Sex worker activism, feminist discourse and HIV in Bangladesh.

This paper explores the relationship between sex worker activism and HIV-related discourse in Bangladesh, relating recent developments in activism to the influence of feminist thought. Following their eviction in 1991 from brothels from red light areas, Bangladeshi sex workers started a social movement, at just about the same time that programmes started to work with sex workers to reduce the transmission of HIV. This paper argues that both sex worker activism and HIV-prevention initiatives find impetus in feminist pro-sex-work perspectives, which place emphasis on individual and collective agency. However, by participating in these programmes, sex workers failed to contest the imagery of themselves as 'vectors' of HIV. In this way, they were unwittingly complicit in reproducing their identity as 'polluting others'. Moreover, by focusing on individual behaviour and the agency of sex workers, HIV programmes ignored the fact that the 'choices' made by sex workers are influenced by a wide range of structural and discursive factors, including gender norms and notions of bodily purity, which in turn have implications for the construction of HIV-related risk.

Introduction

It was only during the 1990s that sex workers1 in Bangladesh became visible in public discourse. This was largely the result of sex worker activism, which was a response to their eviction from brothels in 1991, and their identification as a key population at heightened risk in HIV discourse. Through activism, sex workers demanded greater recognition of their identity as workers and called for the realisation of rights equal to those of other citizens. This position is concomitant with the pro-sex-work view in feminist thought, which regards sex workers as active agents and sees prostitution as a form of ‘work’. Such a perspective is also reflected in HIV programmes in Bangladesh, which often focus on the empowerment of sex workers so that they can exert agency and play a role in HIV prevention. This paper aims to offer a critical account of how the nexus between sex worker activism, feminist debate and HIV discourse in Bangladesh produces a complex interrelationship that reproduces understandings of sex workers as a ‘pollutant other’. The already prevailing identity of sex workers as socially dangerous is reflected by HIV discourses that portray sex workers as vectors of disease to the general population.

Feminist theoretical conceptualisation and popular discourse on sex work centre upon the victim/agent dichotomy, in which a sex worker is either seen as a victim of situations, such as economic exploitation and patriarchy, or as an agent in control of her life (Carpenter 2000). Anti-sex-work perspectives regard sex work as a manifestation of violence against women, because it validates men's mastery over women (MacKinnon 1993, as cited in Anderson 2002, 345). It is seen as a dehumanising experience for it is not recognised as an ‘authentic’ form of human interaction (Barry 1995, as cited in Anderson 2002, 346). According to the perspectives advocated by some radical feminists, sex work is the manifestation of ultimate inequality (Anderson 2002) in which male sexual desire is satisfied at the expense of turning women into sex objects. The availability of the female body in the sex market and the presence of willing customers highlights this inequality.

Pro-sex-work perspectives, on the other hand, tend to see sex work as an occupation or profession. Nussbaum (1999, as cited in Kotiswaran 2011, 30) argues that sex work is similar to other kinds of labour such as domestic work, entertainment or university teaching. Pro-sex work feminists demand for sex workers all the job-related rights, such as protection against violence, that people in other occupations enjoy, and call for better working conditions (Kempadoo and Doezema 1998, as cited in Lozano 2010, 32). Deriving ideological support from liberal feminism, this view argues that the oppression of women in sex work is not unique to the sex industry; rather, oppression is also present in other occupations (Overall 1992, 1994, as cited in Scott 2005, 16). Sex work advocates also argue that the commodification of emotion is not necessarily destructive; sex workers separate their core selves from the labour that they perform (Kempadoo 1998, as cited in Kotiswaran 2011, 30). This argument has been criticised by anti-sex-work feminists on the grounds that sex work involves the sale of embodied sexual services. What in situations such as rape and abuse may be considered as sexual harassment, in the case of sex work is regarded as normal (Kole 2009).

With the advent of AIDS, sex workers became target of HIV-related intervention. In part, this derived from the fear that they represented a potent source of infection, in much the same way that, historically, sex workers have been subjected to such beliefs. In the Middle Ages, women sex workers were seen as sinful and polluting (Rossiaud 1988, 55–8, as cited in Scott 2005). In the twelfth and thirteenth centuries, a connection was thus drawn between sin and bodily contamination. Sex workers, being considered lustful women, were regarded as dangerous (Scott 2005). More recently, through a stereotypical association with unprotected, multi-partner sex, sex workers are considered not only to create risk for themselves, but also for their clients (Sanders 2007).

