes to express its sincere gratitude to the Family Health International,
(FHI), HIV/AIDS Prevention and Control Program, Nepal, for entrusting this important
study to CREHPA. Thanks are also due to Dr. James L. Ross, Country Director, FHI,
Asha Basnet, Associate Director, Dr Laxmi Billas Acharya, Program Officer-Research
and other staff of FHI for their encouragement and support to the research team during
the study. The study team is grateful to Dr. Pertti Pelto for providing technical input to
the study team during the initial study period.
The study would not have been completed without the cooperation and support of the
local key informants, local NGOs, and the subject themselves. The study team is grateful
to all of them.
- The study team
The Study Team
The Core Team
Anand Tamang
Nirmala Gurung
Study Coordinator
Field Coordinator
Field Researcher
1. Anu Bista
2. Bhadra Ghale
3. Prabina Joshi
Project Support Unit
Yadubhuwan Karki
Bobby Shakya
Bishakha Tamang
Radhika Singh
Finance and Administration
Transcriber
Transcriber
Word Processor
Abbreviation and Acronyms
AIDS
Acquired Immune Deficiency Syndromes
AIDSCAP
AIDs Control and Prevention Project
BCI
Behavior Change Intervention
CREHPA
Center for Research on Environment Health and Population Activities
FHI
Family Health International
FSWs
Female Sex Workers
HIV
Human Immunodeficiency Virus
IDUs
Injecting Drug Users
NCASC
National Center for AIDS and STDs Control
NGOs
Non Government Organizations
SACTS
STD/AIDS Counseling and Training Center
SEDA
Society for Development and Education
STIs
Sexually Transmitted Infections
SWs
Sex Workers
UTI
Urinary Tract Infection
EXECUTIVE SUMMARY
HIV is emerging as a major threat among sex workers (SWs) and their clients. Several young
women sell sex in various professional disguises that put them at special risk to health problems.
No reliable data exists about the population of SWs operating in cities and towns outside
Kathmandu Valley. Pokhara located in Kaski district is one of the most popular destinations for
tourists and trekkers. However very little is known about how SWs operate in Pokhara, their
network and vulnerability to contracting HIV/AIDS.
Objectives of the Study
The main objectives of the study are to explore and document the existing network of SWs in
Pokhara, the types of professional disguises under which they solicit sex clients, the nature of
problems including health related problems they encounter in sex profession and vulnerability to
HIV/AIDS. Size Estimation of SWs' population in Pokhara is also an important component of the
study.
Study Design and Methodology
A combination of rapid ethnographic study tools was employed in the present research to explore
SWs' networks and estimate their population. Size estimation of the SWs was depended largely
on key informant interviewing and mapping in order to arrive at reliable estimates. Mapping was
done in three steps to identify the geographical location/site of SW concentration and also to
systematically estimate the size (population) of this sub-population in the town.
The fieldwork for the study was undertaken during October-November 2002 by a team of four
female researchers and supported by the research team of CREHPA involved in IDU network
study in Pokhara. In the process, the study team visited 28 locations/sites all over Pokhara and
talked to as many as 412 informants. Majority of them provided information about the
concentration sites and approximate number of SWs in each site. In some of the cabin restaurants,
dance restaurants and dohari restaurants, the owners confided about the involvement of their
female staff in commercial sex. Cross-verification/triangulation of the SW's identity was carried
out using mystery client approach wherever possible.
Information regarding sexual networks was gathered through in-depth interviews of 32 SWs. This
exercise also included free listing on several topics from the sex workers, such as types of clients,
place for soliciting clients, places for sexual activity, general problems faced by them in sex trade,
health problems encountered in past 12 months, etc.
FINDINGS
Size Estimation of SWs
The number of female SWs in Pokhara is approximately 300. Although there is no gold standard
for size estimation of hidden population like female sex workers, in view of the extensive
geographical coverage and intensity of mapping exercises carried out by the research team, the
above estimation can be considered a reliable estimate.
Categories of SWs: Eight categories or forms of commercial sex work were identified in course
of mapping exercise. Of these, Cabin restaurant based SWs comprise the largest category (90
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SWs or 31%), followed by bhatti pasal based SWs (19%), Dance restaurant based SWs (14%)
and Hotel based SWs (14%). Call girls operating from rented accommodation have insignificant
representation (below 9%) in Pokhara.
In the course of mapping, 29 cabin restaurants, 25 bhatti pasals and 17 hotels were identified as
the establishments engaging SWs as waitresses and helpers. The number of dance restaurants are
just five but they employ a large number of SWs to serve as waitress and dancers (average eight
SWs per dance restaurant). Twelve rented houses were identified for having Call Girls and these
are located at Matepani, Ram Bazar, Tallo Deep, Amar Singh areas of Pokhara.
Background Characteristics of SWs
Among the 32 SWs covered for case studies, 15 were cabin restaurants based, 8 worked in Bhatti
Pasals, 5 were dance restaurant based and remaining 4 were employed in hotel and ordinary
restaurants. The large majority of them were young; between 15 and 19 years of age. Three SWs
were minors (under 16 years). Those who were single (unmarried), married and separated were
equally represented in the case study sample.
The birthplace of a half of them (16 SWs) was Kaski district ( 9 were born in Pokhara valley
itself). One SW was born in India. The previous residence of nearly half (15 SWs) was in villages
and urban areas of Kaski district (10 SWs from Pokhara). Nine SWs came from adjoining
districts of Tanahu, Parbat and Lamjung and 3 SWs from Kathmandu. Majority of the SWs (17)
were engaged in sex profession for about one year. Seven SWs were for 3-4 years or even more.
The current age vis-a-vis duration in sex work shows that many girls enter into sex profession at a
very young age of 14-15 years.
Awareness about STIs and HIV/AIDS
The majority of SWs were aware about various forms of sexually transmitted infections (STIs).
Majority of them (29 SWs) was also aware that HIV/AIDS is transmitted sexually. Only 7 SWs
knew that AIDS is also transmitted through blood transfusion or through sharing of used syringes.
Condom Use
Although condom use during last sex with clients was high (29 out of 32 SWs), not everyone uses
condom consistently (23 SWs). Several SWs complained that army men and police personnel do
not use condoms even when they were insisted. Instead they threatened SWs for being arrested if
they were not allowed to have sex without condoms. Moreover, very few SWs used condoms
consistently with their husbands and boyfriends. For instance, only 3 out of 22 SWs having
boyfriends and only 2 SWs out of 12 SWs having husbands reported using condom consistently
during sex with them.
Perception about Contracting STIs & HIV/AIDS
Most of the 23 SWs who reported using condom consistently with their clients, do not perceive
themselves to be at risk of contracting STIs and HIV/AIDS. Only 2 SWs were worried that they
could be at risk. The remaining 2 SWs said they were not bothered. One of these two SWs (not
bothering about the infection) was not aware about STIs and HIV/AIDS and the other was
mentally disturbed. Among the 9 SWs not using condoms consistently with clients, majority of
them (5 SWs) feared of being at risk of contracting STI/HIV.
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Exposure to STIs and HIV/AIDS
One fourth of the SWs experienced some STI related problems such as foul smelling discharge,
vaginal bleeding, vaginal itching, burning urination and lower abdomen pain. One SW named
Aansu (17 Yr. Unmarried) (named changed) mentioned about experiencing heavy white
discharge, burning urination and lower abdomen pain. However, she was not aware of any signs
and symptoms of STIs. Likewise, Rupa (30 Yr. Separated) (name changed) mentioned about
vaginal bleeding. She had undergone treatment for white discharge from SEDA. She has yet to
seek treatment for vaginal bleeding. Asha (26 Yr. Married) (name changed) had experienced
white discharge while her husband had complaints about puss discharge from his penis.
Networks of SWs
Unlike the SWs of Kathmandu, very few SWs in Pokhara solicit clients in the streets or public
places. However, as in cities of Kathmandu valley, contacting SWs in Pokhara is not difficult.
Clients can contact SWs at cabin restaurants, discos, dance restaurants and Bhatti pasals. The
introduction of Dohori Sanjh to give a new flavor to traditional Nepali cultural entertainment
have given additional cruising area for SWs in Pokhara. In other restaurants and hotels, clients
can negotiate the price with the owners and take away the girl of their choice. Persons seeking
SW can easily find one through local taxi drivers too.
Clients of SWs
As many as 39 types of clients were listed by SWs. Of these, the main clients (as mentioned by
over half of the SWs) comprise of four types: 1) Drivers of taxi, bus/truck and their Khalasi or
assistants (87% SWs); 2) Service holders in government and NGO offices (87% SWs); 3) Police
(59%); and 4) Army (57%). Other regular clients include Lahure (foreign army recruits),
Businessmen (44% each), local youths (41%), students (34%), hotel owners/staff (34%) and drug
addicts (31%)
Networking with Clients
Majority of SWs employed in restaurants/hotels and Bhatti Pasals, solicit clients directly while
serving food and drinks. For some, the owners of these restaurants/bhatti pasals fix the clients.
Sometimes, the SWs' friends help arranging the clients. The place for contacting clients for the
large majority of the SWs (22 SWs) is the working place (restaurants/hotels/Bhatti Pasals) of the
SWs themselves. Eighteen SWs cited owners of the restaurant/Bhatti Pasals where they are
employed as their middlemen. In fact, owners of the Bhatti pasals and restaurants serve as an
important link between clients and the SWs employed in their business in Pokhara. The owners
negotiate the price (fees) directly and receive the money in advance from the clients. In such
situation, exploitation by owners, such as not telling exact money negotiated by owners and
parting with only half the negotiated amount to the SWs were the frequent complaints. Some SWs
who are minors, were also frustrated by non-payment of their monthly salary by restaurant
owners.
Place for Sex with Clients
Hotels located at Lake sides, Mahendra Pul, Prithivi Chawk and other places in the heart of
Pokhara are popular place where clients take SWs for sex. Most clients taking SWs to the hotels
within Pokhara normally have sex during daytime (spending 2-3 hours) but some insist for
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overnight stay. Outside Pokhara, the popular place where SWs usually go with their clients is
Begnas Taal (Lakes in the outskirts of Pokhara), hotels along the Pokhara–Baglung highway,
Pokhara-Syangya highway and Kotre (picnic spot). Some SWs even mentioned that their clients
take them to places such as Butwal, Bhirahawa/Sunauli, Nepalgunj, Narayanghat, Hetauda,
Kathmandu and Tatopani for 2-3 days for sex.
Roughly every third SWs had experienced group sex. Just one client negotiates the fee with a SW
for an overnight stay in a hotel and his friends joins him in the hotel room and all of them
indulge in sex against her desire. Sometimes the "boyfriends" of the SWs themselves trick the
SWs for having sex in a group. In one case, two SWs who used to solicite clients together and
agreed to go with two clients in the same hotel ended up having sex with five men in that hotel.
Problems Encountered in Sex Professions
The SWs have listed 26 different types of problems that they encounter in their sex profession.
The frequently cited problems include: police arrests and harassment (14 SWs); clients forcing
them to have oral sex/masturbation, etc (12 SWs); family members scolding/beating them (10
SWs); teasing by local boys and calling them names (10 SWs), forced sex and beating by local
boys (9 SWs), clients not giving money after sex (9 SWs), and clients keeping them for longer
hours for sex than the time originally negotiated (9 SWs). Interestingly, issues such as 'clients'
refusal to wear condoms' (3 SWs) and 'risk of contracting STIs and HIV/AIDS' (1 SW) were not
perceived by SWs as major problems.
Health related Problems Encountered by SWs
SWs have experienced 24 types of health problems in the past 12 months preceding the study. Of
these health problems, five were related to menstruation and four related with STI/UTI. However,
the frequently cited problems encountered by SWs were: lower abdomen pain (14 SWs), cough &
cold (13 SWs), fever (11 SWs), white discharge/foul smelling discharge (11 SWs) and headache
(10 SWs). The proportion of SWs exposed to white/foul smelling discharge (34%) is quite
significant among the SWs interviewed in-depth. However, those SWs mentioning other forms of
STIs (vaginal itching and vaginal irritation) were quite few in proportions (below 10%).
Severity Perception of Health Problems
Severity rating of top 15 problems and HIV/AIDS (out of 24 health problems in the free lists) was
conducted among 17 SWs. Although HIV/AIDS was not reported by any of the SWs, this was
also added in the lists of problems for severity rating exercise. Unfortunately the large majority
of the SWs contacted could not rate many of the health problems in the lists. Among those who
could rate these 16 health problems, it was interesting to find over half of them rating 'irregular
menses' (9 SWs) and AIDS (8 SWs) as severe. Six SWs also considered 'white discharge/foul
smelling discharge' as a severe health problem. Nearly two thirds of the SWs rated headache as
intermediate problem (10 SWs) while another two-thirds rated 'cough and cold' as mild health
problem (10 SWs).
