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Stamford Journal of Media, Communication and Culture, Issue 02, December 2012

Understanding the Risk of HIV/AIDS among Bonded Sex Workers from a Structural Violence Framework: A Close Look at Daulatdia Brothel
Habiba Sultana*
Abstract: This paper shows how the bonded sex workers of Daulatdia brothel suffer disproportionate risk of HIV/AIDS due to structural violence. Bonded sex workers are not only the victims of unequal power relations but also subject to negative portrayal in society. The imagery that they invoke is associated with pollution, danger and contagion. Both these factors contribute to obstruction of their human agencies and results in realization of health needs beyond the potential level. Sex workers as a category have remained invisible in the official documents for long. It was only in the 1990s that they appeared in the public discourse. This was due to their increased importance in public health programmes and their movement. It was the time when policies and programmes were undertaken to address the HIV risk of the sex workers. But these interventions failed to address the structural factors that give birth to unequal distribution of power within the brothel setting. Drawing from first hand data and based on analysis of policies on HIV/AIDS in Bangladesh, this paper argues that brothel based bonded sex workers are at a greater risk of HIV/AIDS due to their structural environment, which if not addressed, creates risk of infection.

Introduction This paper aims to show how the power structure of the brothel creates increased risk of HIV/AIDS for the bonded sex workers. In doing so, the study concentrates on exploring: how the choice of the bonded sex workers is constrained by the multiple layers of power relations; how their human agency is obstructed by structural factors; and how structural violence causes HIV risk to them. As such, the research looks at the status of the bonded sex workers as shown through their negative representation, subordination, discrimination, and exploitation, and explains their vulnerability to HIV/AIDS through the theoretical point of view of structural violence. The framework of structural violence explains how curtailment of human agency hinders potential level of achievement of needs. The root of the violence lies in unequal distribution of power. The bonded sex workers lead a life of slavery. They are bought and thereafter controlled by their madams. For many years, prostitution remained hidden in public discourse. It was only after the growing importance of HIV/AIDS and the movement of the sex workers in Bangladesh in the 1990s that it cropped up in public discussion. Since then, rhetorical change has taken place in the literature as the word prostitute was being replaced with the term sex worker. Policies were adopted to address the risk of HIV/AIDS infection in which behavioural change interventions were

Habiba Sultana: Assistant Professor, Department of Anthropology, Jagannath University, Dhaka, Bangladesh.


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suggested. However, the internal exploitation of the marginalized categories of sex workers remained untouched in these policies. This paper argues that the risk of HIV/AIDS of the bonded sex workers is being shaped by their social environment and is influenced by structural violence. Unless structural factors are addressed, behavioural change interventions are less likely to bring about desired results. This paper begins with the conceptualization of structural violence. An analysis of the vulnerability of the brothel based bonded sex workers are provided in the next part. In the following section, the framework of structural violence is being used to examine the HIV risk of the bonded sex workers. The final part highlights the HIV/AIDS interventions and shows how the individual behavioral change programmes suggested in the policy framework, obscures the structural factors that create risk of transmission of the disease. Objective of the Research The objective of this paper is to show how structural violence creates disproportionate risk of HIV/AIDS for the bonded sex workers. In doing so, this study aims to do two things. First, to reveal how the human agency of the bonded sex workers is curtailed by structural factors such as unequal distribution of power and negative moral judgment . Second, to show how the policies and interventions on HIV/AIDS that focus on individual behaviour change, fails to address the structural production of risk. Methodology This research was conducted among the bonded sex workers of Daulatdia brothel. Field visit was carried out during June-August 2011. Samples were selected on a purposive basis. Altogether thirty in-depth interviews were carried out. Analyzing the stories of the sex workers the drivers of vulnerability were revealed. The data collected are qualitative in nature. In support of the qualitative data, three case studies were also done. Ethical considerations were maintained while informed consent was taken prior to the interviews. The data were coded and analyzed into major themes. Apart from that, secondary literature on prostitution was reviewed, while policies and programmes on HIV/AIDS were examined. Limitation of the Study This study has its limitations in the following areas. Firstly, the sample size is not large enough to allow for generalization of the findings. Secondly, the environment of the Daulatdia brothel might be different from that of other brothels of Bangladesh; therefore, the findings do not represent facts about all the brothels of the country. Thirdly, since the research focused on collecting data on bonded sex workers only, interviews were not carried out with the organizations (such as NGOs, NASP etc.), working on HIV/AIDS. This resulted in another limitation: the study did not look at the influence of the NGOs working with the sex workers at the brothel setting on structural violence. Conceptualizing Structural Violence Structural violence, as a concept was first coined by Johan Galtung (1969). It refers to those constraining social structures that limit ones ability to realize full potential. By

