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Table 2 Sex worker narratives: Work environment influences on HIV prevention and risk, 2008–2014 (N = 24 studies)

From: Work environments and HIV prevention: a qualitative review and meta-synthesis of sex worker narratives


Features that support HIV prevention

Features that undermine HIV prevention

Occupational health & safety standards in indoor venues

The street just doesn’t appeal to me, because of the whole security safety issues. You know, I like being in a parlour because it is safe. Yeah, sure, you don’t make as much, they take a big cut, but that’s the price you pay, you know, for your health and life. (Indoor parlour) [37]

The street’s way too dangerous. It’s just so easy for people to do anything they want. Like we’ve lost about, lost two lovely ladies from the street, and you know, just like that, you could just, yeah, just there’s nothing you can do about it when you’re standing out on a corner or any part of the street, there’s nothing much you can do about it. There may be a lot of traffic, but not many people pull over to help. (Street/Independent) [37]

[on the street] they [spotters] can take the license plate down and the car make, but once buddy gets you two blocks away, how are they going to stop the guy from shooting or stabbing you? They might prevent it from happening to the next girl, cause they got his plate number, but for you, there’s no protection. None at all. (Street) [10 ]

He took me to the graveyard. . . There were 5–6 people totally drunk. They did like that only and did not even give me a rupee. They did without condom. (Street) [39]

They took me by car to a guesthouse and they force me to have sex with four other men. [Do you know if they used condoms?] No. Not used condom because it was a force. (Street) [47]

Influence of third parties

We meet the boss every Monday and each FEW attends the meeting. Our boss told us in the meeting that the ‘classes’ (intervention sessions) are worth attending. He is really supportive of us taking the classes. After the classes, he often reminds us that health should be our priority and we can make more money if we are healthy. He even jokes that the intervention saves us money to buy condoms and reminds us that no one else outside might be this considerate of us. (Entertainment establishment) [49]

I explain to the girls that they should use condoms. I emphasize the fact that these people from SHIP are giving us knowledge so that our lives are safe, and we can prevent ourselves from acquiring any such infection or disease. (Madam and SW) [38]

It is important for my girls to enjoy good health. If she is sick then I need to ensure that she gets medical attention either in our own clinic or outside… I charge her room rent and that is to my benefit; she is getting a room and health care—that is to her benefit. (Madam) [38]

[I] t is safer with a boss such as when there is a problem, they deal with it. When policeman catch us, they pay for us … They protect us. When people fight us, they also protect us. (Brothel) [42]

He [the lodge manager] says ‘use condom and do’ but if he [the client] says it’s not fun, then the manager says ‘Take your money and go, we get 100 other clients. (Indoor) [39]

They [building staff] really pay attention: we get all the lists of all the offenders and stuff, and they’re put up [by the door] and staff study them. One of the staff caught one [a violent client]. He was a visitor in the house, and he came in as a date, and they called the police, and he got arrested. (Indoor – supportive housing) [40]

Last time, a client wanted oral sex without a condom. I could not persuade him to put one on. Then, I called Manager W from the guest room. The client argued with the manager and said he can get the service in another brothel. Manager W insisted that wearing a condom is regulation here and asked the client to leave politely.(Spa) [50]

Last time, I put on a condom for a client. But he took it off under the table. Angry, I refused to continue sex with him. I put on my clothes and went downstairs. I know the boss will protect and support me, so I dared to refuse him. (Roadside hotel) [50]

I am always concerned with their health. I tell them to pay more attention to their personal hygiene. They should always wash their hands after massage, and I tell them to prepare condoms.(Massage Parlour) [55]

I got raped and the guy just walked out the door. I was crying and the manager came to me and all he said was, “As soon as you walk in the room, you are on your own. It’s not my problem or my responsibility for your safety. (Indoor parlour) [52]

Usually, if a man is taking too long my madam starts to blame me and says that I have sat twice, so if he takes a long time I take the condom off. With this customer I convinced him and he discharged quickly so there was no trouble. (Brothel) [53]

If we sent any client back she used to get angry, so we did not use [condoms] regularly”. (Brothel) [39]

One day I was harassed by a client and when I told the bar manager, he demanded sex so that he can help me. (Bar) [46]

Girls from the dalal bari (houses where pimps bring clients) rarely misbehave…The girls there are bound to do all kinds of sex…They rarely can protest or behave badly. For us it is different. If I bring a customer I can make him use a condom or drive him away — I can do that — they cannot do that. (Indoor/Independent) [53]

The boss never talks about condom use. He pretends he doesn’t know [the sex business]. There is no talk about condom use or HIV prevention among girls either. Nobody talks about this. We only talk about which client is rich or which is decent (Massage Parlour) [55].