Conclusions and Policy Implications
The number of female sex workers in Pokhara is approximately 300 and not very high as
estimated by some Pokhara based NGOs. Commercial sex work exists in eight different forms or
types and the large majority of them mainly operate in disguise as either waitresses, dancers, or
helpers of cabin restaurants, dance restaurants, bhatti pasals, and discos. Majority of SWs solicit
IV
clients directly by themselves or through their friends in their places of work. Several restaurants
and bhatti pasal owners employ young girls to earn extra money by arranging clients.
Unlike in Kathmandu, street based SWs are very few and not visible in Pokhara. Call girls'
network is also not conspicuous in this city. Clients of SWs vary widely and even include exservice men or pensioners (ex-soldiers) which is quite unique for Pokhara. Regular clients include
taxi drivers/drivers, policemen, Lahure/lahure's sons and local youths. SWs are quite mobile and
prepared to go anywhere with their clients if clients can pay the money charged by them.
Many young SWs who are in greater demand among some clients continue to be highly
vulnerable to various forms of harassment and sexual exploitation including group sex. They are
also exploited by their employers (restaurant owners) by not paying their salaries and not
disclosing the amount charged to their clients.
Since young SWs are not in a position to negotiate condom use with their clients, they are highly
vulnerable to STIs and HIV/AIDS. Inconsistent condom use with their clients and non-use with
their steady sex partners (boyfriends and husbands) also makes them highly susceptible to STIs
and HIV infections. SWs' inability to recognize HIV/AIDS as a major problem and the
importance of condom use for disease prevention aggravates their vulnerability to STIs and
HIV/AIDS.
Many SWs do not confess their sex profession so easily which will make any behavior change
intervention (BCI) program among SWs difficult. Therefore, it is important to sensitize and
involve hotel and restaurant owners to access SWs for BCI program and also for condom
promotion through them. The program should specially target young girls engage in sex trade and
should foster condom negotiation skills with their clients. It is also important to motivate these
SWs to make periodic health check-up and voluntary testing for STIs and HIV.
V
CONTENTS
Acknowledgement
The Study Team
Abbreviations and Acronyms
Executive Summary
Chapter 1: INTRODUCTION.......................................................................................... 1-7
1. 1 Background............................................................................................................... 1
1.2 Objectives of the Study............................................................................................. 2
1.3 Study Design and Methodology ............................................................................... 3
1.4 SW Coverage for In-depth Interviews...................................................................... 5
1.5 Training and Fieldwork ............................................................................................ 6
1.6 Data Management and Analysis ............................................................................... 7
1.7 Ethical Considerations.............................................................................................. 7
1.8 Obstacles Encountered ............................................................................................. 7
Chapter 2: MAPPING OF SEX WORKERS' CONCENTRATION............................. 8-12
2.1 Mapping of Female SWs .......................................................................................... 8
2.2 Size Estimation of SWs ............................................................................................ 9
Chapter 3: CHARACTERISTICS OF FEMALE SEX WORKERS IN POKHARA.. 13-22
3.1 Age and Marital Status of SWs .............................................................................. 13
3.2 Birth Place & Previous Residence of SWs............................................................. 13
3.3 Occupation of SWs................................................................................................. 14
3.4 Duration of Engagement in Sex Profession............................................................ 15
3.5 Awareness about STIs and HIV/AIDS and their Transmission Routes ................. 16
3.6 Extent of Condom Use ........................................................................................... 16
3.7 Perception about Contracting STIs & HIV/AIDS .................................................. 19
3.8 SWs' Exposure to STIs and HIV/AIDS.................................................................. 21
Chapter 4: NETWORKING OF FEMALE SEX WORKERS IN POKHARA........... 23-36
4.1 Clients of SWs ....................................................................................................... 24
4.2 Networking with Clients......................................................................................... 25
4.3 Networking with Owners of Restaurants/Hotels and Bhatti Pasals ...................... 27
4.4 Place for Sex with Clients ...................................................................................... 29
4.5 Problems Encountered in Sex Professions ............................................................ 31
4.6 Health related Problems Encountered by SWs....................................................... 33
Chapter 5: SUMMARY & CONCLUSIONS ........................................................... 37-39
Bibliography
Chapter 1
INTRODUCTION
1. 1 Background
HIV is emerging as a major threat among female sex workers (SWs) and their clients.
The prevalence of HIV among SWs in Kathmandu was 2.7 per cent in 1996, which
increased to 17.3 per cent in 2000 (SACTS/FHI, 2000). It is estimated that about 70
percent of the Nepalese SWs returning from brothels of India are infected with
HIV/AIDS (NCASC, 2002). Since prostitution is illegal in the country, sex work is a
hidden profession. Studies show that several young girls and married women sell sex in
various guises while some SWs directly solicit clients in the streets and public places, or
contact their clients through middlemen/pimps or directly through telephones. The social
mapping and focused ethnographic study conducted by CREHPA in Kathmandu valley
(2001-2002) identified a total of 2008 SWs. The professions most commonly recognized
for selling sex in various guises include: waitresses in cabin and dance restaurants, as
dancers in dance restaurants and discos and as masseurs in massage parlors.
Approximately 800 SWs were those working in over 175 cabin restaurants and about 260
as street based SWs operating from 3-4 major public places and bus stations.
Many of the SWs are migrants from neighboring districts and remote villages seeking
employment in the valley. They generally migrate with their relatives, friends including
husbands. Likewise, a significant number street based sex workers are those who were
engaged initially in carpet and garment factories but later gets involved in street based
sex work either because they received very low wages, were sexually exploited by the
factory owners and friends or they were coaxed by their peers and elder siblings in sex
profession (CREHPA, 1996).
Comparatively, the plight of street based sex workers is quite different from the rest of
the sex workers in the valley. Apart from tolerating frequent sexual abuse and rape from
police and juvenile gangs of the city, most street based sex workers have to succumb to
various sexual demands of their clients and pimps. The rapid ethnographic study
conducted among street based SWs of Kathmandu in 2001 revealed that despite a high
prevalence of sexually transmitted infections among street based SWs such as foul
smelling vaginal discharge (62%), lower abdomen pain during intercourse (67%), painful
intercourse (57%), burning urination (52%), vaginal itching (38%), genital ulcers (29%)
and puss discharge from vagina (29%), very few amongst them sought medical attention.
Moreover, due to their lower price tag (as compared to the higher price tag for sex
workers employed as waitresses in dance and cabin restaurants of the city), competition
among street based sex workers was high and as a result, these SWs were compelled to
solicit clients and bear the sexual pains. Sometimes the street based SWs were also found
indulging in other crimes like pick-pocketing and pushing (selling) drugs (Tamang et. al.
2001).
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The vast majority of the SWs are aware that using condom is the main precautionary
measures against sexually transmitted infections (STIs) including HIV/AIDS. Despite
their high level of knowledge about HIV transmission through unprotected sex and
multiple sex partners, consistent use of condom was low and sexual exposure with
multiple sex partners (other than sex clients) was high among the majority of the SWs.
For instance, studies conducted among SWs in the highway routes of Nepal
(New ERA/FHI, 2000) revealed that half of the SWs have sexual contacts with men other
than their clients. Such men either happen to be husbands, boyfriends, or owner/staff of
hotel and restaurant, etc.
HIV/AIDS awareness and condom promotion messages have reached most SWs and their
clients either through intervention programs and/or media coverage. These have lead to a
steep rise in sale of condoms an increased used of condom by SWs and their clients.
However, SWs are not in a position to negotiate strongly with clients who refuse to wear
the condom, except for asking higher price for sex without condom. Few SWs succeed in
persuading their clients to wear condoms by telling them they would like to avoid getting
pregnant (which they felt to be an easier way to convince their clients) instead of telling
them that they fear about contracting of STDs/AIDS. Eighty percent of the street-based
sex workers interviewed in Kathmandu for ethnographic study admitted that their
profession was making them susceptible to contracting HIV/AIDS. Although prevalence
of STIs was high among these SWs (57-67%), none of them reported about having
infected with HIV (CREHPA/FHI, 2002b).
.
Women engage in commercial sex puts them at special risk of health problems for a
variety of reasons. Frequent sexual contact with a variety of partners makes these women
especially vulnerable to sexually transmitted infections (STI), Human Immunodeficiency
Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS). They are also at the risk of
unplanned or unwanted pregnancies. These SWs also represent a potential reservoir for
rapid transmission of these diseases through out the general population. As they work at
the fear of exposure to police or other authorities, and often attempt to hide their
activities, very little is known about their network and vulnerability. Moreover, no
reliable data exists about the population of SWs operating in different towns and cities
This rapid qualitative study is intended to gather information about the ways SWs operate
in Pokhara, a town that is most popular among trekkers and foreign and endogenous
tourists. The study will attempt to identify the types of network of SWs, their
concentration sites, types of clients they serve and their risk perceptions about
HIV/AIDS. The findings of the study will be useful to compare with the findings from
the similar study conducted previously in Kathmandu Valley and help designing
appropriate program.
1.2 Objectives of the Study
The main objectives of the study were to explore and document the existing network of
female sex workers (SWs) in Pokhara, the nature of professional disguise under which
they solicit sex clients, their mobility, types of clients served and the extent of condom
2
use by them. Estimation of the population of the SWs operating in the Pokhara valley is
an important component of the study.
1.3 Study Design and Methodology
As a part of research methodology finalization, a short exploratory visit to Pokhara was
made by the research team (Sept 26-28 2002). The team contacted local based
organisations like SEDA Nepal, Richmond Fellowship Nepal, Community Support
Group (an Ex-IDUs organisation), Sahara Club, Samudayik Sewa Kendra and Aama
Samuha, to explore the possibilities of using their networks in identification of SWs in
the valley. Some of the main sites of SW concentration identified by them such as slum
locations in Naya Bazar and Lalten Bazar and Bus Park area were visited by the team.
One Cabin Restaurant in Prithivi Chowk was also covered by the male researchers using
mystery client approach. It was informed to the team by representatives of the local
organisations, key informants from slum areas and bus parks that most SWs in Pokhara
operate from hotels, rented residential flats, dance restaurants and cabin restaurants and
hardly few SWs could be visible as street based sex workers. Call girls operating from
rented houses/flats have also been reported by the local informants
Considering the fact that most SWs operate in disguise (as waitresses, hotel attendants,
etc.), it was always a tough task for the researchers to identify a SW and confirm her
involvement in commercial sex trade. Moreover, the SWs had to be approached at their
place of work (hotel/restaurant based establishments). Accordingly, study relied upon a
combination of rapid appraisal methodologies to interview the SWs. Size estimation of
the SWs was also depended largely on narrative method and social mapping in order to
arrive at a reliable estimates.
Based upon the above assumptions and risks, it was decided to employ a rapid
ethnographic technique that will combine a host of different research methodologies.
Each of the methodologies employed in the study, the research subjects and their
applications/utilities are presented in Table 1.1.
Mystery client approach was employed to ascertain the sex profession of the young girls
working in places such as cabin and dance restaurants, Dohori restaurants and in Baglung
Bus Park area. These places were identified earlier as sites of SW concentration. Male
researchers of CREHPA involved in the on-going IDU study in Pokhara acted as clients
and after negotiating their fees they brought the SWs in a hotel (Hotel Ashok). The male
researchers introduced the SWs to the female researchers in the hotel. The female
researchers explained the objectives of the study and interviewed the SWs. In the hotel,
one room was rented for the purpose of interviewing IDUs and SWs. Ten SWs were
invited to the hotel in this way. Of these ten, only four agreed to be interviewed. The
remaining six SWs declined to be interviewed saying that they do not have time for being
interviewed.
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Table 1.1: Range of Qualitative Methodologies Used in the Rapid Study
Method/Tools
Subject
Purpose/Applications
Remarks
Key Informant
Interviews
Local residents &
leaders;
Pimps (hotel &
restaurant owners
& staff/ Taxi
drivers);
Local housewives
to identify and contact SWs
in a locality/ establishment;
to identify NGOs/Groups
working with FSWs in the
locality
Useful for size
estimation
Snow Balling
SWs
to identify additional SWs in
a locality or establishment
through the principal SW
interviewed
Mystery Client
Approach
SWs (Male
researchers will act
as Mystery Clients)
Social Mapping
NGOs, & Local
key informants
to confirm involvement of
female staff or waitresses of
restaurants in sex trade and
convince them to participate
in the interview
to estimate the population of
SWs in a given location;
to identify NGOs/Groups
working with SWs in the
locality
Identifying the
principal SW will
be a tricky exercise.
