A fifth of female sex workers live with violence, attacked four times a month, on average, according to an analysis of data on 109,366 such workers, gathered over six months to September 2015 by Swasti Health Resource Centre, a Bengaluru-based nonprofit, as part of its work under the Avahan initiative (Phase 3).

Those with more clients and income were more likely to be attacked, the data reveals, which in turn placed them at greater risk of sexually transmitted infections (STIs), including HIV-AIDS. This could be because they were less likely to get tested.

As many as 24,815 women, or 22.7 per cent, reported 92,838 bouts of sexual, emotional and physical violence against them in the six-month period of the survey, carried out in five states: Maharashtra, Andhra Pradesh, Telangana, Tamil Nadu and Karnataka.

The most prevalent form of violence is physical with 39,832 incidents reported, followed by emotional (35,887) and sexual violence (17,119).

Violence increases risk of sexually transmitted infections

Violence inflicted on sex workers increases their risk of contracting STIs, including AIDS. While sexual violence has a more obvious connection to STIs, physical and emotional violence also play a major role in increasing their vulnerability.

Sex workers are among those most vulnerable to HIV infection, according to a 2005 World Health Organization (WHO) report.

While direct impact involves incidents of rape and forced sex, the indirect impact of violence manifests itself in the inability of sex workers to negotiate safer sex with clients, partners and other possible sexual partners.

In India, female sex workers have the third-highest HIV prevalence among key risk groups, according to the department of AIDS control’s annual report, 2013-14.

Why timely diagnosis is important

Regular testing for STIs is important for sex workers and their children. But, as the Swasti study shows, violence impedes the chances that a sex worker will be tested for HIV.

While 95 per cent of women who had faced less than six incidents of sexual violence tested for STIs/HIV, 89.5 per cent of those who had faced more than six incidents did.

Women who faced lesser violence also tended to be tested as the norm requires — two times a year.

Struggle for survival: More money, more violence, more infection

Poverty not only forces women into sex work; it also makes them vulnerable to violence. More money and more clients are correlated with more violence and STIs.

More than a quarter of sex workers are attacked by clients. On some occasions, while a single client approaches a woman, upon arrival she is confronted with the prospect of engaging with much more.

In such cases, reluctant sex workers are often forced to have sex without their consent. Spouses or husbands and partners or boyfriends also inflict violence.

More than half of all sex workers, 55,930, operate from home, while 15,314, or 14 per cent, work from brothels or lodges; 4,741, or 4.3 per cent, from bars and the remaining 32,184, or 29.4 per cent, operate from locations that include streets and markets; some are devdasis (temple prostitutes). Those who work from brothels or lodges are at greatest risk of violence.

Sex work, not a crime, so why do police and courts endanger the women?

Sex work in India is ambiguous legal territory. It is not a crime, but running brothels and soliciting clients are illegal under the Immoral Traffic Prevention Act (1956). The Act was established to curb trafficking and combat sexual exploitation for commercial purposes but police and courts increasingly interpret it in ways that lead to harassment, detention and arrest of sex-workers, endangering them further.

Most sex workers do not report violence; if they do, between a fourth to a fifth choose community organisations — 81 percent of sex workers surveyed were registered with such organisations — data shows.

Social support is important for sex workers to “challenge power relationships and structural barriers that contribute to their vulnerability”, said a 2012 report in the British Medical Journal. It cites the ongoing Avahan initiative, to explain how community organisations empower sex workers, reduce violence and address healthcare discrimination.