A public health focus on sex workers reflects the prevailing stereotype that sex workers are sources of disease. The medical metaphors of health and disease serve the same function that earlier forms of moral discourse did; dividing women into clean (not at risk) and polluted (dangerous and risky). The Contagious Diseases Acts, which were introduced in the UK in 1864, 1866 and 1869, identified sex workers as polluters of the male body politic (Bell 1994). The purpose of this legislation was to protect the British army and navy from sexual diseases. Under the Act of 1864 in particular, sex workers were made subject to surgical examination and even detention. The Act of 1869 provided for their moral and religious instruction along with lessons on personal hygiene (Bell 1994, 56). In colonial India (of which Bangladesh was then a part), sex workers were defined as criminals under the Cantonments Act XXII of 1864, the Contagious Diseases Act XIV of 1868, a perspective later enshrined in the Indian penal code. Indian sex workers were also subject to periodic medical check-ups and confinement in lock-up hospitals (Ghosh 2005).

Since the emergence of HIV, international organisations such as the World Health Organisation (WHO), the Joint United Nations Programme on HIV (UNAIDS), the Global Fund for HIV, TB and Malaria, and the United States Agency for International Development have played an increasing role in HIV governance (Ahmed 2011). Human rights and feminist groups have lobbied both national and international organisations working on HIV to influence their policies. An amendment to the United States Leadership against HIV, Tuberculosis, and Malaria Act (2008) mandated that if an organisation wished to receive funds through this Act, it should have a formal policy opposing sex trafficking. On the other hand, the updated Joint United Nations Programme on HIV/AIDS (UNAIDS 2012) adopts a pro-sex-work perspective by recommending harm reduction measures as part of HIV-prevention interventions among sex workers.

Against this backdrop, the present paper aims to understand how – somewhat contradictorily – HIV policies of Bangladesh exhibit a pro-sex work perspective while the participation of the sex workers in HIV programmes has created a situation in which the image of sex workers as diseased, polluted and dangerous has been reproduced. The paper seeks to demonstrate that even though sex worker leaders have claimed agency, sex workers in Bangladesh are part of a complex structure in which the agency they claim in HIV discourse and through political activism can hardly be understood in terms of liberal choices made by free agents. Rather, understandings of sex work are strongly shaped by gender norms and prevailing notions of purity and pollution of the body in the context of Bengali society.

This paper begins with an analysis of how sex work is conceptualised in Bangladesh and its relationship to ideas of pollution. In the following section, the political activism of sex workers is critically analysed, focusing particularly on how this activism draws from feminist philosophy. The final element of the paper highlights the inter-relationship between HIV discourse and sex work and relates it to broader feminist debate.

Sex workers in Bangladesh: polluted identities

As indicated earlier, sex workers have historically been identified as vectors of disease. Within a gendered discourse of promiscuity and risk, sex workers are seen as transgressors, for they exhibit sexual agency, trespass the realm of femininity and participate in risky behaviour. Within the norms of gender and morality, sex work is seen as evil. At the very centre of this moral discourse lies the ‘female body’.

Cross-culturally and throughout history, notions of purity and impurity have been closely bound up with the female body. Cultural values such as the bodily purity of women are important in the context of contemporary Bangladeshi society. Mary Douglas (2003) argues that the body can be seen as symbolic of society. The openings of the body represent vulnerable points. Substances generated at the orifices (saliva, semen, excreta etc.) are marginal because they cross the boundaries of the body and are therefore dangerous. Like the body, the order of society connotes danger at its margins. Transgression brings danger (for example, adultery may cause disease).2 Through ideas about pollution of body and of society, certain moral codes and values are endorsed. Such notions of purity are closely related to the sexuality of women in Bangladesh.

Rozario (1992) argues that through ideological mechanisms such as honour and shame, purity and pollution and parda (the veil), female sexuality is strongly controlled in Bangladesh. Parda, which is closely associated with family honour, restricts women's participation in the public domain. A woman who is shameless loses her sexual purity, and the notion of ‘purity’ normalises the female body. Gender norms in Bangladesh are imposed on women through the institutions of family and religion and through a focus on bodily purity, submissiveness and the repression of sexuality. Even in the cases of rape, discussion of the sexuality of women is discouraged. Mookherjee (2006), for example, found that in order to protect family honour, incidents of rape during the 1971 liberation war of Bangladesh were kept secret. When rape victims from that war made their narratives public in the People's Tribunal of 1992, they faced scorn and social ostracism.3 Ideas about pollution in Bangladeshi society are also associated with maintaining the purity of patrilineage, since women are viewed as the pathways through which pollution enters into the family chain (Khan and Arefeen 1989).