This can also serve
to estimate SWs
population in the
locality/
establishment
Risks of denial for
being interviewed.
Also Costly affairs
Takes time (at least
2 weeks) to cover
the entire urban
wards of Pokhara
Owners of the some of the Bhatti pasals were cooperative with the research team when
they were approached and confided about the objectives of the study. They did not
hesitate to call their waitresses in front of us and asked these girls to cooperate and
respond to the interviews. The owners convinced their waitresses saying "These sisters
(researchers) are here for your own benefits (health care), you must talk to them...". The
research team was able to interview 6 SWs after they were motivated by the bhatti pasal
owners.
Chain sampling or 'Snow-balling' was yet another useful technique adopted in the study.
Through snow-balling six SWs were successfully interviewed in-depth. SWs were given
small incentives and travel expenses to bring in their fellow SWs at the hotel where the
researchers had rented a room for interviewing. Direct contacts with SWs at their place of
work was not too effective since on one hand it took lot of time for the researchers to
convince the subject and ascertain her profession (as SW). In most cases, the subject
denied about her involvement in sex trade saying "...other girls go out with clients, but I
am not that type. I go out only with my boyfriends".
4
Hiring some of the male IDUs as local facilitator for identifying SWs was another
successful approach employed by the research team. The researchers had maintained
contacts with several male IDUs in the course of the IDU network study in Pokhara.
Some of these IDUs had mentioned about visiting SWs for sex. Three male IDUs had
agreed to act as local facilitators for the research team and introduced the researchers
with SWs they had acquainted with. Five SWs could be successfully interviewed in-depth
by the researchers with the help of the male IDUs. Two female IDU involved in sex
profession were also contacted by the research team through a volunteer of an NGO
involved in BCI program in Pokhara. Of these two, interview for one SW could be done.
The second SW had gone to Kathmandu.
Mapping of SWs locations, their size (population) by type of establishment or
professional disguise under which they operate has been an important task of the present
study. Mapping exercise was initiated towards the middle of the present study and spread
over eight days. Local informants at the identified sites were contacted by the research
team for mapping. The help of the research team involved in mapping of IDUs in
Pokhara were sought both for research walk in mapped location and application of
mystery client approach for SWs' identification.
1.4 SW Coverage for In-depth Interviews
The target was to cover around 30-50 SWs for in-depth case study. However, the research
team could interview only 32 SWs during the study period. As mentioned earlier,
although the research team were able to meet directly 72 SWs in the process of the study,
many of them either reluctant to participate in the research or denied their involvement in
sex trade altogether.
For example, in the course of trangulation of information derived through mapping and
KI interviews, the research team visited 34 establishments (cabin restaurants, dance
restaurants, bhatti pasals, etc.). In these 34 establishments, as many as 104 SWs were
identified and 72 SWs were met directly by the research team (53 SWs were met during
mapping exercise). In course of informal discussion to re-ascertain their sex profession,
only 32 SWs readily admitted that they were involved in the sex trade. The remaining 40
refused to admit that they were involved in sex trade. These SWs argued saying that
though they have boyfriends they were not involved in sex. Others argued saying "we sit
with our clients and dine together but we do not go out with them". However, the local
key informants and facilitators hired by the research team disagreed to what these SWs
said. One facilitator (a SW who helped the research team to contact with other SWs) said
" Didi, these girls are telling lies. How can they tell such lies? I know them when we
worked together in the same restaurant. They have gone out with many boys".
Among the 32 SWs covered for in-depth case study, 15 SWs (47%) worked in cabin
restaurants, 8 SWs in Bhatti Pasals, 5 in dance restaurants and remaining 4 were
employed in hotel and ordinary restaurants.
5
The following information were solicited by the researchers :
•
•
•
•
•
•
•
•
•
Background characteristics (age, marital status, place of origin, usual occupation part from
SW (if any), family composition, residence, and the like)
Involvement in commercial sex (entry, duration)
Type of clients served (usual/frequent, clients in the past one week)
Network (network with fellow SWs within and outside Pokhara, network with
pimps/middlemen, mobility within and outside Pokhara)
Place of soliciting clients and place of sexual activity
Use of condom (consistent, variation in condom use by type of client, condom negotiation)
Risk perception of STI and HIV/AIDS
Problems encountered in sex trade
Population Size and concentration areas of SWs
The above information was solicited through in-depth interviews by the research team.
The research team also collected free lists on several topics from the sex workers, such as
types of clients, place for soliciting clients, places for sexual activity, general problems
faced by them in sex trade, health problems encountered in past 12 months, etc.
1.5 Training and Fieldwork
Four female researchers (one Field Coordinator and three Field Researchers) assisted by
the male researchers involved in the male IDU study was involved in conducting the indepth case studies. Two out of the four female researchers were previously involved in
SWs study in Kathmandu. All the team members received orientation training about the
study methodology, the types of information sought and recording of information. The
study coordinator visited the team in Pokhara twice to review the progress of the
fieldwork and provide necessary guidelines to the study.
Fieldwork was launched during October 2002 after Dashain Holidays and continued after
Tihar (November 2002). Social mapping was carried out after Tihar with the support of
the research team involved in Male IDU study. As mentioned before, in order to facilitate
the fieldwork and access the SWs, 3 local facilitators (1 male IDU, 1 female SW-cumIDU and 1 SW) were recruited on a short-term basis in each area of concentrations. The
spots (venue) for the in-depth interviews were the hotel room rented by the research
team, place of work of the SWs and resident of the SWs themselves.
6
1.6 Data Management and Analysis
Being a rapid qualitative study, the interview guidelines formed the basis of soliciting
information from the SWs. Researchers recorded the information obtained from the
interviews in their field notes (using a note book/ diary). The field notes were later
expanded by the researchers as individual case histories after they returned to their hotel
rooms during the evening. Since the case studies were in Nepali, they were transcribed
and analysed manually. A meeting was held between CREHPA team members and FHI
representatives to discuss on the study report content and chapterization plan which
served as the guide for the present report preparation.
1.7 Ethical Considerations
Informed consent of all the sex workers was obtained verbally before they were
interviewed. All SWs were told about the purpose of the research and convinced them
about the confidentiality of the data. Those SWs contacted through mystery client
approach were brought to the female researchers who then explained them why they had
to be brought in such a manner. They were explained about the objectives of the study
and their consent to participate in the study was sought. The names of SWs appearing in
this report are not their true names. All original names of the SWs have been kept
confidential and used internally by the research team for the purpose of verification and
expansion of field notes only.
1.8 Obstacles Encountered
The majority of the SWs were reluctant to admit about their involvement in sex trade
when approached to them directly. Even the SWs who were brought by their friends on
our request were reluctant to admit about their sex profession. As a consequence, the
study took more time than required to complete the fieldwork.
7
Chapter 2
MAPPING OF SEX WORKERS' CONCENTRATION
2.1 Mapping of Female SWs
Mapping of sex workers (SWs) was done in three steps to identify the geographical
location/site of SW concentration and also to systematically estimate the size
(population) of this sub-population in the town. As the first step in the mapping exercise,
the Pokhara municipality area was divided into four mapping zones to facilitate the
research team to cover a specific area in detail and also to avoid overlapping of the
information. The four zones marked by the team were: 1) East of Seti River; 2) Northern
part of Pokhara covering Srijana Chowk and Prithivi Chowk; 3) West of Srijana Chowk;
and 4) South of Prithivi Chowk and Srijana Chowk. The tourist map of Pokhara was used
to delineate these four zones and for plotting the concentration sites of SWs. Four
research team, each team comprising of 3 researchers were involved in mapping of SWs
in each of the four zones. Two of the team members were previously involved in
mapping of IDUs in Pokhara.
Conducting research walk and identifying local informants comprised the second step in
mapping exercise. Initially two days were spent in research walk and informant
identification. In the course of the research walk the team discussed with many local
informants. Some local NGOs such as Sahara Club, Samudayaik Prahari Sewa
(Community Police Service) and Aama Samuha (Mothers' Group) to obtain the required
information. In the process, the study team visited 28 locations/sites all over Pokhara and
talked to as many as 412 informants such as shopkeepers, hotel/restaurant owners, tea
stalls owners, bhatti pasal owners, male injecting drug users, taxi drivers, bus drivers and
their assistants and police personnel. Many of them were helpful in providing information
about the concentration sites and approximate number of SWs in each site. In some of the
cabin restaurants, dance restaurants and dohari restaurants, the owners confided about the
involvement of their female staff in commercial sex. Some owners also convinced to their
female staff to co-operate with the study team for interviews. Some also gave the number
of sex workers working specially in different cabin and dance restaurants.
Several informants mentioned about the concentration of SWs in bhatti pasals around the
Baglung bus station. In the process of "triangulating" the information, one taxi driver
stressed the fact that this location was like "No mistake mission". He explained saying
"Tyahn gaye pachi khali haath pharkinu pardaina, auta na auta pai halcha" (once you
visit that area, you need not return empty hand, you will get at least one).
As the third step, direct contacts with the SWs was made in majority of the locations and
establishments in order to re-confirm/triangulate the information about their involvement
in sex work and reduce the chances of overlapping of the information. Male researchers
acted as (mystery) clients to find out if the female employees in cabin and dance
restaurants including in Dohori restaurants were really SWs and how many of these
employees were engaged in sex profession. The help of local facilitators was also sought
8
in certain locations to contact SWs that they knew personally. In some establishments,
the owners themselves confided about their female employees' involvement in sex work.
It may be mentioned that in recent months, some restaurants have begun introducing
Dohori (a popular means of entertainment through singing traditional folk songs) in
Kathmandu and Pokhara to give a different flavor in evening cultural entertainment to
customers. In such restaurants (three in all), separate group of women and men (3-4 in a
group) clad in their traditional dress, sing traditional songs and through the songs they
tease the group of opposite sex.
2.2 Size Estimation of SWs
At the time of launching the present study, one Pokhara based NGO working in SWs for
the long time estimated the SW's population to be around 3000. Our mapping exercise in
Pokhara listed 286 SWs out of which 281 were identified as working in seven different
types of business establishments and the remaining 5 were street-based SWs (soliciting
clients around old bus park area near Prithivi chowk). Based on our mapping exercise, the
minimum and maximum range of SWs population is 281 and 321. Although there is no
gold standard for size estimation of hidden population like female sex workers,
considering the wider geographical coverage and intensity of mapping exercises carried
out by the research team (including triangulation and direct contacts), we are confident
that the total number of female sex workers in Pokhara is approximately 300. This
estimation is much lower than the exaggerated figures being quoted by the Pokhara based
NGO.
During the mapping process, the research team made direct contacts with 53 SWs
through mystery client approach and direct contact through local facilitators (the total
number of SWs contacted directly in the entire fieldwork was 72). These 53 SWs
provided the names of 127 SWs working with them in their locality. The remaining 106
were listed with the help of restaurant owners and local informants. Though listing of the
SWs were done at specific location/sites either by SWs themselves or by local facilitators
and informants, the possibility of double counting (overlapping) cannot be ruled out
especially for SWs identified at dance and dohori based establishments. However such
overlapping could be minimal.
The research team visited all the 31 cabin restaurants∗, all the 6 dance restaurants and 3
dohori restaurants of Pokhara during the mapping work. Since the number of hotels,
ordinary restaurants, Bhatti pasals, etc., are several and they are spread widely in
Pokhara, only those listed by local key informants were visited by the research team to
confirm/trangulate the information (presence of SWs). The size estimation shows that the
cabin based SWs comprise the largest category of SWs (90 SWs or 31%), followed by
Bhatti Pasal.based SWs (19%). The proportion of dance restaurant based SWs (14%) and
hotel based SWs (14%) are also quite significant in Pokhara. These four categories
∗
A cabin restaurant in Pokhara is categorised as the one having a separate cabins or rooms with curtains to
maintain privacy for the customers. In Kathmandu valley during 2000-01, such type of restaurants
displayed the name 'cabin restaurant' on their signboards or shop boards, which was removed later on due
to public pressure when sexual activity inside such restaurants became an open secret.
9
together add to more than three-fourths (78%) of the total SWs in this town. Call girls
operating from rented accommodation have insignificant representation (below 9%).
However, they comprise relatively the most invisible category of SWs.
In the course of mapping and trangulation, the research team found 29 cabin restaurants,
25 Bhatti pasals and 17 hotels employing SWs. The number of dance restaurants are just
five but they employ a large number of SWs to serve as waitress and dancers (average
eight SWs per dance restaurant). The number of rented settlements that harbor call girls is
12 and confined to Matepani, Ram Bazar, Tallo Deep, Amar Singh areas. All the three
dohori restaurants have been identified to employ SWs.