Understanding the Risk of HIV/AIDS among Bonded Sex Workers from a Structural Violence


social structure Galtung means economic, political, religious and even cultural structures (Simmons, 2010). Galtung provides an example of structural violence:
if a person died of tuberculosis in the eighteenth century it would be hard to conceive of this as violence since it might have been quite unavoidable, but if he dies from it today, despite all the medical resources in the world, then violence is present according to our definition. If resources are monopolized by a group or class or are used for other purposes, then the actual level falls below the potential level, and violence is present in the system(Galtung, 1969 : 168).

By structural violence is meant those impediments to fundamental human needs that could have been removed, had the structure not been uneven. Structural violence therefore can be defined as the following:
avoidable impairment of fundamental human needs orthe impairment of human life, which lowers the actual degree to which someone is able to meet their needs below that which would otherwise be possible (Galtung, 1993: 106, cited in Farmer et al., 2006).

Farmer with others (2006) argue that, structural violence is referred as structural for the fact that, it is ingrained in those structures of social world which are composed of political and economic organizations; while it is violence because, it brings about harm. The root of structural violence lies in unequal distribution of resources. Therefore, some people benefit from the structure, while others suffer from deprivation of access. Examples of structural violence are unequal access to healthcare, education, legal services, and political power and so on (Farmer et al., 2006). The very structure, within which inequality is produced, however appears omnipresent and remains invisible. Structural violence appears normal even to its victims, for it is given such a status by the institutions of society. To Galtung (1969) structural violence remains silent and appears as natural as air around us. To what extent structural violence will cause injury will depend to a large extent on how marginal a person is within the overall structure:
The situation is aggravated further if the persons low on income are also low in education, low on health, and low on power as is frequently the case because these rank dimensions tend to be heavily correlated due to the way they are tied together in the social structure (Galtung, 1969 : 171).

Structural violence therefore, has several characteristics. Firstly, it springs from unequal distribution of power and resources within the social structure. Secondly, it hinders realization of needs to the extent that potential level is not achieved. Thirdly, it disproportionately affects people by limiting access to services, which otherwise could have been avoidable if the structure was not unequal. And finally, the inequality in social structure appears inevitable and is seen as normal. According to Farmer, the concept of inequality per se, needs to be studied from a historical as well as political economic point of view, for the choice of the individual victim is shaped and restricted by these processes (Farmer, 2004). Farmer argues:
Those who look only to powerful present-day actors to explain misery will fail to see how inequality is structured and legitimated over time. Which construction materials were used, and when, and why and how? Without a historically deep and


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geographically broad analysis, one that takes into account political economy, we risk seeing only the residue of meaning. We see the puddles, perhaps, but not the rainstorms and certainly not the gathering of thunderclouds (Farmer, 2004: 309).

Farmer applied the framework of structural violence in his study of HIV/AIDS. He argues that the limited human agency is associated with elevated risk of disease. Social arrangement such as poverty, gender inequality and racism are connected with the distribution of infectious diseases such as HIV/AIDS (Farmer et al., 2006). To Farmer:
Everyone interested in structural violence should have a particular interest in these diseases (Tuberculosis and AIDS) and in the social structures that perpetuate them (Farmer, 2004: 315).