Sex workers, as they trespass the boundaries of the private sphere, become public women. In contrast to modest women who are not expected to be sexually skilled, who are not expected to talk about sex and are who are not supposed to claim money (Pheterson 1993), sex workers exhibit an active sexuality. Because of this, they may be viewed derogatorily as having fallen (potita), as being bad (kharap), as spoiled (nosto), as sluts (beshya) and market-place women (bajarer-meye) and so on (Chowdhury 2006, 343).4 The stigma of sex work is such that women are denied basic rights and suffer structural violence. For many years, brothel-based sex workers were not allowed to wear shoes outside the brothels, neither were they allowed to wear the traditional women's dress of shalwar-kameez, so that wider society could easily detect their spoiled identities and ostracise them accordingly (Ara 2005). Religious leaders have also considered sex workers impure, refusing to perform their funeral rites (Blanchet 1996, 27–8, as cited in Caldwell et al. 1999) and not allowing their bodies to be buried in ordinary cemeteries.

From ‘prostitution’ to ‘sex work’: the sex worker movement and feminist discourse

The eviction of sex workers from brothels in the late-1990s generated public panic in Bangladesh.5 This anxiety reflected a fear of ‘contamination’ among the middle classes (Chowdhury and Gulrukh 2000), who feared that newly evicted sex workers would migrate into the suburban zones within cities. Society at large was seen as the space of the middle class (us), while brothels were the space of the sex workers (them). So long as spatial distance was maintained between these two realms, society remains virtuous and the middle class found a sense of security (Chowdhury and Gulrukh 2000). Moral panic centred on the fear that the eviction would result in uncontrolled and unconfined sex, posing a danger to society at large (Huq 2006). This also revealed a double moral standard within society: on the one hand, sex work is regarded polluting while, on the other hand, it is believed that sex work protects good women from sexual harassment by providing for the release of ‘natural’ male sexual urges (Huq 2006, 136).

After their eviction from the brothels, sex workers became politically active. A number of human rights-based organisations and non-governmental organisations (NGOs) expressed their solidarity with the growing sex work movement, while two sex worker associations – Durjoy Nari Shongho and Nari Mukti Shongho – came into being (Crago 2008). In 2002, the Sex Workers Network of Bangladesh was formed. All these groups supported an agenda for ‘sexual rights’ and demanded greater sexual freedom (Huq 2006). They used a ‘rights framework’ to demand women sex workers' recognition as citizens and legitimate workers (Azim 2005).

On International Women's Day, 8 March, 1994, the International Women's Day Celebration committee adopted the slogan Shorir Amaar Shidhanto Amaar (my body, my decision). This slogan was proposed by Naripokhkho (a women's organisation with a pro-feminist stand).6 The slogan reverberated in dozen of places in Bangladesh where events were organised by the committee (Huq 2012). Brothel inmates marched with the activists on international women's day and reported feeling empowered by doing so (Azim 2011). In a press statement, evicted sex workers from the Tanbazar/Tanbazaar brothel7 urged:

We are women, we work for our living, and we are citizens of this country. Our rights as women, as workers and as citizens deserve the same respect and protection as any other citizen. (Huq 2006, 135)

Importantly, this early activism created room for a closer alliance between the emergent sex worker organisation and other human rights groups and women's organisations in Bangladesh (Huq 2003, 62). The National Women's Network of Bangladesh (known as Doorbar in Bengali) subsequently included sex worker groups as part of their network (Huq 2012). Another major effect of the emerging movement was a change in the terminology used by the print media with the word ‘prostitute’ being replaced by the term ‘sex worker’ (Huq 2012). This promoted the view that sex workers should be seen as workers and not as fallen or morally degraded women (Huq 2006).

This re-positioning of sex workers can be understood from a pro-sex work feminist perspective. When recognised as such in legal and political contexts, sex workers are entitled to avail themselves of work-related benefits such as protection against harassment. Addtionally, the term ‘sex work’ is a gender neutral expression and can include men, women, hijra (a person who adopts a gender role that is neither male nor female) and trans people (Spector 2006). It is also inclusive of other work-related activities associated with the provision of sexual services, such as erotic dancing and stripping as well as pornography. It was not surprising therefore that the relatively small but highly marginalised hijra groups of Bangladesh also expressed their solidarity with this broad-based movement (Huq 2006).