Table 2.1 presents the estimated number of SWs in Pokhara by types and number of
specific establishments where they are employed and solicit clients. The location specific
concentration of SWs and their size (number) in each location by type of SWs is
presented in Table 2.1a.
Table 2.1 Estimated number of SWs by category of SWs identified in Pokhara
S.N.
Types of SWs
1
Cabin restaurant based
2
Bhatti Pasal based
3.
Dance restaurant based
4
Hotel based
5
Rented settlement/Call girl based
6
Ordinary restaurant based
7.
Dohari Restaurant based
8.
Street based
TOTAL
Number of
establishments
employing SWs
29
25
5
17
12
7
2
97
10
Number of SWs
listed
%
90
54
40
39
25
24
9
5
286
31.5
18.9
14.0
13.6
8.7
8.4
3.1
1.7
100.0
Table 2.1a Location wise concentration of SWs and their size (number) in each location by
type of SWs
S. Location
n
Name
of Types
Establishment
1 Srijana Chowk
2
3
4
5
6
7
8
9
A1
B1
C1
D1
E1
F1
G1
H1
I1
J1
Zero Kilo Meter A2
B2
Jarebar
A3
Dam Side
A4
Mustang Chowk A5
Hallan Chowk A6
Chiple Dhunga A7
B7
C7
D7
E7
F7
G7
H7
I7
Mahendrapool A8
B8
C8
D8
Shabagriha
A9
B9
C9
D9
10 BaglungBus Park A10
B10 (6 No.)
11 Tallo Deep
A11
12 Naya Bazaar
A12
13 New Road
A13
B13
C13
D13
CR
CR
CR
CR
CR
CR
Ho
RT
RT
CR
TB
CR
TB
RT
CR
CG
CR
CR
CR
CR
Do
CR
CR
DR
RT
CR
CR
DR
DR
RT
RT
CR
TB
Ho
TB
CG
TB
TB
CR
CR
RT
Estimated Number
SW
3*
3*
2
4*
3*
3
1
3
3*
3
4*
2*
5*
4*
4
3*
3*
3*
2
3*
3*
8*
5*
3
3
25*
10*
6
3*
5*
3
11
Range
Info1. Info2. Direct Obs. Min Max
3
2
3
2
3
3
2
3
2
3
2
1
2*
1
2
4
2
3
2
4
3
2
3
2
3
3
2
4*
2
4
2
2*
2
1
2
4
5
4*
3
5
1
3
4
1
4
2
2
3*
2
3
3
4
3
3
4
2
2
2
2
2
2
1
4
1
4
4
2
4
2
4
2
1
2*
1
2
1*
1
1
1
1
5
5*
5
4
5
3
5
3
3
5
2
5
3
2
5
3
5
3
3
5
1*
5
1
1
5
3*
4
3
2
4
2
3
2*
2
3
7
9*
5
5
9
2
1
2
1
3
2
4
3
2
4
3
3
3*
3
3
7
6*
6
6
7
7
8
5
5
8
5
6
5
5
6
3*
2
3
2
3
5
5
4*
3
5
2
2
3*
2
3
20
25
10
10 25
15
8
4
4
15
6
10* Not possible 6
10
4
7
6*
4
7
1
2
2
1
3
2
3
2*
2
3
4
3
4
3
5
3*
3
3
Most Likely Fig.
3
3
2
4
3
4
2
4
3
3
4
2
5
4
2
1
5
3
3
3
1
3
2
9
3
3
3
6
8
5
3
4
3
25
10
10
6
3
2
5
3
Table 2.1a Location specific concentration of SWs and their size (number) in each location by type of SWs
S.n Location
Establishment
Types
Estimated Number
SW
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Indra Marga
Dhasa Tole
Kami Dhara
Milan Tole
Nagin Tole
Buddha Chowk
Amar Singh
Home
Home
Home
Home
Home
A19
A20
B20
C20
Home
Naya Bazar
A21
Prithvi Chowk A22
B22
C22
D22
E22
Prithvi Chowk Bhatti (12)
(Bus Park)
Hotel (7)
Street
Shivalaya Marg A24
B24
C24
D24
Bhatti
Chiyapani
Home
Matepani
Home
(Sukumbasi)
Matepani (Near Home
Church)
Dhikelathar
Home
(Karki Tole)
Range
Most
Likely Fig.
Info Info2 Direct Obs. Min Max
1.
.
1
1* Not possible 1
1
1*
1
Not possible 1
1
2
2* Not possible 2
2
1*
1
Not possible 1
1
2*
2
Not possible 2
2
1
2
2*
1
2
5
10
3
3 10
2
3
2*
2
3
2
1*
1
1
2
1
1* Not possible 1
1
4
3
3
3
4
4
5
5
4
5
2
3*
3
2
3
2
2
2
2
2
8*
5
8
5
8
4
5
5
4
7
15* 20
8
8 20
CG
CG
CG
CG
CG
RT
DR
CR
CR
CG
CR
CR
TB
CR
Do
DR
TB
10*
3*
5*
2*
7*
-
Ho
SB
CR
CR
CR
CR
TB
CG
CG
12*
4*
2
2*
-
10
4
3
3
2
2
2
1*
1*
15
5*
4
3
2
4
-
6
3
4
3*
2
3*
5*
Not possible
Not possible
6
3
3
2
2
2
2
1
1
15
5
4
3
2
3
5
1
1
12
5
4
3
2
3
5
1
1
CG
-
3*
-
Not possible
3
3
3
CG
-
1*
-
-
1
1
1
Total
181 321 286
Note: The names of the establishment are coded to suppress their real
name. Most likely figure is taken from the figure having (*) sign.
CR= Cabin Restaurant Based SW
Ho= Hotel Based SW
RT= Restaurant based
TB= Tea Stall/Bhatti Pasal Based
CG= Call Girl
Do= Dohori Based
DR= Dance Restaurant Based
SB= Street Based SW
12
1
1
2
1
2
2
10
2
1
1
3
5
3
2
8
7
15
Chapter 3
CHARACTERISTICS OF FEMALE SEX WORKERS IN POKHARA
This chapter describes the female sex workers' background characteristics including their
level of awareness and risk perceptions about sexually transmitted infections (STIs)
including HIV/AIDS of the 32 female SWs interviewed in-depth for the present rapid
qualitative study in Pokhara. The background characteristics described here pertains to
respondents' (sex workers') age, marital status, place of birth and place of previous
residence (before working in Pokhara), types of employment (occupation) and duration of
involvement in sex trade. Respondents' level of awareness about STIs and HIV/AIDS,
extent of condom use including condom negotiation, risk perception about contracting
STIs and exposure to STIs/HIV are also discussed in this chapter.
3.1 Age and Marital Status of SWs
The large majority of the SWs (19 out of 32 or 60%) interviewed for the present study
were young - between 15 and 19 years of age. Three SWs were minors (15 years of age)
and one SW was 30 years of age. In terms of marital status, among the 15-19 age group,
10 SWs were unmarried, 7 married and 2 had divorced/separated from their husbands.
None of the SWs aged 20 and above were single (unmarried). The number of SWs aged
20 years and over who were divorced/separated from their spouses (8 SWs) exceeded
those who were married (5 SWs) in the sample. The oldest respondent (30 years of age)
was a divorced mother of three children (Table 3.1)
Table 3.1 : Distribution of SWs according to their broad age group and marital status
Marital Status
Unmarried
Married
Separated/Divorced
Total
15-19
10
7
2
19
Age in Years
20-24
x
3
4
7
Total
25 +
x
2
4
6
10
12
10
32
3.2 Birth Place & Previous Residence of SWs
The birthplace of a half of the SWs (16 out of 32 SWs) is Kaski district. Of them, 9 were
born in Pokhara valley itself. Seven SWs mentioned that their places of birth were the
adjoining district of Tanahu. The birthplaces cited by the remaining SWs are Lamjung,
Parbat, Rupendehi, Kathmandu, Nawalparasi, Kavre and Jhapa. One SW cited India as
her country of birth. Her father had served the Indian army.
The previous or the last residence of nearly half (15 out of 32 SWs) is Kaski district. Of
these, 10 SWs were from Pokhara itself. Seven are from Tanahu 3 from KTM, 2 from
Jhapa and one each from Parbat, Rupendehi, Makwanpur, Lamjung, Nawalparasi. It is
13
evident from the respondents' place of previous residence that the majority of the SWs of
Pokhara have migrated to Pokhara from different places (Table 3.2).
Table 3.2
Distribution of SWs according to their Place of Birth and Place of Previous
Residence
District
Kaski district
Pokhara
Tanahun
Kathmandu
Jhapa
Lumjung
Parbat
Kavre
Rupendehi
Nawalparasi
Makwanpur
India
TOTAL
3.3
Place of Birth
Place of previous residence
16
(9)
7
1
2
1
1
1
1
1
1
32
15
(10)
7
3
2
1
1
1
1
1
32
Occupation of SWs
All the 32 SWs interviewed for the present in-depth case studies were employed in
various cabin and dance restaurants, bhatti pasals (restaurant offering liquor and snackes),
hotel and ordinary restaurants. They either work as waitresses, dancers, helpers/cleaners,
or as dish washers. Among the 32 SWs, 15 SWs were employed in cabin restaurants, 8
Bhatti Pasals, 5 SWs in dance restaurants, 3 SWs in hotels and 1 SW in an ordinary
restaurant.
It was interesting to find that for the 15 SWs working as waitresses in cabin restaurants
and 8 SWs working in Bhatti Pasals, the present job was their first ever jobs. Cabin
restaurants are notorious places where waitresses are expected to engage themselves in
various non-penetrative sexual acts as desired by clients inside the cabins. It is also the
place where SWs negotiate prices with their clients for going out with them for sex.
Comparison of the previous occupation of the SWs indicates that for the large majority of
the SWs (21 SWs), their entry into current (sex) profession was after leaving agriculture
work (6 SWs), daily wage labor (5 SWs), worker in a noodle factory (1 SW) or as a
housewife (9 SWs).
Similar to the SWs in Kathmandu, some SWs, irrespective of their marital status,
reported that they have steady partner or boyfriends for security reasons (to escaped from
being harassed by local youths) with whom they have intimate sexual relations.
However, there are some SWs who do not cherish such relationships. One SW refuted the
idea of keeping a boyfriend when she was probed if she was having a boyfriend. She
14
replied saying "Sittaima kena arkako ochhian hune?Hoki Didi?" (Why should I become a
free bed for someone? Am I not right Sister?). - Meera, married, 24 years, Bhatti Pasal
SW. (Table 3.3).
Table 3.3 Distribution of SWs according to the nature of current and previous occupations
Types of Occupation /
Employment
Waitress in cabin restaurant
Current
occupation
15
Previous
occupation
-
Waitress in Bhatti pasal
8
-
Waitress in dance restaurant
2
3
Dancer in dance restaurant
Waitress in ordinary restaurant
Waitress in Hotel
Dish washer in cabin restaurant
Dish washer in dance restaurant
Dish washer in ordinary restaurant
Cleaner in cabin restaurant
Cleaner in Tea/Bhatti pasal
Country liquor manufacturing &
sales
Student
Poultry farm
Daily wage labor
Agriculture
Noodle factory
Housewife
3
1
2
1
1
2
1
1
3
1
1
1
1
-
1
5
6
1
9
Remarks
2 SWs are also engaged as
dish washer (1)and cleaner
(2)
2 SW are also engaged as
cleaners in the same
establishment
1 SW also work as dish
washer and as dancer in the
same restaurant
The total adds more than 32 SWs due to multiple occupation
3.4 Duration of Engagement in Sex Profession
Over a half of the SWs (17/32) covered for the in-depth case studies reported that they
were in sex profession for about one year, out of which 10 SWs said they were in this
business for less than months. Eight SWs were involved in sex trade for 2-3 years and
the remaining 7 SWs for over 3-4 years or even longer. In terms of current age of the
SWs, those mentioning less than one year in sex profession are very high (12 out of 17
SWs) among teenaged SWs (15-19 years). Since a significant number of this age group
of SWs (7 SWs) are also found to be sex profession for over one year to 4 years, it
reflects the fact that many girls enter into sex profession in a very young age (Table 3.4).
15
Table 3.4
Distribution of SWs according to their duration of engagement in sex
profession by age of the SW
Duration in Sex profession
Less than 6 months
7-12 months
13-24 months
25-36 months
37-48 months
49 +months and over
TOTAL
15-19 Yr
7
5
2
2
3
19
Age in Years
20-24 Yr
1
2
2
1
1
7
Total
25 + Yr
2
2
1
1
6
10
7
6
2
5
2
32
3.5 Awareness about STIs and HIV/AIDS and their Transmission Routes
The large majority of SWs (22/32) were aware about sexually transmitted infections
(STIs) through their signs and symptoms. For instance, they identified STIs as "a person
suffering from genital ulcers"; "foul smelling (white) discharge/pus discharge",
"contagious disease"; "difficult to urinate/painful urination". Others identified STIs by
their sources of transmission - "if had sex without condoms" (13 SWs).