It is better to train the girls. The boss doesn’t care about us. He has his business to take care of. He never talks about this with us (Sauna) [55]

Sex worker/Peer support

When I first came here to start working, it was [another SW] who taught me how to use condoms. She said that this was the hygienic way [57].

In the waiting room, new FEWs will stay with old FEWs. We don’t feel as embarrassed to discuss these things (sex and condoms) in the venue compared to when we are outside. (Entertainment venue) [49]

Clients prefer to spend hours talking and drinking before taking a girl for sex…we observe and consider the clients and check references with friends. (Entertainment venue) [41].

Sometimes mammies would ask us to show pity for new girls who were in the same room with us and teach them things they didn’t understand. In this case, we would tell them a lot of things and teach them a lot. (Indoor) [49]

When my friends [sex workers] knew when or where there were free services for HIV or STI testing and counseling, they called me and asked me to go there with them. (Indoor) [56]

My friend [sex worker] encouraged me to use a condom when I had my first client. She told me to use condoms to protect myself from being infected. [Furthermore,] I was too shy to buy condoms at first. My friend [sex worker] bought them for me and taught me how to use them. (Indoor) [56]

My FSW friends advised me that using condoms could prevent diseases (Indoor) [56].

When I get into a conflict with clients, my colleagues will come to mediate the conflict and persuade the client to use a condom (Indoor). [56]

I don’t talk to friends about my genital symptoms because friends who are jealous of me might disclose it to clients. Also I may be asked to stop working for a while, or even not be allowed to work in this bar if the bar owner knows about this.I wait and quietly visit a health clinic alone. (Entertainment venue) [41]

I felt tidak pantas (inappropriate). Even though I do what they [other sex workers] do, I will never associate myself with them. I will not share anything with them; I just feel it isn’t appropriate. From day one I felt that someone here disliked my presence. (Brothel) [58]

During my first weeks there, no one told me to use condoms or even offered me a condom. I didn’t know what condoms looked like, so when I had clients I just did it, simple and crazy, really crazy. (Brothel) [58]

Interactions with police

On the corner, doing it in the car, I used to be scared all the time, paranoid about cops, scared about getting charged… It’s a lot easier now. I can come and go, and cops actually say hi to me. (Indoor – supportive housing) [40]

It’s safer. I can just yell for help, and, you know, in the alley you can’t really yell, you know? It’s hard to run away, and… you don’t know whether they’re going to get violent or something. There’s a lot more chance of that outside than at my place. [If it happened in my room] I’d run for the door. It’s happened before, and the staff have come, and they told him to leave, or they even got the police to get him to leave. They do that right away. It took 4 cops to get this guy to leave. Then they barred him [from the place]. (Indoor – supportive housing) [40]

We faced many problems as we stood on the streets; mainly from the police and the local goons. Police used to dump us in the vans, ask for Rs. 60,9 and used to have sex with us. They used totake money as well as service. The local goons used to charge…They used to say, “You people stand here and earn well, so you have to give something to us.” If we said no, they would beat us up. See here, they once stabbed my hand with a knife [showing a large scar on her hand]. (Street) [38]

They mistreat us so much. Even policemen rape us, and if you try to resist, they threaten you with arrest and detention [59].

[The police] look in your purse and if they find condoms, they put you in jail, but clients are released. (Street) [44]

The difficulties were great, especially when we started. The local police dispatched people to drive us out. They didn’t understand. They would take our condoms and throw them on the groun [57].

They’re not out to get us, but they don’t really have any compassion or concern about us. A lot of us girls start carrying pepper spray or bear spray. But you have to be careful too, because as soon as the cops search you, jack you up, they take away what you can to protect yourself with, even rigs. (Street) [10]