HIV programmes in Bangladesh: sex workers as a ‘key population’ at heightened risk

It is difficult to put an official figure for the actual number of sex workers in Bangladesh. This is due to the fact that official documents often avoid using the term prostitution or sex work. Rather, sex workers are often referred to as ‘socially deprived women’, ‘socially handicapped women’ and ‘women in moral danger’ (Tahmina and Moral 2000; Kabeer 1989, as cited in White 1992, 14). Khan and Arefeen (1989) found no data on sex work in census documents from 1974 to 1981. Furthermore, there are variations in the number of sex workers reported by different sources. According to Hossin (2012) there are around 100,000 female sex workers in Bangladesh. On the other hand, an Action Aid publication from about the same time claims that the number is between 60,000 and 100,000 (ActionAid Bangladesh 2013). Sex work remains effectively legal in Bangladesh (Huq 2012). However, there are laws in some cities prohibiting public soliciting, such as the Dhaka Metropolitan Police Act (Shukla 2010).8

The emergence of HIV in Bangladesh increased the visibility of sex workers. According to UNAIDS estimates, HIV prevalence among 15–49-year-olds in Bangladesh remained at less than 0.1% between 1990 to 2012 (UNAIDS n.d.). In spite of this overall low HIV prevalence, emphasis was given to the development of harm-reduction services and condom promotion (NASP 2011). In part, this was because UNAIDS/WHO (2000) guidelines suggest that in low-HIV prevalence countries, attention should be paid to sub-groups that have risky lifestyles and the potential to ‘bridge’ diverse population groups (UNAIDS/WHO 2000, as cited in NASP 2011). In parallel, a renewed emphasis on human rights placed emphasis on individual autonomy and the participation of target groups in decision-making (Uvin 2007). Empowering marginalised groups, changing power relations and mobilising populations to claim their rights were seen as tools for promoting human development (Uvin 2007). Development organisations and others recognised that in order to reduce the harm of HIV, sex workers required greater control over their bodies (Chowdhury 2006, 340). As such, sex worker agency came to be emphasised, reflecting a pro-sex-work framework.

In 1997, NGOs including CARE Bangladesh began training sex workers as peer educators for HIV prevention. Sex workers also became the targets of free condom promotion. A range of national and international NGOs undertook programmes on leadership-building among sex workers and emphasised organisation-building (Chowdhury 2006). CARE Bangladesh also organised workshops bringing together sex workers from different countries to learn about human rights issues. Motivated by these, local sex workers first formed Durjoy Nari Shongho (Crago 2008). The availability of funding at national and international levels helped support work including organisational development and condom promotion, among other measures (Tahmina and Moral 2000).

From ‘victims’ to ‘vectors’: HIV and sex worker organisations

Early HIV programmes in Bangladesh were grounded on the premise that since sex workers have multiple sex partners, they pose a dangerous source of the disease. The draft National Policy on HIV and STD-related issues of Bangladesh (1996), for example, states:

Because of high rates of partner change among sex workers, and because sex workers are usually fewer and more easily identified than the larger group of clients, interventions directed at sex workers provide an important opportunity to slow the spread of HIV. (Ministry of Health and Family Welfare 1996, 62)

This statement reflects the prevailing view which stigmatises sex workers as dangerous ‘others’. The 3rd National Strategic Plan for HIV and AIDS response (2011–2015) of Bangladesh marked a slight shift in emphasis by suggesting that harm-reduction interventions, such as the distribution of condoms and syringes, the provision of outreach programmes, such as Voluntary Counselling and Treatment and group-based peer education (NASP n.d.), also had a role to play as part of the prevention response. Nevertheless, through a focus on sex workers as agents of condom promotion, sex workers were portrayed not as vulnerable victims, but as potential sources of infection.

Because of this focus, programmes place responsibility for HIV transmission largely on the individual, adopting what might best be described as a ‘subtle’ pro-sex work perspective, in their assumption that if only sex workers are empowered to have better control of their bodies and rendered capable of negotiating condom use with clients, they can prevent HIV transmission. A degree of rationality is assumed here in that these risk-reduction models assume that if individuals are given the right information and tools (condoms) they will rationally change their behaviour. This ‘hygienist’ approach was in contrast to more prohibitive ‘sanitationist’ practices by seeking to empower, providing individuals with protection, rehabilitation and reform so that they can act as responsible subjects (Scott 2003). By promoting self-control, social rights and responsibilities, hygienist practices allow for the regulation of persons in line with neo-liberal practices of governance (Scott 2003). Through a focus on individual behaviour change, sex workers are brought under the gaze, and hence the governance, of hygienist practices. Paradoxically, sex workers' lobbying for the recognition of their occupation as ‘work’ supported such a view.