Knowledge about HIV/AIDS was also very high among all the SWs interviewed. For
instance, the large majority of them identified AIDS as a dreadful life-threatening,
incurable disease (24 SW). But some SWs believed that AIDS makes a person very weak
and his skin will turn dark (2 SWs) and a person infected with AIDS dies after 10 years
(1 SW). As regards, the transmission routes, most of the SWs interviewed (29 out of 32
SWs) perceived that AIDS is transmitted sexually. Only about a fifth (7 SWs) mentioned
that it is transmitted through blood transfusion and also through sharing of used syringes.
3.6 Extent of Condom Use
Information was solicited about the extent of condom use by SWs with their clients,
husbands and boyfriends. As can be seen from the marital status of the 32 SWs (Table 3.1
above) covered for the in-depth study, 10 SWs were unmarried, 12 were married and
remaining 10 were separated. Among the 10 unmarried SWs, 8 were having boyfriends
and two did not (one of the two admitted of having three boyfriends before getting
involved in sex trade). Among the married SWs, less than half (5 SWs) had boyfriends.
However, almost all the 10 SWs who were separated reported of having boyfriends.
Overall, 22 out of 32 SWs had boyfriends and 12 had husbands. The tendency of having a
boyfriend among SWs was also documented in the previous SW study conducted in
Kathmandu valley.
Although almost everyone (30 out of 32 SWs), have ever used condoms during sex with
their clients, not everyone have been using condom every time they had sex with clients
(consistent use). Several SWs complained that army men and police personnel do not use
16
condoms even when they were insisted. Instead they threatened SWs for being arrested if
they were not allowed to have sex without condoms. Stressing on this facts one SWs said:
" If I do not allow army men and police to 'do' (have sex), they would threaten me
saying I will be arrested. They insist of having sex without condom and threaten
me saying that If I object sex without condom, I will be caught and taken to police
station. I have to heed to their demand"
- Rupa, 30 Yr. Separated
Among the 32 SWs, the number of those using condoms consistently with their clients
were 23 (72%). Condom use during last sex with clients was reported by almost all of
them (29 SWs). It was discouraging to find a low proportion of SWs using condoms
consistently with their husbands and boyfriends. Out of the 22 SWs having boyfriends,
only 5 (23%) have ever used a condom and only 3 (14%) have used consistently.
Likewise, among the 12 SWs having husbands, only 4 (33%) mentioned about ever using
a condom with their husbands and only 2 (17%) using condom consistently (Table 3.5)
Carrying condoms by SWs in their purses is very rare. Very few SWs (2 SWs) mentioned
that they carry condoms with them all the time. Approximately one third (11 SWs) of the
SWs said that they arrange condoms sometimes only, while the majority of the SWs (17
SWs) depended upon their clients for arranging condoms. Some SWs even mentioned
that the owners of the restaurants/hotel where they work also supplied condoms to clients
arranged by them.
Q:
A:
Who makes the arrangement to bring the condom?
Mostly, the clients bring it themselves. Owner provides to those who do not bring, that is why we
don’t have to worry about condoms.
Q:
A:
How often do you use condom with your boyfriend?
My first boyfriend did not use it at all. Those (sandeep, sagar, suraj) with whom I went from the
Lotus, they all used condom whenever we had sex. Its been a month that I have not met my
boyfriend, after I started working in this restaurant.. After having sex with the clients at the
Lakeside hotels I come back.
Q:
A:
At that time, did you use condom with your boyfriend for the last time or no?
Yes, I did.
Q:
A:
Why did you use it then?
At that time I was afraid that I might become pregnant and so I used it.
Q:
How far have you thought that you might be infected with HIV/AIDS and sexual diseases through
you partner?
Till now we have always used condom and even the hotel owner had sent us giving condom and
we have not asked to use it as they always brings with them. So, they must have thought about it.
Even the owners have thought about it and send us giving condom when we go out with the
clients.
A:
- Reena, 16 Yr. Unmarried
17
Q:
A:
Did you use condom with your last client or not?
I already told you that I always use condom with my clients and I even used then. The use of
condom prevents from AIDS, sexually transmitted disease and pregnancy.
Q:
A:
How many times did you use condom when you were with your husband?
Even now I don't want any children and I still use condom, but not very often, and if I doubt I'll
become pregnant then I use condom or else I don’t use it.
Q:
A:
For the last time, did you use condom when you had sex with your husband?
I did not use because I was not scared of conceiving at that time.
Pawita, 20, Married
Table 3.5 Extent of Condom use by SWs According to the types of their Sex Partners
(N = 32 )
Type of Sex Partner
Ever use of
Last use of
Consistent use of
condom
condom
condom
Clients (N=32)
30 (94%)
29 (91%)
23 (72%)
Husbands (N = 9)
4 (44%)
3 (33%)
2 (22%)
Boyfriends (N = 22)
5 (23%)
3 (14%)
3 (14%)
Among the 15 SWs who never used condom with husband/boyfriends, the reasons behind
not using condoms are:
"Why should condom be used with husbands?" (8 SWs);
"I trust him (boyfriend). He has no relations with others" (7 SWs).
"Condoms do not make sex enjoyment for both of us" (2 SWs)
" We (husband & wife) trust each other. Moreover, my husband has undergone
vasectomy operation. So why to use condom? I don't use condom either with my
boyfriend since I love and trust him too. But I have taught my boyfriend who is a
young college student about withdrawal method" (1 SW).
"He (boyfriend) does not like to wear condoms at all. He also desires to have a
child from me. But I am taking oral Pills without his knowledge to avoid getting
pregnant" (1 SW).
It is evident from the above mentioned statements that some SWs were less concerned
about their risk of contracting STIs including HIV/AIDS or transmitting the same to their
spouses or boyfriends. The reasons mentioned for consistent use of condom with
husbands/boyfriends as expressed by the 7 SWs were: "Do not want to become
pregnant/no desire for a child" (4 SWs) "To protect ourselves (both the partners) from
STIs and HIV/AIDS " (2 SW);"We are just married but I do not trust him" (1 SW)
18
Q:
A:
Why don't you use condom with your husband?
I trust my husband. He doesn't go out with other girls but he comes to me instead and except that I
want to give birth to his child but I don't know why till now I have not been able to get pregnant.
Q:
Do your guest think about the fact that they might be infected with HIV/AIDS and Sexually
Transmitted Disease from you?
Maybe because some of my guests haven't thought about it that is why they refuse to use condom
while having sex. But there are some who being aware of the fact and insist on using condoms.
A:
- Aariti, 16, Separated
3.7 Perception about Contracting STIs & HIV/AIDS
3.7.1 Risk Perceptions among Consistent Condom Users
Among the 23 SWs who said they use condom consistently during sex with their clients,
most of them (19 SWs or 83%) do not perceive themselves to be at risk of contracting.
Only 2 SWs were worried that they could be at risk. The remaining 2 SWs said they were
not bothered. One of these two SWs (not bothering about the infection) was not aware
about STIs and HIV/AIDS and the other was mentally disturbed (Table 3.6).
The explanation given by 2 SWs, who despite using condom consistently with their
clients, perceived themselves to be at risk, are as follows:
"My boyfriend (taxi driver) has relation with another girl named Sunita who is in
same profession like mine. He tells me saying that if I get pregnant he will take
care of the child. If I get AIDS we will live with AIDS and also die together. But I
am so scared"
- Sarita, 15 yr. Unmarried
19
3.7.2 Risk Perceptions Among non-consistent Condom Users
Majority of the SWs (5 out of 9 SWs) who did not use condoms consistently feared of
being contracting HIV. However, 3 SW did not perceive themselves to be at risk although
their (Table 3.6). The information on risk perception from 1 SW could not be obtained
since she was lost for follow-up.
The reasons for not perceiving at risks as expressed by the three SWs are:
"My regular clients come to me only and they do not go elsewhere for sex. So
there is nothing to fear. But with non-regular clients I always persuade to sue
condoms".
- Sunita, 21 yr, Separated
"I had been to Gandaki Zonal Hospital for check up. The doctors told me that I
was nether pregnant nor has HIV in my blood sample. So I do not consider to be
at risk."
- Sumina, 15 yr. Unmarried
"I go out with my boyfriend only. He has sexual contact only with his wife and me.
So I do not consider to be at risk"
- Susma, 26 yr. Separated
Q:
A:
Why don’t you use condom?
As he is my husband, and secondly he has already done family planning, and we both believe each
other.
Q
A:
How: much do you use condom with your boyfriend?
We had sex for 2-3 times only and I have not used condom for once.
Q:
A:
Why did you not use it?
We love each other and we believe each other, that is why.
Q:
A:
And are you not afraid of becoming pregnant when not using condom?
I use a method so that is why I don’t become pregnant.
Q:
A:
What do you do?
I ask him to throw the semen out when he ejaculates, and he don’t know how to throw out. And if
he throw inside, I go to the medical and buy medicine as not to become pregnant just before my
regular cycles starts and my cycles starts.
Q:
Are you conscious that your husband and your boyfriend might get AIDS and sexual disease
through you?
They both believe me, so even I cannot betray them. That is why when I go out with others
(clients) I always use condom.
A:
Q:
A:
Are they conscious that they might get these diseases through you?
No, They both trust me, and my husband does not know that I go about like this, and even my
boyfriend knows that I am married.
Asha, 26, Married
20
Table 3.6
Levels of Risk Perceptions among SWs reporting Consistent and Nonconsistent Use of Condoms
Extent of Condom use
with clients
CONSISTENT CONDOM
USERS (N = 23)
NON-CONSISTENT
CONDOM USERS (N = 9)
SWs
Perceiving
themselves to
be at Risk
2 (9%)
SWs
Perceiving
themselves
NOT at Risk
19 (83%)
SWs
NOT
Bothered at
all
2 (9%)
No response
5
3
-
1
7
22
2
1
-
TOTAL (N= 32)
3.8
SWs' Exposure to STIs and HIV/AIDS
All the 32 SWs covered for the present in-depth study were asked if they ever had
experienced any sexually transmitted infection including HIV/AIDS, if so, what have
they done to cure the infection. It was discouraging to find some SWs not aware of STIs.
Only 8 SWs mentioned that they have experienced some STI related problems such as
foul smelling discharge (2), white discharge (5), vaginal bleeding (1), vaginal itching (2),
Burning urination (1) and lower abdomen pain (1).
One SW (Aansu, 17 Year, Unmarried) (name changed) mentioned about experiencing
heavy white discharge, burning urination and lower abdomen pain. However, she was not
aware of any signs and symptoms of STIs.
Since past one year, Rupa (30 Year, Separated) (name changed) suffers from vaginal
bleeding. She had undergone treatment for white discharge from SEDA. She has yet to
seek treatment for vaginal bleeding.
"Though I am highly concerned about contracting STIs and AIDS, but my foolish
clients don't like to wear condoms. As I need money, I have no option but to face
the risk"
- Rupa, 30 yr, Separated
21
The case of Asha (26 yr. Married) (name changed) is a good example to show how some
of the SWs do recognize white discharge as a form of STI. During earlier interviews
(Free listing exercise on types of health problems encountered in past 12 months), Asha
had mentioned that she had suffered white discharge and her husband too had complaints
about puss discharge from penis. Explaining about the problem she said
"Just recently when I suffered from white discharge, my husband also had
problem of puss discharge (Li nga bata Peep Jasto Pani Baggeko). We got
ourselves treated from Kathmandu Army Hospital, in Kathmandu. The medicine
helped to cure the problems for both of us. I think my husband contracted the
problem through me. I was scared about the White discharge too since I knew it
was a Naramro Rog (bad disease) and I use to feel shy to tell anyone about the
discharge problem. I even asked to examine my blood sample but there was
nothing positive in the blood sample"
-
22
Asha, 26 yr. Married
Chapter 4
NETWORKING OF FEMALE SEX WORKERS IN POKHARA
Pokhara being one of the favorite destination for tourists and trekkers, the attraction of
sex workers to this town is obvious. As described in Chapter 2 of this report, the previous
residence of 22 out of 32 SWs covered in the study was outside Pokhara, out of which, 17
SWs were residing outside Kaski district previously. Another important feature is the
young age of the majority of the SWs – 19 years and below. All the three marital
categories - unmarried, married and separated women are represented equally in the
study sample.
