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| Gharwali |
Background and Objective
Gharwalis are those who own the houses where the sex trade occurs. Every house has one Gharwali and 3-4 Female Sex Workers. The Gharwali runs the sex trade at her house.
The Gharwalis play a very important role in the AIDS awareness program. We need to reach out to the FSWs and the Gharwalis are the agents through whom we can reach the girls. The Gharwalis are influential and have a strong impact on the girls.
We have 13 FSW NGOs who work in areas designated by MDACS. They work in these areas to increase awareness about HIV/AIDS and to induce uptake of services. The NGOs supply condoms to the FSWs, conduct testing camps and provide informative material on HIV and AIDS.
These NGOs face a lot of trouble in interacting with the FSWs. Even though the penetration level of the NGOs is high among the FSW areas and the awareness levels have increased in the past few years, still there is difficulty in bringing about attitudinal change among them.
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| FSWs |
In order to design a strong communication program for the FSW that brings an attitudinal change, we decided to conduct a focused discussion with a group of Gharwalis. The Discussion was targeted at understanding the minute aspects of life of the FSW that will enable us to design the campaign / communication.
FOCUS GROUP DISCUSSIONS
The following is the questionnaire that was created to be given to the Gharwalis to help us find out information about the problems faced by them as well as the Female Sex Workers under them. The answers to these will also give a comprehensive idea as to how they handle the health issues and other things that they face in their profession.
1 To understand the needs of the Female Sex Workers as perceived by the Gharwali
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In your opinion on an average for how many years is a Gharwali able to carry out her profession?
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What are the basic needs for which you have to struggle?
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Why do girls come into this profession?
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What makes them stay in this profession?
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How long do they continue in this profession on an average?
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What are the reasons for discontinuation?
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How many spells of such discontinuation normally occur in a year or two?
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How does it affect the Gharwali and her income?
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Do the girls change locations? Why?
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What are the most common illnesses the girls suffer from?
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What is done at the first instance when the girl complains of illness?
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Which are the Major illnesses and Minor illnesses most commonly encountered amongst the girls?
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What is done if hospitalization is needed?
2 Issues of change of client behaviour over a period of time
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What type of clients approach you most of the time?
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What are the most common addictions seen by you all in your clients?
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Is there a change of the class of clients who approach you?
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Are there any instances where the clients are refused by your girls?
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What are the reasons for refusal?
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What are the problems faced by you when some of your girls refuse clients?
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How do you handle the situation when your girls find that clients suffering some kind of health problems?
3 Behavior regarding the Utilization of Health services
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Where do you feel comfortable to get medical aid for your girls when they are sick?
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Why do you like this care giving service?
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On an average, how much money is spent per month on each girl?
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What do you do if some girl is very sick and requires a lot of money to be spent on her?
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How many days of treatment is given once started?
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What kind of treatment do you use most – home remedies / self-medication?
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What are the changes that you feel are needed to be done by us so that utilisation of scientific treatment is available for your girls?
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Do the shopkeepers give you medicines when you tell them the symptoms?
4 Myths and beliefs
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What are the common beliefs about the diseases the girls suffer from?
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What are the home remedies you most commonly indulge in?
5 Condom Use
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Do you use the Condoms supplied by the government centers?
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What are the reasons for its use? Or what are the reasons for its non-use?
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Which types of condoms are most popular with the clients?
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Do the clients get their own condoms? If not, then are they willing to use the ones given by you all?
6 Do you think your group needs more information on the issue of diseases spread by unsafe sex?
If yes, then
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How many days training do you think will be needed?
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What is the best time for the training?
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What are the issues that you think need to be covered during the training?
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Do you think your people will attend the trainings?
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Do you think you all can help us or do you know of any NGO that you all will feel free to be associated with?
7 Do you have any suggestions for us to improve the services provided to you?
RESULTS OF FOCUS GROUP DISCUSSION
The Focus Group Discussion was held on 6 July 2011 at MDACS, from 2 pm till 3.30 pm. for Gharwalis (the women under whom the female sex workers work in brothels). There were 16 participants in all from different parts of Mumbai. It was observed that some of them were quite free and frank. However, some of them were found to be a bit hesitant to respond to questions. Although some amount of inhibition did disappear during the course of the discussion. A special thanks to
Dr. Sunita Shanbhag, Professor, PSM Seth G S Medical & KEM Hospital, Parel, Mumbai, for putting it together.