Sex work activism brought sex workers together around a common platform. While differences between hotel-based sex workers, brothel-based sex workers and street-based sex workers have long been recognised, differences between individuals living in brothels have less often been focused upon. Khan (2010) identifies four types of brothel-based sex worker: the landlady (bariwali), the tenant (bharatia), the madam (sardarni) and the bonded (chukri) sex worker. While landladies own the brothel premises, the independent sex workers operating and living there do so as tenants. Madams are the female owners or managers of brothels. They ‘own’ the bonded young women who work there, providing them with food and housing, while in return keeping their earnings. Chukris are typically bonded to serve madams for up to four or five years (Ara 2005, 11).

These differences are not merely ones of categorisation but reflect sex workers' ability to exert agency and exercise power. Bonded sex workers remain at the bottom of the power structure, and within this structure, agency is rarely a free choice. Rather, it is shaped by one's position within the power structure. As such, making sex workers responsible for their ‘individual’ behaviour has little meaning for many sex workers. In addition, to view sex workers as a homogenous category moves the focus away from the fact that violence and abuse can have multiple dimensions, both external and internal. Sex worker movements often highlight external oppression (by society and the state towards sex workers as a whole), but historically have paid less attention to the internal violence that sex workers suffer from power holders inside the brothel.

The UNAIDS (2012) Guidelines on HIV and Sex Work warn against conflating sex work with trafficking. In Annex 3 of the guidelines, it is argued that trafficking for the purpose of commercial sexual exploitation involves coercion or deception, and thus involves the provision of sexual services against the person's will. This violates fundamental human rights and removes the agency of trafficked persons. Sex work, on the other hand, is freely entered into and involves consensual sex between adults. However, this same report acknowledges that women are often trafficked or coerced into selling sex (UNAIDS 2012, 4). The choice, consent and agency emphasised by UNAIDS guidelines, and by much of the pro-sex work feminist literature, cannot be seen as ‘free’ choice in the context of Bangladesh, for it involves a complex process in which ‘choice’ is strongly shaped by cultural norms and social pressures such as those described. An individual behaviour change framework for HIV prevention pays little attention to these broader structural factors, even when they are acknowledged to exist. Choi and Eleanor (2007) report that in countries such as China, sex workers may refrain from condom negotiation owing to poverty; a similar situation prevails in Bangladesh. Likewise, Amanullah and Huda (2012) report that condom use is rare with regular partners and with boyfriends, a situation that has its parallels all over the world.

In the process of raising their status from ‘fallen women’ to regular workers, sex worker groups have utilised and promoted a pro-sex work discourse. Within this struggle, they portray themselves as active agents. But entry into sex work and the decision to remain in the industry is rarely an entirely free choice. Would pro-sex work feminists define as ‘workers’ those women who have been deceived, sold into a brothel and then ‘willingly’ choose sex work after having taken customers and thereby become ‘impure’? While the identification of sex workers as active agents may make them ‘suitable targets’ for empowering HIV interventions, their position within the broader sex work movement and the agendas of their organisations are also shaped by feminist and human rights considerations. These two processes are interconnected, the one influencing the other.

Sex workers, by identifying as key populations at heightened risk facilitate a view of themselves as ‘dangerous’. This in turn reproduces the view that female sexuality itself is dangerous (Sacks 1996). By doing so, they not only identify themselves as vectors of disease, but obscure the fact that they themselves may become the victims of HIV infection as well.

Conclusion

Sex worker activism in Bangladesh began as a protest against brothel eviction and violence. It created an imaginary in which sex workers came to be seen as the victims of oppression. Through this movement, an attempt has been made to transform their identity from that of ‘fallen women’ to that of ‘ordinary worker’. This reflects an alignment with pro-sex work ideologies in feminist discourse. Dominant HIV discourse also places importance on the agency of sex workers. Influenced by a rights-based approach, different non-governmental organisations have undertaken programmes of empowerment for sex workers seeking to reduce the transmission of HIV. Most such work has involved interventions at the individual level, focusing on the promotion of condoms, awareness of safer sex, the distribution of clean needles and syringes and the provision of clinic-based health-care services. HIV risk is seen as requiring a ‘technical fix’ such that, if the individual behaviour of sex workers can be altered, then HIV transmission can be prevented. What this framework does not take into account is the fact that sex workers live their lives as part of broader power and community structures and that in countries such as Bangladesh, the choices they make are rarely, if ever, free. Rather, their actions are shaped by structural factors, as well as by notions of purity and pollution.