Unlike the SWs of Kathmandu, very few SWs in Pokhara solicit clients in the streets or
public places. It was reported that earlier, there were many street-based SWs looking out
for clients in old bus station area but they were driven away by social organizations like
Aama Samuha and Samudayak Prahari Sewa. As a result, SWs began operating through
disguise employment.
As in cities of Kathmandu valley, contacting SWs in Pokhara is not difficult. One can
visit a cabin restaurant any time in a day to enjoy a bottle of beer or during evening hours
in a Dohori restaurant to listen to folk songs or observe young girls dancing in dance
restaurants. Female waitresses in these joints serve drinks and snacks and they can be
easily approached and fix a deal (price). In certain restaurants, clients can also negotiate
the price with the owners of the restaurants and take away the girl of their choice.
The rates charged by SWs or by their middlemen/brokers ranged from Rs 400 to 600 for
1-2 hours during daytime and between Rs.1000 and Rs.2000 for overnight stay with the
clients. The charges for taking a SW outside Pokhara is very high (Rs. 3,000 – Rs. 5,000
per night).
"I fix clients myself among those who come to the hotel without hotel owner's knowledge.
People come here to drink beer, and when they do, we sit with them. When they ask us to
go with them, I ask for money first and after fixing money with them I sneak out of the
hotel around 7-8 o'clock (evening), and go to Himalaya or Jharna which ever hotel the
clients take us. I take money from the clients before hand itself"
- Sarita, 15 Yr.
"I usually go out during the daytime and I charge Rs 400 to Rs. 800. Some clients even
gives more money when they are happy. Some even give money (Rs.400- Rs 600) for
looking at my body (naked). I don’t go out at night as I have children".
- Asha, 26 Yr.
"One day, Didi (sister) of this hotel told me to go with with three men (customers) and to
the lakeside. At first I denied, but she scolded me and finally convince me. She herself
dropped me at a hotel at lakeside.. One person had with me for 2/3hours and gave me
Rs3000 and another had with me for whole night and gave me Rs5000 and later both of
them dropped me to the hotel. The third man was different. He scolded me and
encouraged me not to do these types of work. He told me that I was like his daughter. All
23
of them were from Kathmandu. They come to visit us for these types of work. Their age
was about 25-30 years".
- Bala, 17 Yr.
Any person who wish to seek a SW can easily contact SWs through local taxi drivers
who would take the him to Baglung bus park area. Taxi drivers consider this place as 'No
Mistake Mission' – meaning there is 100% sure to contact a SW in Baglung bus park
area. Similar scenarios were observed in the New Bus Park (Goganbu) area of
Kathmandu during the previous studies (FHI/CREHPA, 2001).
4.1 Clients of SWs
SWs have listed as many as 39 types of clients (in terms of profession of the clients)
ranging from rag-pickers, drug addicts, taxi drivers to police, army, lawyers, doctors and
foreigners. These clients can be grouped into 22 types. Of these, the main clients (as
mentioned by over half of the SWs) comprise of four types. They are: 1) Drivers of taxi,
bus/truck and their Khalasi or assistants (87% SWs); 2) Service holders in government
and non-government offices (87% SWs); 3) Police (59%); and 4) Army (57%). Other
regular clients include Lahure (foreign army recruits), Businessmen (44% each), local
youths (41%), students (34%), hotel owners/staff (34%) and drug addicts (31%) (Table
4.1)
Table 4.1 Distribution of SWs according to the types of Clients served by them
S. N.
Types of Clients
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Taxi drivers/bus & truck drivers/Khalasi
Service holders in govt/non-government offices
Police
Royal Nepal Army
Lahure (foreign army recruits)
Businessmen
Local Youths
Students
Hotel owners/staff & their friends
Injecting drug users/drug pullers
Lahure's sons
Bank staff
Skilled laborer (workers in garage/furniture/computer)
Seasonal migrants working in foreign countries
Foreigners
School teacher/principal
Doctor/Lawyer
Contractor
Vegetable seller
Dhoti (terai community)
Nepalese Visitors from Kathmandu/other district
Middle-aged person
24
Frequency of
responses (N =32)
28
28
19
18
14
14
13
11
11
10
9
9
6
5
5
4
3
2
2
2
2
1
%
87.5
87.5
59.4
56.2
43.7
43.7
40.6
34.4
34.4
31.3
28.1
28.1
18.8
15.6
15.6
12.5
9.4
6.3
6.3
6.3
6.3
3.1
Q:
A:
What types of customers come to you? How many of them come to you regularly?
They are mostly taxi-drivers, Hong Kong ex-army's sons and officers come to us. Among them,
taxi-drivers, Hong Kong ex-army's sons are regular visitors.
- Bina 16 Yr.
4.2 Networking with Clients
Since most SWs in Pokhara are employed in restaurants/hotels and Bhatti Pasals,
majority of them solicit clients directly while serving them food and drinks while for
some, or through the owners of these restaurants/bhatti pasals. Sometimes, their friends
(fellow SWs) also help them to arrange the clients. It was obvious that the place for
contacting clients for the large majority of the SWs (22 out of 32 or 69%) is the working
place (restaurants/hotels/Bhatti Pasals) of the SWs themselves. Only 4 SWs said that they
wait at the Baglung Bus Station or at the local bus stations to look out for their clients.
Remaining 6 SWs cited other hotels, tea stalls, discos, and lakeside as the place where
they usually meet their clients.
The following excerpt from an in-depth interview with Pawita (name changed) explains
how young SWs in Pokhara solicit clients through their networks with restaurants, discos
and friends.
Q:
A:
Did you do this job (sex trade) all alone or with the friends?
I should say, with friends. When we are in need of money or if we feel like enjoying ourselves,
we go together to the Gazal, disco, dance restaurant, meet clients and go out with them.
Q:
A:
How much do you charge your clients?
I am quite choosy about clients. So I charge them Rs. 2,000/- to Rs. 5,000/- per night and with
some Rs. 7,000/-. But usually I charge Rs. 2,000/-. However, my clients must bear the cost of food
and rooms charges.
Q:
A:
Who are your clients?
Lahure from Singapore and Hong Kong, Lahure's sons, office staff, businessmen.
Q:
A:
Where do you go to have sex with your clients?
I go to the lakeside hotels and while I was in Kathmandu, I used to go to the hotels too with the
clients.
Q:
A:
How do you meet your clients?
I go to the Disco, Gazal, and dance restaurants and eat, drink and dance. There I meet clients. I
will first find out if the client is not troublesome for me, able to pay me and also drop me back
from the hotel, then only I decide to go with such clients.
Q:
A:
While you go out to the discos, Gazal and dance restaurants, will your friends be there too?
Of course, we go together.
Q:
A:
With whose help you use to take to find your clients?
At the beginning, Chami (a SW) used to arrange clients for me but later I go out and met the
clients.
25
Q:
A:
How much money did Chami use to take from you when she arranged clients for you?
She never took money from us. But how much did she take from the clients, we did not know.
However, she use to fulfill our needs such as she bought clothes for us, take us to the restaurant
and even gave us pocket money if we need.
Q:
A:
Was Chami in the same job as you all do?
Yes, she was famous and knew everyone. She was famous in Pokhara. But now I am married and
now I don’t know where she is now. She has spoiled a lot of girls and forced them to do this job, if
the parents of the new girls find her she'll be finished.
- Pawita, 20 Yr.
Clients being arranged by owners of restaurants and bhatti pasals where SWs are
employed were mentioned by 18 SWs. On the other hand, 10 SWs mentioned that they
find their clients themselves without anybody's assistance while 5 SWs negotiated with
their clients through telephone. Additional 7 SWs said that they sometimes depend upon
their fellow SWs (friends) to contact their clients. Taxi drivers as sources of contacting
clients were mentioned by just 2 SWs (Table 4.2)
Q:
A:
Who arranged clients for you for the first time?
The manager at the hotel had fixed a guest for me. At that time, I was badly in need of money.
When the guest promised to give me Rs2000, I agreed and went with him.
Q:
Which medium do you think is the easiest one to get guest? The ones searched by someone else or
by yourself?
For me it is easier to go out with guests searched by someone else because when I go out with a
person I know they try to have sex for free.
A:
- Aarti, 16 Yr.
Some SWs considers it safer to go with the clients arranged by restaurant/hotel owners.
Apart from being cheated with money (not paying money after sex) as perceived by SWs
like Aarti, going out with self arranged clients are believed to be quite risky.
Q:
A:
If you have to go out searching for clients, then where do you go ?
I don’t go out to other place, but only two places: Baglung bus park and Hotel X in new Road
Q:
A:
How do you meet your clients?
Mostly, the owner and his wife of the hotel fix the clients, and if I have to find a client, I go to the
cabin or sit near a table with my hair left free waiting, and the clients comes. And if I go to the
Baglung bus park, I am sure to find 1-2 clients, I don’t have to come empty handed.
Q:
A:
Who else fixes clients for you?
My friends involved in work like mine.
Q:
A:
Do the hotel owners and his wife take money from you or from the client?
The owner of the Newroad hotel takes money from my client. They charge about Rs.600 from
clients and give me Rs. 400. In the Baglung buspark area, we have to give half the money to the
hotel owner only if they arrange the clients for us.
26
Q:
A:
Do you prefer to arrange clients yourself or you like the hotel owners to arrange for you?
I like my clients to be fixed by the hotel owners.
Q:
A:
Why do you say so?
I already told you earlier, I am not able to judge what type person the client will be and I get
scared. I feel safe when the client is fixed by the hotel owners and if the person is not a good type
then they will not fix it. Also if the clients' wife or relative is around then it will be worst and it
won't be safe for us. When the owner tell the clients " are you not coming here today or are you
not going to enjoy today", then we will know who are the clients who is going to come to us.
- Asha, 26 Yr
Table 4.2 Places and Mode of contacting clients by types of SWs in Pokhara
When and How do you
contact your clients?
Cabin
based SW
Dance
based SW
Bhatti Pasal
Based SW
Hotel/
restaurant
based SW
Total
When clients are eating at
the restaurant/hotel
Hotel owners arranges
11
2
1
3
17
5
3
8
2
18
Friends help to
clients
Through telephone
3
3
-
1
7
4
-
1
-
5
2
-
1
-
3
-
1
2
-
-
2
1
Total N =
15
5
8
Column total exceeds N figures (32) due to multiple responses
4
32
contact
If clients that we like comes
to take us
Taxi driver brings them
By Visiting at Gajal/Dance
restaurant or at discos
4.3 Networking with Owners of Restaurants/Hotels and Bhatti Pasals
The owners of the bhatti pasals and restaurants serve as an important link between clients
and the SWs employed in their business. The owners negotiate the price (fees) directly
and receive the money in advance from the clients. What the SWs get is 50 percent of the
fee charged to the clients and few tips from the clients. However, SWs working in most
bhatti pasals seem to be contended with the arrangement since they receive monthly
wages as employees (as waitress, dishwasher, cleaner, etc.) plus free meals in addition to
50% of the fee charged to their clients.
Some SWs employed in restaurants are exploited by the restaurant owners in various
ways such as performing multiple chores like waitress, cleaner and dishwasher in the
same restaurants without giving any extra salaries. Some restaurant owners never paid
them their monthly salaries. The main reasons for involvement in sex trade as complained
27
by some of the SWs are linked to their low/underpaid monthly salaries. The case of two
stepsisters, Sunita and Puspa working together in the same restaurant exemplify the
extent restaurant owners exploit young girls. These two girls were not paid their monthly
salaries as waitresses cum cleaners and they were also cheated by their owners on the fee
charged for sex.
" Since I was working in this restaurant for last 3 months as a waitress, Didi
(female owner) has not paid me my monthly salary of Rs. 1500. What I get is Rs
500 or Rs 750 from her from time to time for serving guests for sex. I am not
allowed to receive money from the guests. They pay directly to Didi then Didi
suppose to pay me half of what clients pay her. But this never happens. The
guests tells me that he paid Rs. 2,000 or Rs Rs 4,000 to Didi for the night but Didi
lies on the amount she receives. One guest paid Rs 3,000 to Didi. But Didi gave
me just Rs 750 saying that she had negotiated for just Rs. 1,500. She is a big
cheater. That's why I want to quit her job. Whenever I ask her for my salary, she
always says "Paisa Chhaina (no money)".
- Sunita, 21 Yr. Separated
The above statement of Sunita is supported by Puspa (18 Yr., Unmarried). According to
her, the Didi (of same restaurant) does not pay her properly. Expressing her woes, she
said:
"She gives me only Rs 500 to Rs.750 for going out with clients which according to
Didi is half of the fee charged from the clients. Some of my clients piad her Rs
4000 to Rs.5000, but everytime I get Rs 500 to Rs 750 and not more. I am fed up
with this kind of exploitation. But I cannot go to any other place for job. Jhahaan
bhaye pane tyahi to hola ni, haina? (This types of exploitation will be everywhere
you go, Won't it be?)"