FINDINGS OF THE FGD
Perceived needs of the Gharwalis:
On an average how many years is a Gharwali able to carry out her profession?
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18.75% were of the opinion that it is 40-50 years – from the age of 30-35 years up to 60-70 years of age.
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12.5% women said for about 20-30 years.
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6.25% women said that it could be 15 years also.
Basic needs for which the Gharwali has to struggle for
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31.25% women said earnings have reduced,
a.
As girls run away with their partners and do not listen to Gharwali.
b.
They give their money to partners
c.
The girls boss over them, especially the Bengali girls. "
Ladkiyan dam dene lagi hai, baat nahi sunti hai" as one of them said.
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18.75% women said that they feared police raids.
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12.5% said that they really had to struggle for money.
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6.25% was worried of stigma in the neighbourhood.
Why girls come into this profession?
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18.75% women said that these girls come from poor families and are sold to them by middlemen.
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12.5% said that the women are cheated after being promised good jobs in cities
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12.5% said that girls come into this profession for easy money, after they see other women from the village who have earned money in this trade.
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12.5% said that women may enter after false promise of marriage or widowhood
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Another 12.5% said that they could also come into this if they are tortured by husbands and forced into this profession.
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6.25% said after separation from husband
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6.25% said that orphan girls can also come into this profession
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6.25% said that women are also sold from across the border (Nepal).
What makes them stay in this profession?
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31.25% women said that girls stay back due to the easy money that can be earned.
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18.75% stated that parents & relatives become used to the large sums of money and grow dependent on them.
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12.5% stated that they continue in this profession as family refuses to take them back due to social stigma. They said that, ek baar ladki Mumbai gai, to dhabba lag jaata hai ladki pe.
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12.5% said that if the girls try to find another job, they are sexually abused there or the people there ask them for sexual favours, hence they come back. They said, “
Baazar ki aurat hai, ye aur kahan jaayegi.”
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6.25% women said that when these girls go back home they are sexually abused by their father, brothers & other relatives, therefore they come back.
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6.25% said that they stay back as here they have the freedom to eat, sleep and work as they please.
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Another 6.25% said that the girls go out seeking love, care & stability in relationships; they don’t get any, so they continue in this profession.
What are the reasons for discontinuation?
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6.25% said that some girls leave when they think that they have earned enough & bought some land. They are ready to settle down.
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6.25% stated sometimes girls want to go back to parents’ house, so they leave the profession.
Do they change locations and why?
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12.5% stated that about 50% girls change locations.
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12.5% said that they go to new places like Surat, Rajasthan or Nagpur and set up trade there.
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6.25% said that if girls fall sick and are sent back home, after some days they come back and work for a different Gharwali. They said that are informed about the new location of the girls by the pimps.
Most common illness in girls
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31.25% stated that menstrual problems are quite common in girls. These include excessive bleeding, pain during menses.
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18.75% said that cancer was common among these girls. They said, “
Thaili ka cancer ho jaata hai ladkiyon ko. TATA hospital leke jaate hai. Kisi ka thaili nikalna padta hai.”
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12.5% stated that abortion (for unwanted pregnancy) was common in these women. They said that, “
Baccha ruk jaata hai, phir thaili saaf karvate hai baar baar.”
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12.5% women said that STI (
guptrog) and another 12.5% said that HIV was common in these girls.
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12.5% said that TB was also commonly seen in these women, whereas, 6.25% said that Respiratory problems were quite common.
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6.25% said that breast lump was seen in women, while another 6.25% said that diseases of the uterus were commonly seen. They said, “
Thaili kharab hoti hai, thaili me gaat ho jaati hai, phir use nikalna padta hai.”
What is done at the first instance when the girls complain of illness?
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18.75% said that they take the girls to visit a doctor in the first instance of complaints.
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18.75% women said that if a girl complains of burning micturation or white discharge, they advise Home Remedies. They advise them to wash the area with salt water or rice water for a day or two and if still not cured, they take them to a doctor.
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18.75% said that they take the girls to the NGO working in the area.
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12.5% said that they use medicines or cream (which is there in the house), for 1-2 days (given by NGO, once every 3 months). If not cured, then they take her to the doctor.
