Wider Cellphone Use Among India’s Sex Workers Threatens HIV-Prevention Programs

India, which has been a surprising success story in AIDS prevention throughout the aughts, might be on the verge of a serious health crisis thanks to the more widespread use among sex workers of cellphones, those fragile, rectangular amulets of modern independence. Though India's sex trade used to be largely localized in small neighborhoods such as Kamathipura, the red-light district in Mumbai, where prostitutes lived in brothels under the watchful (and often tyrannical) eye of a rent-charging madam, wider access to cellphones among the lower classes has given formerly brothel-bound sex workers the ability to ply their trade indepently, complicating the efforts of India's healthcare workers to target their message of HIV prevention and track the disease's spread through the population.

The New York Times' Gardiner Harris reports that, while cellphones on the one hand have helped sex workers in India achieve a certain degree of professional independence by letting them dictate the terms of payment and choose the clients they do business with, cellphones have also contributed to the recent closings of "hundred of ancient brothels." So, explains Harris, although brothel closings represent "something of an economic victory for prostitutes, [it] may one day cost them, and many others, their lives." That's because, as part of an enormous (and surprisingly) successful AIDS prevention effort underwritten by the World Bank and the Bill and Melinda Gates Foundation, the campaign to prevent the disease from becoming a national crisis — something that in 2002, the C.I.A. deemed inevitable when it estimated that India would have as many as 25 million AIDS cases by 2010 — made it a point to specifically target high-risk groups like prostitutes, gay men, and intravenous drug users.

Part of the reason that this strategy was so successful to limiting AIDS cases in India to about 1.5 million is that the sex trade was largely concentrated in specific urban neighborhoods, a fact that strengthened the impact of safe-sex messages on posters proclaiming pithy safe-sex aphorisms like "When a condom is in, risk is out." Thanks to data gathered during a 2009 government survey, which found that about 2,000 prostitutes served about 8,000 men each day in Delhi's red-light district Garstin-Bastion Road, the government estimated that if it could deliver up to 320,000 free condoms each month and train prostitutes in the area to practice safe-sex, AIDS infections could be "significantly reduced."

The push to focus AIDS prevention efforts on high-risk groups succeeded, but the mobilization of India's sex industry (coupled with less funding from the Gates Foundation and urban renewal projects) threatens to dilute neighborhood-centered AIDS campaigns. Explains Harris,

Now that mobile phones are untethering prostitution from brothels, those targeted measures are threatened. At the same time, the advent of cellphones seems to be expanding the sex marketplace - luring more women into part-time sex work and persuading more men to pay for sex. Cellphone-based massage and escort services are mushrooming across India.

Although widespread cellphone use may herald a new era of sexual independence for India's sex workers, it makes HIV-prevention programs far more difficult, and threatens to unravel more than a decade of success in stemming the spread of AIDS throughout India.

Cellphones Reshape Prostitution in India, and Complicate Efforts to Prevent AIDS [NY Times]