- Patli,18 Yr., Unmarried
Q:
A:
Do you have friends who are also involved in this profession?
Yes I have nine friends involved in this profession. The owner of this hotel arranges customers for
all of us.
Q:
A:
What work do you have to do in this hotel?
We have to clean, give food and have sex with our customers in the hotel and outside the hotel
too.
Q:
A:
What amount do you charge your customers usually?
We have sex with the customer that come to our hotel. So we don't know what amount the owner
takes. The owner later gives the money to us according to his wish.
Q:
A:
How do you prefer to meet your clients?
I want to arrange clients myself. But it is very difficult to find them so I have to depend upon my
owner to arrange clients for me if I have to carry on with this profession.
- Bina 16, Yr.
28
4.4 Place for Sex with Clients
The usual place for having sex with SWs are hotels located in Lakeside, Dam site,
Mahendra Pul, Prithivi chawk, Zero Kilometer, Baglung Bus Park, Purano Bus Park,
Srijana Chowk, New Road, Sarangkot, Fedi, and other small hotels and guest houses
around Mahendra Cave and David's Fall.
Some SWs have also mentioned places like Chinese Gumba, Shanti Ban, Bindabasini.
Clients taking SWs to these places within Pokhara normally have sex during daytime
(spending 2-3 hours) but some insist for overnight stay. Some SWs encourages their
clients to come to their rented room instead of accompanying the clients to hotels.
Outside Pokhara, the popular place where SWs usually go with their clients is Begnas
Taal (Lakes in the outskirts of Pokhara). Some SWs are also employed at the small hotels
and resorts of Begnas Taal.
Along the Pokhara–Baglung highway, places like Kande, Hemja and Kusma and Baglung
itself are popular venue where these SWs mentioned that their clients take them. Other
places outside Pokhara are Pokhara viewpoint (along Pokhara-Syangya highway), Kotre
(picnic spot), Butwal, Bhirahawa/Sunauli, Nepalgunj, Narayanghat, Hetauda, Kathmandu
and Tatopani. SWs taken by their clients in these places usually have negotiated for very
high fees and they spent 2-3 nights.
The case of Shrila, 26 Yr. (excerpt given below) is a typical example to show the extent
of mobility of a SW in Pokhara. Shanti has been in sex profession for about 3 years. She
works as a waitress in a Bhatti pasal in Pokhara and travels with her clients for sex to
places outside Pokhara.
Q:
A:
Which are the places you go with your clients to have sex?
I go to different places. To stay for the night, I go out of Pokhara like in Kathmandu, Bhairahwa,
Sunowli, Narayangadh, Hetuadha, Baglung, Tatopani, etc. Like wise in Pokhara I go to the
Lakeside, Sharankot, Mahindra Goofha, Brindabasini Mandir, etc.
Q:
A:
Which places have you been last week with your clients?
Last week, I went out with my boyfriend to have sex and enjoyment in Baglung, I stayed for two
days and came back. In the remaining days, I served two policemen from Mahendrapool and one
local taxi driver. We had sex in the hotel itself and they were arranged by the hotel owner.
Shrila, 26 Yr.
4.4.1 Types of Sex Acts or Positions Preferred by Clients
Types of sex acts, such as oral, anal and vaginal, determine the level of exposure to STIs
and HIV infection. In the present study, information on the types of sex acts that clients
prefer to engage with SWs and condom negotiation has been solicited. According to
SWs, the non-vaginal penetrative acts that their clients generally persuade them to
perform are: playing with or fondling penis, sucking tongue and sucking penis or oral sex
popularly known as 'tourist style' which are high risk behaviors since condom use is
29
virtually absent in such acts. Once the clients get sexually aroused, then they go for
vaginal intercourse. The most common position preferred by clients for penetrative
vaginal intercourse as explained by the SWs are: 'Doggie' style (penetration from behind
after forcing SWs to bend) and 'normal' position (lying position, man on top). Some SWs
mentioned that their clients sometimes prefer to have sex in 'standing' position and also
'woman on top' and 'woman on lap' positions. Anal sex was also preferred by few clients
but disliked by all SWs. None of the SWs reporting oral and anal sex mentioned that their
clients had used condoms or they could persuade them to use one during such acts.
Q:
A:
What type of sexual activity do the clients prefer from girls like you?
The customers have sex for a long time and ask us to play with their sexual organs. While staying
at night, they want us to do it 2-3 times and troubled us. They also bite us in our private parts. If
we do not obey they even beat us.
Q:
A:
What kinds of sexual activities do your customers force you to do?
They ask us to play with their sex organs first for erection. Then they have sex. They want to have
sex for 3-4 hour and trouble us. They want to have sex in open social places too.
- Bina. 16 yr.
4.4.2 Exposure to Group Sex
Roughly one in every three SWs interviewed (7 out of 20 SWs) mentioned that they had
fallen victim of group sex. Of these 7 SWs, one had been exposed to group sex three
times, two SWs had such ordeals twice and remaining four SWs had encountered group
sex only once so far. According to these SWs, just one client negotiates the fee with a
SW for an overnight stay with him in a hotel. Once the client arrives at the hotel with the
SW in the night, his friends join him and they engage in sex all the night through.
Sometimes the "boyfriends" of the SWs themselves trick the SWs for having sex in a
group. In one case, two SWs who use to solicited clients together and agreed to go with
two clients in the same hotel ended up having sex with five men in that hotel.
The following are some of the explanations on how SWs are tricked or cheated by clients
for group sex and the types of ordeals they have to undergo.
"The son of an army was my regular client. That evening, he took me to a hotel
at lakeside. There his two friends had also stayed in the same hotel On that whole
night all the three of them had sex with me turn by turn. I became so tired and I
was unable to move"
- Goma, 16 Yr. Married
"My boyfriend is responsible for this. On that night, he took me for an overnight
stay in a hotel at Lakeside. I did not know that he had already invited three of his
friends and when his friends also attempted to have sex with me, I got panic and I
tried my best to escape from their clutches. Unfortunately, I could not run away
since it was night and I was under the influence of beer. They did it the whole
night turn by turn and inflicted lot of pains".
- Prava, 16 Yr. Married
30
" I had agreed to go with a client. But I found that there were two of them. When I
refused to have sex with both of them, they threatened me saying that if I refuse,
they will do whatever they want to do to me. I had no choice. Both of them had sex
with me turn by turn. I was crying with pain and requested them to do give me
some rest in between. They agreed to do so. So far I have faced group sex twice".
-
Sumina, 15 Yr. Unmarried
"My friend Kali and I were approached by two clients saying they are just two of
them and they will pay Rs 1500/- to each of us for one night stay with them in a
hotel. When we reached the hotel, there were five men. Three clients began to
have sex with Kali. I was scared and refused to have sex. Kali persuaded me to
agree to have sex with the two men as they had promised to pay extra money. I
had no option but to have sex with the two men. We did not get the extra money"
Q:
A:
Aariti, 16 Yr. Separated
Till now for how many times have you been involved in-group sex?
So far, I have been involved twice in-group sex. First one was when my regular client, a taxi
driver asked me to go out with him and I agreed to go. There were already three of his other
friends who had already come there in the hotel room and were enjoying themselves with drinks
and eatables. They all forced me for group sex and they left me there alone and they came back.
The next time was a policeman who had already talked with my hotel owner, and after taking me
with him, he had other two friends and they all had sex with me and gave me RS 500 and let me
go home. That is why I get scared when I have to face group sex. But how can I tell if I am going
to face group sex?
Srila, 26 Yr.
Q:
A:
How many times have you faced group sex? How did you get involved in it?
I have faced group sex 2-3 times. Once, a man talked with my owner, paid and took me out for a
night. After going out, he called his friends and they had sex with me, taking turns. It was very
painful as it was against my interest. Next morning he dropped me to my hotel. If I tell the owner
then he won't believe me. So it is very difficult.
Bina, 16 Yr.
4.5 Problems Encountered in Sex Professions
The SWs in Pokhara listed 45 different types of problems that they encounter in their sex
profession. These problems can be clustered into 26 problems as presented in Table 3.4
below. The types of problems mentioned by the SWs range from frequent abuse by local
youths, police arrests, cheating on their money by both clients and owners of
restaurants/bhatti pasals, to contracting STIs and HIV/AIDS.
31
Of the various problems mentioned by SWs, relatively common problem is police arrests
and other forms of harassment such as asking money and asking sex by police personnel
(14 SWs). Another common problem that several SWs (12) have mentioned was the
ordeal of being forced to have oral sex, stimulate penis (through masturbation) and bear
the pain of nipples/breasts being squeezed by clients. Ten SWs mentioned that they fear
of their family members scolding and sometimes beating them for their involvement in
the sex trade. Other common problems mentioned by the SWs include: teasing by local
boys and calling them names (10 SWs), forced sex and beating by local boys (9 SWs),
clients not giving money after sex (9 SWs), and clients keeping them for longer hours for
sex than the time originally negotiated (9 SWs).
"The customers troubled me a lot. They force me to drink alcohol. While eating food, they
tease me, they want me to go with them. If I don't go then they forced me to go with them
and indulge in sex according to their desire. Sometimes they leave me there, alone. At
such times I find difficulty to find my way home. I am forced by the owner to do so
without my desires. Sometimes I have to go for one whole night, or sometimes they ask
me out for 2-3 hours but have to stay for 4-5 hours. I don't know how much money they
pay for it. We only get half the amount. In my village, they tease me a lot, so I go at
9:00pm in the night and return back at 6:00am in the morning. My mother doesn't ask me
any thing and I haven't said any thing to her too".
- Bina, 16 Yr.
Q:
A:
What problems did you face last week?
I faced problems like- When I was at the Baglung Buspark looking for a client, I did find one who
was very cunning. At first he told me that he would give me RS 500 and after having sex he gave
me only RS 300 and went off. And after that one driver took me to Narayanghar, and kept me
there for two days, and took me to different places, and while I was suppose to come back, he left
me there and ran off, and I had to face a lot of problems to come back to Pokhara. That is why I
am afraid.
- Shrila, 26 Yr.
Though not a frequent incident, the fear of being followed or chased by local youths and
forcibly pulling young SWs inside the taxi are reported. Five SWs mentioned this
particular problem. Stressing on this problem, one teenaged SW narrated about how she
was saved by her friend from the clutches of a large group of youths. She said:
"One late evening 15-16 local boys chased me. I was very scared. Fortunately, I
meet my friend Kali and another Dai (brother) from that Tole (locality). Both of
them saved me. Dai took me to his house and fed me. I slept in his house that
night"
- Aariti, 16 Yr. Separated
32
Interestingly, clients' refusal to wear condoms (3 SWs) and the risk of contracting STIs
and HIV/AIDS (1 SW) did not occur as major problems among the SWs interviewed
(Table 4.4).
Table 4.4 Types of Problems Encountered by SWs in their Sex Professions (N=32)
S.N.
Types of Problems faced in Sex Profession
1
2
Police arrests/beat/ask money/keep their records/ask sex
Clients force us in various sex acts including oral sex, masturbation
and squeeze nipples/breasts
Family members scold/beat/hate
Boys tease/insult saying "Bhalu", "Randi", "Machikni"
Boys force us for sex and beat/threaten if not obliged
Clients run away without paying for sex
Restaurant/bhatti pasal owners pay less than half the fees charged
to clients for sex
Clients negotiate for one hour but keep us for 3-4 hours or whole
night and have repeat sex
Need to hide from family members
Society hate us because of our profession
Local youths forcibly pull us into the taxi while we are on duty or
walking along the road and chase us
Clients refuse to wear condoms
Restaurant/bhatti pasal owners keep all money and even don't pay
our monthly salary
Clients don't pay the full money for sex
Clients force us to consume things we dislike (alcohol, Charas etc.)
Boys misbehave inside the restaurants and pull our hands
Clients don't pay for the items they eat in the restaurant
Clients want to have sex in public place
Young boys takes longer time to ejaculate
Fear of contracting STIs and AIDS
Clients starts to fight/quarrel if their intentions not fulfilled by us
Risky to go out with clients to places known/familiar to us
Clients we had sex with, ask us to arrange young girls (below 15
yr) for them next time
Difficult to get rental accommodation if our profession is known
Not having money
Difficult to find clients by ourselves directly
3
4.
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
# of
SWs
14
12
%
43.7
37.5
10
10
9
9
9
31.2
31.2
28.1
28.1
28.1
9
28.1
7
5
5
21.9
15.6
15.6
4
4
12.5
12.5
3
3
3
2
1
1
1
1
1
1
9.4
9.4
9.4
6.2
3.1
3.1
3.1
3.1
3.1
3.1
1
1
1
3.1
3.1
3.1
4.6 Health related Problems Encountered by SWs
SWs have cited 24 different types of health problems that they had experienced in the
past 12 months preceding the study. Of these health problems, five were related to
menstruation (irregular menses, lower abdomen pain during menstruation, heavy and
prolonged menstruation, spotting, and lumpy discharge) and four related with STI/UTI
33
(white discharge/foul smelling discharge, burning urination, vaginal itching and vaginal
irritation). However, in terms of frequency of responses, the frequently mentioned
problems encountered by SWs are: lower abdomen pain (14 SWs), cough & cold (13
SWs), fever (11 SWs), white discharge/foul smelling discharge (11 SWs) and headache
(10 SWs). The proportion of SWs exposed to white/foul smelling discharge (34%) is
quite significant among the SWs interviewed in-depth. However, those SWs mentioning
other forms of STIs (vaginal itching and vaginal irritation) were quite few in proportions
(below 10%) (Table 4.5).
Q:
A:
What are the health problems that girls like you engaged in sex profession face?
My friends have faced many health-relating problems like irregular menstruation, excess white
discharge, headache and fever that disturb our work. We don't get medical facility easily. That is
another problem.
Q:
A:
What are the health problems that you have faced in last one year?
I faced many problems like irregular menstruation for three months. I was very scared. The owner
of the hotel I worked took me to the Gandaki Hospital for check up. They checked my stool, urine
and blood and gave me medicines. I thought that I was pregnant, but the report was negative. Now
also, I don't have menstruation timely, excess white discharge also gives me problems and I get
cold and fever frequently. When I face such problems, I go to Santosh Medical hall and take
medicine. I take Gulaf tablets (oral contraceptive pills) regularly so that it won't affect my health. I
am very serious about the menstruation problem and sex diseases. I am also little bit afraid about
cold and cough and fever.
Q:
A:
What problems do you face nowadays?
Menstruation problems.
Q:
A:
How have you tried to solve the problem?
I haven't done any thing about it. Sooner I am planning to go for the check up.
Q:
A:
Where do you go if you have health problems?
If I have serious problems then I go to Gandaki Hospital. Otherwise for other small problems, I go
to Santosh Medical hall and take the medicine. It is easy for me because they know me well.
- Bina, 16 Yr.
34
Table 4.5
S.N.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Types of Health related Problems Encountered by SWs
during past 12 months
Health problems Encountered
Lower abdomen pain
Cough & Cold
Fever
White discharge/foul smelling discharge
Headache
Irregular menses
Lower abdomen pain during menstruation
Giddiness
Chest pain
Pain in limps
Heavy & prolonged menstruation bleeding
Burning urination
Vaginal itching
Vaginal irritation
Spotting menstruation
Lumpy menstruation discharge
Typhoid
Weakness
Loss of appetite
Eye irritation
stone in gal bladder
Skin problem
Tonsils
Diarrhea
No Health Problem in last 12 months
# of SWs
14
13
11
11
10
8
6
6
6
5
5
3
3
2
2
2
2
2
2
1
1
1
1
1
3
(N=32)
%
43.7
40.1
34.4
34.3
31.2
25.0
18.7
18.7
18.7
15.6
15.6
9.4
9.4
6.2
6.2
6.2
6.2
6.2
6.2
3.1
3.1
3.1
3.1
3.1
9.4
4.6.1 Severity Perception of Health Problems
In an effort to assess how SWs perceive about the severity of health problems, severity
rating of top 15 problems (out of 24 health problems in the free lists in Table 4.5 above)
was conducted among 17 SWs. Although AIDS was not mentioned in the free lists of
health problems encountered by the SWs, this problem was also added in the severity
rating exercise.
Table 4.6 presents the severity rating of the sixteen selected health problems by SWs of
Pokhara. Unfortunately the large majority of the SWs contacted could not rate most of
the health problems into the three raking orders (severe, intermediate and mild). Among
those who could rate the health problems, it was interesting to find over half of them
rating 'irregular menses' (9 SWs) and AIDS (8 SWs) as severe health problems. More
than a third of SWs (6) also considered 'white discharge/foul smelling discharge' as
severe health problems. Other health problems appearing in the top 15 in the free lists
were rating as severe by less than a fourth of the SWs. Nearly two thirds of the SWs rated
35
headache as intermediate problem (10 SWs) while another two-thirds rated 'cough and
cold' as mild health problem (10 SWs).
Table 4.6 Severity rating of health problems of sex workers in Pokhara
S.N.
Problems
1
Irregular menses
2
3
Headache
White discharge/ foul smelling
discharge
Fever
Lower abdomen pain
Vaginal itching
Lower abdomen pain during
menstruation
Cough & cold
Heavy & prolonged menstruation
bleeding
Vaginal irritation
Chest pain
Pain in limps
Burning Urination
Giddiness
Spotting menstruation
4
5
6
7
8
9
10
11
12
13
14
15
16 AIDS
Severity rating
Severe Inter
Mild
mediate
(3)
(2)
(1)
9
1
2
Don't
Know
(0)
5
Total
Score
SWs exposed
to the
problem
31
9
6
10
2
4
-
3
9
24
22
10
3
2
4
4
8
5
3
2
5
3
1
4
7
10
10
21
19
18
17
10
8
3
6
3
3
1
10
1
4
12
16
12
10
4
4
1
1
-
v
2
3
1
1
1
2
1
-
13
14
13
14
15
16
12
7
7
5
3
2
1
2
3
1
2
1
9
-
-
8
27
-
36
Chapter 5
SUMMARY AND CONCLUSIONS
The present rapid qualitative study explores the existing network of female sex workers
(SWs) and estimates their population in Pokhara. A combination of ethnographic tools
was employed to explain SWs' networks and map the city to identify their areas of
concentration and estimate their population. Size estimation of the SWs was depended
largely on key informant interviewing and mapping in order to arrive at reliable
estimates. Mapping was done in three steps to identify the geographical location/site of
SW concentration and also to systematically estimate the size (population) of this subpopulation in the town. In the process, the study team visited 28 locations/sites all over
Pokhara and talked to as many as 412 informants. Majority of them provided information
about the concentration sites and approximate number of SWs in each site.
There are eight types or form of professional disguises under which commercial sex work
exists in Pokhara. Comparatively, the major areas of concentration of commercial sex are
cabin restaurants, bhatti pasals, dance restaurants and ordinary hotels/restaurants. Very
few SWs solicit clients in streets and few call girls operate from their homes. Dohori
Sanjh is a new form of evening entertainment for customers in restaurants of major cities
like Kathmandu and Pokhara. Such restaurants employ young girls as waitresses to serve
clients. These are also some of the cruising zones for girls to solicit clients.
Information regarding sexual networks was gathered through in-depth interviews of 32
SWs. This exercise also included free listing on several topics from the sex workers, such
as types of clients, place for soliciting clients, places for sexual activity, general problems
faced by them in sex trade, health problems encountered in past 12 months, etc. The
fieldwork for the study was undertaken during October-November 2002 by a team of four
female researchers and supported by the research team of CREHPA involved in IDU
network study in Pokhara.
The number of female SWs in Pokhara is approximately 300. Since the mapping was
carried out extensively with the help of local informants and triangulated through mystery
client approach and direct contacts, the above estimation can be considered a reliable
estimate. This estimate is much less than the estimates of some Pokhara based NGOs.
Case studies shows that the majority of the SWs (32) were young (15-19 yr) and have
been in sex profession for less than a year to about 3-4 years. A significant proportion of
them are migrants from places outside Pokhara including Kathmandu. Both unmarried
and ever married (includes separated) women can be found in commercial sex work
The knowledge that HIV/AIDS is transmitted sexually was very high among SWs.
However, very few uses condom consistently or are in a position to insists their clients to
wear condoms. The types of persons who are least likely to wear condoms are army men,
police personnel, boyfriends (mostly Lahure's sons, taxi drivers and local youths) and
husbands of the SWs themselves. Whereas army and police personnel oppose condom
37
use and sometimes threaten the girls with possible arrests if insisted, boyfriends and
husbands are not insisted by SWs for condom use.
Most SWs using condom consistently with their clients do not perceive themselves to be
at risk of contracting STIs and HIV/AIDS. On the other hand, majority of those not using
condom consistently fear that they might be at risk. Although none of the 32 SWs
covered in the present case studies reported about contracting HIV, many of them
reported of experiencing some form of STIs (white discharge/foul discharge, vaginal
itching/irritation, etc.) in the free listing exercises. One SW mentioned about visiting a
hospital in Kathmandu along with her husband to treat her white discharge problem and
also her husband's problem of puss discharge from penis.
The place for contacting clients for the large majority of the SWs (22 SWs) is the
working place (restaurants/hotels/Bhatti Pasals) of the SWs themselves. Eighteen SWs
cited owners of the restaurant/Bhatti Pasals where they are employed as their middlemen.
In fact, owners of the Bhatti pasals and restaurants serve as an important link between
clients and the SWs employed in their business in Pokhara. The owners negotiate the
price (fees) directly and receive the money in advance from the clients. In such situation,
exploitation by owners, such as not telling exact money negotiated by owners and parting
with only half the negotiated amount to the SWs were the frequent complaints. Some
SWs who are minors, were also frustrated by non-payment of their monthly salary by
restaurant owners.
The popular place for sex are hotels located at Lake sides and those in the inner city
areas. Outside Pokhara, Begnas Taal (Lakes in the outskirts of Pokhara), hotels along the
Pokhara–Baglung highway, Pokhara-Syangya highway and Kotre (picnic spot) are
favorite destinations. Some SWs even go to places such as Butwal, Bhirahawa. Several
SWs have also reported that they were often cheated by their clients and forced to indulge
in group sex.
SWs seem to be quite concerned with their menstruation related problems and problem of
white discharge they have encountered in the past 12 months. In the severity rating
exercise with 17 SWs, over half of them rating 'irregular menses' (9 SWs) as severe. Six
SWs also considered 'white discharge/foul smelling discharge' as a severe health
problem.
Policy Implications
Unlike in Kathmandu, street based SWs are very few and not visible in Pokhara. Call
girls' network is also not conspicuous in this city. Clients of SWs vary widely and even
include ex-service men or pensioners (ex-soldiers) which is quite unique for Pokhara.
Regular clients include taxi drivers/drivers, policemen, Lahure/lahure's sons and local
youths. Some of the SWs identify them as "boy friends" and seldom use condoms with
these clients. SWs are quite mobile and prepared to go anywhere with their clients if
clients can pay the money charged by them.
38
Several young SWs who are in greater demand among some clients continue to be highly
vulnerable to various forms of harassment and sexual exploitation including group sex.
They are also exploited by their employers (restaurant owners) by not paying their
salaries and not disclosing the amount charged to their clients.
Since young SWs are not in a position to negotiate condom use with their clients, they are
highly vulnerable to STIs and HIV/AIDS. Inconsistent condom use with their clients and
non-use with their steady sex partners (boyfriends and husbands) also makes them highly
susceptible to STIs and HIV infections. SWs' inability to recognize HIV/AIDS as a
major problem and the importance of condom use for disease prevention aggravates their
vulnerability to STIs and HIV/AIDS.
Many SWs do not confess their sex profession so easily which will make any behavior
change intervention (BCI) program among SWs difficult. Therefore, it is important to
sensitize and involve hotel and restaurant owners to access SWs for BCI program and
also for condom promotion through them. The program should specially target young
girls engage in sex trade and should foster condom negotiation skills with their clients. It
is also important to motivate these SWs to make periodic health check-up and voluntary
testing for STIs and HIV.
39
Bibliography
CREHPA,1996. Risk of Unwanted Pregnancy and Reproductive Health Care among
Child Commercial Sex Workers in Kathmandu Valley – A Case Study
CREHPA/FHI, 2002a. A Situation Assessment of Sex Workers in Kathmandu Valley A Focussed Ethnographic Study. Final Report
CREHPA/FHI 2002b. Health Care Seeking Behavior of Street Based Sex Workers in
Kathmandu: A Rapid Ethnographic Study. Final Report
New ERA/FHI, 2000. Behavioral Surveillance Survey in the Highway Route of Nepal:
Round No. 2. Final Report
SACTS/FHI, 2000.
HIV Prevalence among Sex Workers in Kathmandu
Tamang et. al. 2001. Why Sex Workers Do not Use Condoms with their Spouses? An
Ethnographic Study of Potential Bridging Population for HIV/AIDS transmission
in Nepal. Paper presented at IUSSP Conference, Bangkok, June 10-13, 2002
40