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Take medicines across the counter from medical shop by telling the symptoms or showing the old receipts or showing the old medicine strips.
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12.5% stated that the partners of the girls take them to private doctors, as there are long lines in the government hospitals.
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12.5% said that they take the girls to private doctors for minor illnesses and to government facilities for major illnesses.
What is done if hospitalization is required?
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12.5% - the girl is admitted to a hospital and either the partner or another girl stays with her. They said, “
Hum unhe apni bacchon ke tarah hi dekhte hai.”
Common addictions in girls...
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All said there is a lot of addiction amongst the girls
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25% women said that the girls smoke cigarette.
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25% said that most girls drink alcohol.
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6.25% said that they take
ganja bhang, charas, and sniff solution.
Contraception used by girls
TOTAL MISUSE OF ORAL CONTRACEPTIVES WAS DONE BY THE FSW
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12.5% women said that the girls use MALA D, Choice or Saheli.
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6.25% said that some take injections of hormonal contraceptives every 6 months from private hospitals.
CHANGE OF CLIENT BEHAVIOUR OVER A PERIOD OF TIME
Most common type of clients
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75% women said that men with addictions were the most common type of clients.
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12.5% said boyfriends of the girls were common.
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Another 12.5% stated it was womanizers who come. They said, “
Ek baar naad lag jaati hai to aate rahte hai.”
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12.5% said that more adolescent boys (15 – 19yrs) are coming nowadays.
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6.25% women said that local hooligans and bullies were common. They said, “
Tapori log aur wahan ke gunde aate rahte hai.”
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6.25% said that men who were unhappy with their marriage often come to them & another 6.25% said that men with working wives, where wives are not able to give them enough time are also regular clients.
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6.25% said that those men who want to show off their money come to the girls.
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6.25% also said that elderly men (>60yrs) come frequently.
Age group of the clients
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25% women said that more of adolescent boys are their clients now.
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18.75% said that men in the age group of 20-40 years were clients.
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6.25% stated that elderly clients are also frequent. They said, “
Umar badti hai to zyada chichorapan karte hai.”
Most common addictions seen in clients
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43.75% women said that alcohol was the most common addiction.
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18.75% said that ganja addiction was common.
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12.5% said bhang addiction.
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12.5% also mentioned sniffing solution (thinner, etc.)
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6.25% said the clients take
nashe ki goli – button.
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6.25% said that the clients take some kind of aphrodisiacs – sex ki goli. They said, “
Sex se maloom padta hai ki nasha kiya hai ki nahi, nasha kiya to zyaada hota hai.”
Is there a change in class of clients?
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25% women said that nowadays there is an increase in the adolescent clientele. They said, “
Chote ladke aate hai, mobile pe gandi picture dikhate hai aur vaise karne ko bolte hai. Bolte hai ki zyaada paise denge. Aur badi aurat mangte hai.”
Are there instances of client refusal by girls and reason for refusal?
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31.25% said that girls do refuse to entertain clients sometimes.
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18.75% said that the girls refuse those who are heavily drunk.
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18.75% said that those who bully the girls are also refused.
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Another 18.75% said that men with some ulcer or boil on the penis are refused. Some women said, “
Agar aadmi ko jage par fodi ya zakham ho to hum ladkiyon ko kaam karne se mana karte hai, par paise ki lalach me ladkiyan kaam karte hai, hamari baat nahi sunti.”
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12.5% women stated that clients who offer less money are refused.
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12.5% stated that young boys are refused.
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6.25% stated that clients who refuse to use condoms are refused.
Problems faced by Gharwalis when girls refuse clients
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12.5% stated that the clients fight with them, often bringing their group of friends with them.
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12.5% said that when refused, the clients inform the police about them and ask them to shutdown business.
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6.25% said that the clients use bad words and insult them.
When girls find health problems in clients what do they do?
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18.75% said that they refuse such clients.
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Another 18.75% said that they insist on usage of condom. If male does not agree to use a condom then female condom is used.
BEHAVIOUR REGARDING UTILIZATION OF HEALTH SERVICES
Where do you feel comfortable to get medical aid & why?
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31.25% stated that they take the girls to the NGO near them. They like it because it is nearby and the workers come home to visit them. They said, “
Raat me bhi takleef ho aur unko phone karo to woh aate hai, gaadi bhi leke aate hai.”