In Haiti, the spread of HIV/AIDS was related with structural factors. Continuous marginalization of the country by colonization and imperialism gave rise to acute poverty, forcing the country to remain dependent on external aid. Agricultural production was replaced with offshore assembly and tourism (Farmer, 2004). As this happened, Haitian men started trading sex for money. The history of AIDS in Haiti therefore, is related with its long history of subjugation and poverty. A study without these historical forces will not provide a complete picture and will not be able to grasp the structural violence which results from it. In order to grasp the HIV risk of bonded sex workers of Bangladesh, the framework of structural violence has been used in this paper. Special emphasis has been given to the analysis of the process through which the bonded sex workers as a group have historically been subject to stigma, violence, and abuse. Discussions in this paper focus on finding out how the curtailment of human agency and influence of structural factors cause threat of HIV/AIDS to the bonded sex workers. Daulatdia Brothel: Multiple Layers of Vulnerability Daulatdia is one of the eighteen registered brothels of Bangladesh (Akhter, 2011). It is situated near the connecting junction of roads and waterways in Rajbari district. The brothel started nearly 24 years ago. Currently it has 257 homesteads and 1965 rooms (Hossin, 2012). Around 1,600 women and girls reside here (Zakaria,2011). Narrow passageways run across the brothel. On both sides of these are corrugated iron roofed rooms and shops. The place is crowded with sex workers and their clients, while children play in the vicinity. There are different types of sex workers in this brothel. According to Khan M. I. (2010), sex workers are of four types: Landlady (Bariwali), Tenant (Bharatia), Madam (Sardarni), and Bonded sex workers (Chukri). Whereas landladies are those who own houses in brothel premises, independent sex workers operating and living there are called tenants. Madams are female owners/managers of the brothels. They own young women and provide them with food and housing, while in return they extract their earnings. Madams are often retired sex workers. The girls who are purchased by madams are called Chukris. They are required to serve her as bonded sex workers (Ara, 2005). The bonded sex workers remain at the bottom of the power structure of the brothel. They are mainly under-aged; and sold to at around 30,000 taka on average to their madams.

Understanding the Risk of HIV/AIDS among Bonded Sex Workers from a Structural Violence


The primary motive of the madams is to recover their costs which they incur on buying young girls and providing regular bribes in arranging false affidavit. Their next focus is to generate profits as much as they can, for prostitution is associated with risks, which range from police raids to elopement of the Chukris. Also, there is always the threat of eviction from power holders and the likelihood of deterioration of the beauty of their bonded girls. In order to minimize these risks, madams overwork the bonded girls as much as they can, so that they do not incur loss in the long run. The income of a Chukri, per day remains around one thousand taka. Therefore, if the costs of food, shelter, cosmetics and medicine are regarded constant, it takes thirty days for a madam to recover her cost. Madams also need to maintain connection with their political patrons and the government administration, which often is maintained by regular payments. Furthermore, madams keep liaison with pimps so that they can have regular supply of girls. In order to prevent the runaway of the bonded sex workers, madams often keep musclemen. Within this power structure, the mobility of the Chukris is restricted. In cases of disobediences, they suffer physical and verbal abuse; and often are forced to go without meals. Their choice is further restricted by lack of legal support. Reshma, a bonded female sex worker, who was tricked by her neighbor and sold at the brothel, says:
Earlier I used to cry a lot. I was sold at the brothel by my boy friend. I have tried to escape several times, but got caught and suffered severe beating and verbal abuse by madam and her men. But once, I succeeded to run away and went to the police to report my violence. The police officer said that it was my fault that I did not listen to the madam. I should listen to her to avoid getting beaten up and then I was handed over back to madam. She wants me to serve as many clients as possible. I dont even get rest when I am sick.

An example of curtailed human agency can be found in the above case study. The choice of the girl is restricted because of lack of legal support. This reflects the vulnerability of women in a patriarchal state where powerlessness of women is reinforced and reproduced by lack of legal action. The attitude of the law enforcing agency reflects the dominant view of society which does not provide any space for sex workers within it , for they have already stepped into the immoral space .It also manifests structural violence because the sex worker is forced to go back to the life of bonded slavery which she has not willingly chosen . The feminist groups, who are supporters of pro-sex work view, argue that sex work should be seen as a willingly chosen occupation (they do not include trafficked women in this conceptualization) while sex workers should be regarded as human beings with agency rather than passive victims; fails to incorporate the limited choice of the bonded sex workers. NGOs working on trafficking of women and children as well as human rights organizations such as Bangladesh National Lawyers Association and Ain O Salish Kendra work on this issue and have taken part in rescuing victims (Karim, Selim, and Rashid, 2008). These efforts however, have done very little to challenge the overall power structure of the brothel. Brothels continue to run as sex industries where demand for new girls always prevails. The obstructed agency of the bonded sex workers results in feeble negotiating power. Their dependency over their madams and the power structure of the brothel in general,


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creates conditions for sexual, psychological and physical abuse and causes disproportionate risk of HIV/AIDS. The question, which needs to be answered at this juncture, is to what extent these violence are structural and to what extent these are personal. Galtung (1969) distinguishes between personal and structural violence. In personal violence, a subject-object relationship can be established, while in structural violence this relationship is absent. Thus, the violence that the bonded sex workers suffer, may appear personal, for a clear subject-object relationship can be found here. But a careful evaluation will reveal that this is also structural, for structural violence shows up through unequal power relations. As Galtung argues:
..When one husband beats his wife there is a clear case of personal violence, but when one million husbands keep one million wives in ignorance there is structural violence (Galtung,1969 : 171).

Therefore, in the case of bonded sex workers, inequality in power relations gives rise to a systematic disadvantage. Even though madams, pimps or goons as person directly harm these women, this injury to a large extent is the result of the structure of inequality which have historically been rooted in the brothel based bonded slavery and applies equally to all the bonded sex workers. The structure perpetuates and constrains agency and thereby curtails their ability to protect themselves. Associated with structural violence is the risk of HIV/AIDS. The question is not so much about why sex workers as a category suffer from risk of HIV/AIDS, but about why bonded sex workers are more at risk than other sex workers and why is it harder for them to defend these risks and why is it difficult for them to avail medical services compared to others? Structural violence explains how inequality and stigma results from the institutionalized social structure that lowers the level of actual fulfillment of their health needs below what is desirable (potential). Within the brothel setting, madams exercise control over the bonded sex workers. The informants narratives show that, keeping a good relationship with madams is important, for it determines whether the sex worker will be treated with sympathy or as a profit generating machine. Madams often own several bonded girls. Competition regarding who has more demand in the market determines their importance to their madams. How well a bonded sex worker will be treated by her madam depends on her ability to attract and entertain customers, and her capacity to increase madams earnings. Failure to do so leads to lowering of status which in turn renders the sex workers into valueless entities. As Protima says:
I have been detected with disease. I cannot choose my clients which independent sex workers can. I have syphilis. Madam told me to keep it a secret. When my body fails to serve customers, madam forces me to do household chores and serve other Chukris under her. If you cannot serve customers, you have no value to your madam.

Madams keep track of their girls income, decide how many customers to be served and choose whether condoms will be used or not. They also provide decisions on should these girls be serving during illness. Madams sometimes sell condoms to customers. The girls however often take advantage of loopholes of surveillance. As was reported by some informants, often customers who are unwilling to use condoms are allowed by bonded sex workers at the back of their madams. To Michael Foucault, power and resistance

Understanding the Risk of HIV/AIDS among Bonded Sex Workers from a Structural Violence


remain next to each other, such that Where there is power there is resistance (Foucault, 1978:95-96, cited in Mills, 2003). This concept was further developed by James Scott, who suggests that power relations are resisted by off-stage actions such as foot dragging, hidden transcript or non-compliance (Mills, 2003). In the case of the bonded sex workers the exercise of power of the madams gave rise to secret practices which in turn create further risk. Thus, the coping strategies amid unequal power relations reproduced further vulnerabilities for the bonded sex workers. When the sex workers save enough money, they become independent sex workers. This is why; madams tend to maximize their profit. Firstly, madams pay close attention in maintaining the physical beauty of their bonded sex workers. It is this physical beauty that works as a capital, for the more attractive they look, the more economic return they ensure. This is the reason why these girls are given drugs such as Oradexon, which is normally used for fattening cows, so that the sex workers look adult, bulky and attractive (BBC, 2010). Second, older girls are replaced by new ones. Those sex workers, who get older and remain no longer attractive, either accumulate resources and develop connection with power-holders and thereby become new madams; or if they lack these become domestic helps (also called Mashi). Therefore, the structure of the brothel is such that older sex workers are replaced with newer ones and the bonded sex workers by appropriating independence along with social and economic capital can move to a powerful position. Within this entire process, the power structure remains the same, while inequality perpetuates. The informants reported that the environment of the brothel is characterized with cramped living quarters, social ostracism, and is sometimes further aggravated by raids, and extortion. The occupation often requires them to serve customers beyond the level of physical tolerance. Rape and physical injury are part of their job hazard. To Kole (2009), what (such as rape and abuse) in other situations is considered as sexual harassment, in the case of prostitution; is seen as normal. Elements of structural violence can be seen here, for in structural violence, violence becomes so ubiquitous that it adopts a normalized facet. Sex workers since they have degraded themselves in exchange of honor are seen as deserving these treatments. These unfavorable structural factors in turn generate psychological aversion towards life, inducing the bonded sex workers to place lower priority on their health needs, while influencing them to place more importance on immediate survival strategies (WHO, 2005). Apart from the depression that they suffer, they feel a sense of guilt because they think that they are committing sinful act. As Chobi says:
My life is stuck in this brothel. I have lost both this life and afterlife. I was sold here by my neighbor who promised to get me a job at the garments factory. I have now lost the desire of freedom from this brothel because I have nowhere else to go. My parents wont allow me to return to them if they hear that I have become a sex worker. This is my destiny now. I have no escape other than death.

These narratives not only depict the helplessness of the informant, but also points to the negativity which is attached with their identity, such that they are not welcome back in society. In the discourse of morality, prostitution is seen as an evil. It evokes an image of danger which the sex workers pose to the moral order. Prostitution therefore is


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associated with such stigmatized terms as fallen (potita), bad (kharap), spoiled (nosto), slut (beshya), market place women (bajarer-meye) and so on (Chowdhury, R., 2006). The very structure, which constructs a negative identity of the sex workers is shaped by the moral judgement and is reinfroced by patriarchal values. To Khan and Arefeen (1989), in Bangladesh society, men are in control of resrouces which in turn place women at a subjugated position, and allow men to exercise power over women and their sexuality. Those women who breach their boundary of sexuality, are characterized as polluted and are seen as dangerous sources of contamination. The otherness of the sex workers are constructed such that, for many years brothel based sex workers were not allowed to wear shoes (Ullah,2005) or Shalwar Kameez (Ara, 2005). Even they were refused funeral rites and burial in ordinary cemeteries (Blanchet, 1996 cited in Caldwell et al. 1999; Crago, 2008). Within such an environment, sex workers find relief in addiction and alchohol. These substances are often brought along by their customers. Psychotropic drugs not only help them cope with distress , but also instigate them to transgress their sober self identities , which makes prostitution easier (Romero-Daza, Weeks, and Singer, 2003; Vanwesenbeeck, 2001 as cited in Panchanadeswaran, et al., 2008). This, in turn lowers their sense of judgement and thereby creates risk of HIV infection when they are on high. To Galtung (1969), psychological violence results when mental potentials are decreased and human actions are constrained by lies, brainwashing and even threats. Sex workers endure this psychological violence on a daily basis. Therefore, if the sex workers are less likely to have control over their bodies, and are forced to stay in such a social environment that is characterized by psychological violence, deprivation of legal support and prevalence of stigma, they will find themselves at an elevated risk of HIV/AIDS. According to Paul Farmer (2004), the roots of the disease of some disadvantaged groups of people lie more in unequal (economic) structure than in biology. What Farmer means by this is: structure creates risk of disease for the marginalized groups. Therefore to locate risk in biology (as if it is isolated from uneven structure), is to divert attention away from these inequalities which produce disease. For the bonded sex workers, the reason of their structural violence is rooted in the unequal power relations that constrain their human agency. HIV/AIDS and Structural Violence Nexus The World Health Organization (WHO) has identified sex workers as one of the four target groups of HIV/AIDS initiatives (Scambler and Paoli , 2008). In Bangladesh, a number of NGOs have been working closely with the government and the donor agencies in running HIV/AIDS prevention interventions. The programmes of the NGOs are focused mainly on two broad areas. Firstly, service delivery such as STD treatment, condom promotion and so on, and secondly, awareness creation and rights literacy. At the local level, Nari Maitree worked at Mymensingh, while PIACT Bangladesh had its programs in Daulatdia. Also, in Dhaka and Jessore, Nari Unnayan Shakti (NUS) and ACLAB Bangladesh ran their programmes among the sex workers respectively. Their key interventions range from provision of education (for children of sex workers) and creating awareness on other sexually transmitted diseases and HIV/AIDS. At the national level, international NGOs such as ActionAid , OXFAM and CARE Bangladesh along

Understanding the Risk of HIV/AIDS among Bonded Sex Workers from a Structural Violence


with national NGOS such as BRAC , Bangladesh Womens Health Coalition have programmes on similar areas such as advocacy, awareness on rights and HIV/AIDS, schooling for children of the brothels and provision of health care (Karim, Selim, and Rashid, 2008). Furthermore, influenced by the hegemony of rights based approach at the global level, international development agencies like CARE Bangladesh, CONCERN, Save the Children Australia initiated programmes on capacity building and empowerment of sex workers (Chowdhury, R., 2006). CARE Bangladesh organized workshops where sex workers from different countries took part and learnt about human rights issues. Motivated by these, the floating sex workers formed their own organization-Durjoy Nari Shongho (Crago, 2008), which later started working on HIV/AIDS issues on its own. The 3rd National Strategic Plan for HIV and AIDS Response 2011-2015 identifies the sex workers and their clients as most at risk population, and suggests a comprehensive service package which includes distribution of condoms/lubricant, behavior change communication, STI diagnosis and treatment, Voluntary Counseling and Treatment (VCT), Prevention of Parent-to-Child Transmission (PPCT), Assessment of need and referral to health (e.g. TB and hepatitis B and C) and other services (e.g. legal services) along with Community mobilization. The NGOs operating on HIV/AIDS promote condom use through peer educators and offer STI management services. In Daulatdia, programs on HIV prevention includes satellite clinic based treatment of STDs, training of peer organizers to create awareness on sexually transmitted infections and condom use, literacy of human rights along with advocacy. These efforts hardly reached the bonded sex workers directly, for their mobility was restricted. Health care seeking behavior of these girls depended not on needs, but on the willingness of their madams. The informants reported that the madams are more concerned over their immediate return than future risk of HIV/AIDS. This is because of the fact that they cannot keep bonded sex workers forever; rather Chukirs are their short term investment. Madams fear that movement of bonded sex workers outside the brothel premises will give them the sense of independence, and lower their control. In times of illness and when abortion is required, madams take their girls to those practitioners who have remained their trusted partners. These are the unregistered doctors and pharmaceuticals which serve in the vicinity of the brothel (Ara, 2005). Treatment in registered hospitals is far from achievable. A number of factors are associated with this. Firstly, sex workers are often refused treatment in these hospitals. They are also likely to endure harassment from the public. Secondly, they are often overcharged in public hospitals (Ara, 2005). This is done on the ground that treatment of sex workers might avert regular customers because sex workers are seen as bearers of contagious disease. It is feared that, the hospitals that provide service to the sex workers do not sterilize their equipments properly, which in turn might transmit infections to general population (Sethi and Jana, 2003 cited in Akhter,2011). Some NGO clinics provide care for sexually transmitted infections, but do not offer a comprehensive healthcare package. To understand what is at stake, a far broader appreciation of the meaning of threat is required. Prostitution is far more than providing sex in exchange of money. It is the only means of survival for the sex workers and the key to uphold social standing within the


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brothel. For most of the madams, availing STD management services represents a threat to their business, for it publicly affirms disease status. It is rather practical for them to hide such infections. Within the closed culture of the brothel, information on what to do about a particular disease is passed on from peer to peer.
I am sixteen. My customers range from two to ten per day. I am young, customers come to me. This is because of my age. My demand will reduce as I get older. My madam earns a good amount of money by using me. She earns more than five times the amount that other older sex workers earn. Madam is cautious about my beauty. I take regular pills to avoid pregnancy. I am not allowed to go outside this brothel premise. If I get sick, I tell madam, often I ask other girls for advice. Madam tells me to keep my sickness secret and not to reveal it because it will reduce the number of customers and other sex workers will maximize on it.

Within the competitive setting of the sex industry, disclosure of disease has the risk of diverting customers. Furthermore, NGO run programs lack sustainability and are often run in bits and pieces, while sex workers are required to stay in the brothel premise for years. The open disclosure will therefore not only hamper their business, but also lead to a lowering of status. They will be left to endure their sufferings alone. Madams response to these programmes can therefore be seen as a calculative business strategy. Furthermore, while the threat to their earnings and their standing appears to be realistic, the risk of HIV/AIDS is rather vague. Therefore, the ideology that governs the behavior of the madams is grounded on practical considerations of survival and control. The threat of HIV/AIDS conflicts with this. Thus, minimization of risk of HIV/AIDS calls for an understanding of how threat per se is conceptualized by the brothel dwellers and how it is influenced by the overall structure within which the threat of loss of income appears more palpable than risk of HIV/AIDS. The very structure of the brothel shows that power remains in the hands of some people, who in turn, control the human agency of the bonded sex workers. The structural violence that the bonded sex workers face not only comprises of the power relations of the brothel, but it also results from the normative aspect of society that stigmatizes them with negative judgement. Had relations of power been equal, and had sex workers been not seen as outcastes in society; their risk of disease could have been avoided. These are the conditions which Galtung refers as social injustice (Galtung, 1969). The structural violence of the bonded sex workers therefore springs from the very structure which disadvantages them through unequal distribution of power. Locating Bonded Sex workers within the Policies on HIV/AIDS The vulnerability of the bonded sex workers is hardly addressed in the policy documents. In fact, the very term prostitution did not literally exist in official records of the country for a while. Sex workers have been grouped under unskilled non-agricultural labors and beggars in the census records of 1901 and 1911 respectively. They were however categorized as prostitutes under the miscellaneous column in the 1911 census. In the Bangladesh period, they were ignored completely in the censuses carried out during 1974-1989 (Khan and Arefeen, 1989). In the public documents of the government, they

Understanding the Risk of HIV/AIDS among Bonded Sex Workers from a Structural Violence


have been termed as socially deprived women, socially handicapped women and women in moral danger (Tahmina and Moral, 2000; Kabeer, 1989) cited in White, 1992). It was only in the 1990s that the term prostitution became part of the public discourse. This was due to the movement of the sex workers in the 1990s and their rising importance as target groups in the public health programmes. Therefore, the history of prostitution in Bangladesh remained untold on moral grounds. Within this process of erasure of history, the vulnerability of the sex workers can be identified. But ironically, when they gained attention within the media and in the literature of donor agencies, they found themselves constructed as the vectors of HIV/AIDS. As the sex workers, through their movement, demanded recognition of their occupation as a work, the phrase prostitution got replaced with the term sex workers. Also, the influence of several factors such as growing importance of human rights and emergence of rights based approach in the development discourse facilitated the use of the term sex work in the official documents of the Global Programme on AIDS and accordingly came into common usage (Ditmore, 2006). Within this discourse, the bonded sex workers did not have any space and therefore, remained absent. The National Policy on HIV and STD related issues identifies two types of prostitution, i.e., brothel based and floating. The reasons cited for HIV infection were lack of knowledge, intercourse with already infected clients, lack of use and unavailability of condoms, number of sex partners and so on. It recognizes the feeble power of the sex workers in condom negotiation with their clients. It also points out that unless sex workers are empowered to decide their working conditions, and are able to come out of their low self esteem, risk of HIV/AIDS will prevail. The policy regards abolishment of forced prostitution as a long term goal. Within this policy, the power relations which shape the lives of the bonded sex workers have not been highlighted. The only power relation it mentions is the one that exists between a client and a sex worker. The erasure of the bonded sex worker from this policy document plays a great part in obscuring their vulnerability. The 3rd National Strategic Plan for HIV and AIDS Response (2011-2015), identifies four broad categories of sex workers, i.e., street based, hotel based, residence based and brothel based along with male sex workers and Hijra sex workers (NASP, n.d). Among the recent interventions, the HIV/AIDS Targeted Intervention (HATI) covering the period of 2008-2009; and the Bangladesh AIDS Programme (BAP) from 2005 to 2009, focused on targeting all these categories of sex workers. Female sex workers were also target groups of the GFATM Round six. Even in these policies and programmes brothel based sex workers have been overlooked. The 8th round surveillance report of the government of Bangladesh reported HIV prevalence in 15 cities and small border towns and revealed that overall the rate of HIV/AIDS remained at 1 % in all places; but in the frontiers it was 2.7% (Azim. T. et al, 2009). Data on HIV/AIDS of the bonded sex workers were not specified. The 9 th round of serological surveillance report included data on hotel based, street based, casual and residence based sex workers, but provides no information on brothel based sex workers; let alone bonded sex workers (NASP, 2011). All the policy documents, however agree on the issue that sex workers are one of the risk groups. The National Policy on HIV and STD related issues states:


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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, Para-6).

The policies therefore, identify sex workers as dangerous sources of contamination. It is epidemiologically reported that presence of multiple sex partners is one of the causes of HIV/AIDS transmission. Within this discourse, sex workers are seen as the vectors, because they are regarded as having indiscriminate sexuality and their occupation requires them to serve multiple men. This explanation however has another risk; i.e., sex workers themselves can find themselves at a higher risk of HIV infection from the already infected clients (Sacks 1996). These policies ignore the obstruction of human agency that the bonded sex workers endure in the brothel environment. The behavioral change interventions of the HIV/AIDS programmes fail to take these structural factors into consideration. In order to address these issues, a risk environment framework of HIV risk analysis is being proposed by some scholars such as Tim Rhodes (Rhodes et. al.,2005). This framework traces risk within the interaction between environment and individual behavior (Bronfenbrenner, 1979; Rhodes, 20 09; Rhodes, Singer, Bourgois, Friedman, and Strathdee, 2005; Shannon, Kerr et al., 2008 as cited in Goldenberg et. al., 2011). If such a framework is undertaken it can reveal that the risk of HIV/AIDS is not only produced within the unequal distribution of power, but also emerges from sex workers stigmatized identity, exploitative economic relationship and unsupportive legal framework. Therefore, the risk of HIV/AIDS has its roots in the brothel structure and the judgmental social environment which in turn affect bonded sex workers disproportionately. Conclusion In this paper, the framework of structural violence has been used to analyses the disproportionate risk of HIV/AIDS of the bonded sex workers. When social structure limits agency and power relation obstructs autonomy over body, a gap is created between what is actually achieved and what could potentially have been realized. This is obvious in the case of the bonded sex workers. In this paper, after an examination of the nature of power relations surrounding the bonded sex workers, it was shown that, the risk of HIV/AIDS of the bonded sex workers remain within their curtailed human agency. This in turn results from the unequal distribution of power which springs from the power structure of the brothel and the normative structure of society. The bonded sex workers, as a category has neither been identified, nor been addressed in the policy documents. In fact, historically the use of the term prostitution has been avoided. It was only in the 1990s that the influence of global HIV discourse and the movement of the sex workers in Bangladesh brought about the issue in public discourse. The term prostitution was eventually replaced with the term sex worker to emphasize the work related aspect of it. As such, the policy documents of the government and research reports of the donor agencies and NGOs identified sex workers as a target group and suggested behavioral change interventions. What these documents have failed to address was the power relations within the brothel which gives the madams control over the bonded sex workers. HIV/AIDS prevention interventions such as condom promotion and STI management

Understanding the Risk of HIV/AIDS among Bonded Sex Workers from a Structural Violence


services could not address the risk of the bonded sex workers, for the power structure of the brothel was not taken into consideration. This is why, these interventions have not been able to address the psychological depression, economic exploitation and every day forms of violence that the bonded sex workers go through. In order to grasp the real risk of the bonded sex workers, attention should be given to those structural factors that curtail their human agency and give rise to structural violence. References
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