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25% said that they prefer government facilities, especially for major illnesses.
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18.75% said that they or the partners of the girls take them to private practitioners. They said, “
Private mein jaanch jaldi hoti hai, line me rukna nahi padta. Sanstha me vaise bhi general (sardi khasi ke liye) dawaiyan nahi milti.”
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6.25% said that general medicines are not available at the NGO.
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Gharwali gives money to girls for transport and snacks when they go to Nair Hospital for CD4 count.
Do the girls take self medication or use home remedies?
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18.75% girls use home remedies like salt water, rice water or alum water to clean the area in case of burning micturation or white discharge.
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12.5% girls use creams or medicines given by the NGO previously, for 1-2 days.
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12.5% girls buy new medicines from chemist by showing old packets of medicines.
Do the shopkeepers give you medicines when you tell them symptoms?
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31.25% women said that chemists give them medicines for simple ailments like headache, body ache, cold, etc. when they tell them the symptoms.
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12.5% said that the chemist gives them medicines based on old prescriptions.
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6.25% said that chemists ask for new prescription.
MYTHS AND BELIEFS
Common beliefs about diseases the girls suffer from
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25% said that STI are caused due to lack of cleanliness. They said, “
Peshab karne ke baad jagah saaf nahi karte to safed paani jaata hai.”
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12.5% said that STI occurs if condom is not used during sexual intercourse.
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12.5% women said that STI occurs if women wear wet undergarments.
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6.25% said that STI occurs when girls do not wash their clothes in dettol and dry them in sun during menstruation.
Condom Use:
Do you use condoms supplied by government centres?
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50% said that they do not use condoms supplied by government centres.
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6.25% said that they use condoms supplied by government centres.
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6.25% said that both male and female condoms are used.
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6.25% said that they use government condoms if available, if not then they buy from outside.
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6.25% said that Gharwalis buy female condoms from NGO at Rs.3 and sell it for Rs.5.
Reasons for use or non-use
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31.25% women said that the female condoms are not favoured as the inner ring causes pain and pricking sensation and tightness.
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6.25% said that discomfort due to female condom decreases with use, while 6.25% said that discomfort is not present if condom is applied correctly.
Which type of condoms are popular with clients?
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12.5% women said that the clients preferred chocolate flavoured condoms.
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6.25% said that the clients preferred less expensive condoms.
Do the clients get their own condoms, if not, do they use the ones given by you?
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18.75% said that the clients bring condoms with them.
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6.25% said that some clients are willing to use condoms given by FSW
Do you think your group needs more information on issue of spread of diseases?
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68.75% said that they wanted training. One women said, “
Hira chamakta hai baar baar ghisne pe, is liye training zaroori hai.” Another woman said,
“Aapne ungli di hai, hame to haath pakadna hai.”
How many days of training is required and the timing preferred?
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25% women said that one day training is sufficient.
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12.5% said that two day programme would be good.
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43.75% said that 11am to 3pm would be convenient timing.
What are the issues that need to be covered?
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18.75% said that cancer of the uterus needs to be covered.
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12.5% women said that STI/HIV/AIDS and multiplication of HIV should be covered.
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12.5% said that breathlessness and TB should be covered.
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6.25% said that condom usage and benefits should be covered.
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6.25% said that treatment of diseases needs to be covered.
Do you think your people will attend the training?
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18.75% women said that girls will not come.
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12.5% said, “teach Gharwali, they will teach other Gharwalis and the girls”.
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6.25% said that Gharwalis may not teach girls who live with their partners and 6.25% said that partners do not let the girls come.
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6.25% said that peers should be trained, as they are sahelis (friends of girls) and stay in the community.
Place of training
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56.25% women said that they would prefer to have the training in MDACS.
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18.75% said that it should be in a place where there would be no disturbance and where they could be free.
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12.5% said that it should not be in their area as there is not enough place and there would be a lot of interruption.
Who do the girls listen to?
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25% said that the girls listen to their partners.
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12.5% said that the girls are not afraid of anyone.
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6.25% said that they listen to Gharwalis.
Behaviour towards HIV positive people
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12.5% said that they do not discriminate against them.
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6.25% said that those who do not know about the disease do not share utensils, clothes, towels, etc. with patients.
Next Steps:
We will be designing a communication and health programme on the basis of the findings of the FGD.
Thought process:
