I awoke to the sound of a mosquito buzzing near my ear. It was still dark out, and I could see the stars from my window, a rare sight in India when you are in the city.
I, however, was at least a few hours from the nearest one. To be honest, I wasn't quite sure where I was as I was never given the address or directions, having been transported by a private car from Hyderabad, one of India's bustling tech hubs. I was spending a few days at the Prajwala facilities, a compound of several acres hidden away in the outskirts of a small town in rural Andhra Pradesh.
Prajwala (meaning "bright" in Sanskrit), a nonprofit headed by Dr. Sunitha Krishnan, is home to hundreds of women and girls rescued from brothels around India to aid in treatment for rehabilitation and reintegration.
Several months later, I would find myself thousands of miles away, walking through the small alleyways inhabited by the women of the Perna community, a tribe that practices sex work as tradition in many states and territories throughout north India, including Delhi, Haryana, Punjab and Rajasthan. Unlike the women at Prajwala, these women live at home with their own families but are prostituted by their mothers-in-law and husbands. Their husbands or other men in the community drive a group of women to well-known prostitution areas in the town between 12 a.m. and 6 a.m., where they meet customers. The mother-in-law collects the money at night's end.
It is unknown how many Pernas are sex workers today, but there are at least several hundred whom I met through my research. While they may face sexual violence, emotional abuse, and physical assaults from clients, just like women who practice prostitution in brothels, there are distinct differences in their attitude toward the work.
Global estimates suggest that upward of 4.5 million people are exploited in sex trafficking, with India one of the largest hubs. As a researcher studying the psychological and medical effects of sex trafficking and exploitation, I had the opportunity to speak to women who had a variety of experiences. I learned quickly that India's sex trade is a complex world filled with stories of struggle, independence, tragedy and empowerment. At the center of it, I found the voices of individual women fighting for their rights — and the fundamental desire to be heard and respected.
Walking into the several acre, rural compound of Prajwala, I could feel the severity of what was at stake. The facility, funded by several international donors, is surrounded by 20-foot high walls with barbed wire atop; its address is not publicly listed. Dr. Krishnan explained that this level of security was needed for the safety of the women who had been rescued. On many days, traffickers would arrive unannounced, likely having found the compound by following Prajwala's workers from the city. They'd try to lure the women to escape.
What is surprising is that a number of women wanted to go back to their previous life as a prostitute.
One woman who had been rescued in a brothel raid in Bombay shared her rationale: "I have problems at home — my husband left me. That's why I am in this profession. I did it only for my two children ... I was caught." For this woman, and many others, their financial earnings allowed them to support her children back in the village.
While many women in India's sex industry are kidnapped and trafficked when they are still children, a number are sex workers who choose to go into the profession because of financial hardship. They may work according to their own hours and dates, essentially renting space in a brothel. Unlike those in child trafficking, many of them are in their mid-30s when they become sex workers. For these women, being held at an NGO for their "own protection" was not particularly appreciated. But most of them would not have the option to leave until their court hearing to determine if they were trafficked or being held against their will.
Nonetheless, while the women themselves saw the economic benefit of their work, Dr. Krishnan and many in the anti-trafficking community are concerned with the exploitative nature of the profession. The goal at Prajwala is to help all women in the sex trade regain economic and psychological independence. But doing so is undeniably complicated.
For many women, the rehabilitation efforts are immensely useful, but there are a few for whom returning to the sex trade is the preferred option.
My experience with the Perna, a tribal group spread out throughout Northern India in which wives practice as sex workers, was almost entirely different. The Perna were migrants affected by the British Criminal Tribes Act of 1871, which forced tribes to abandon their work in trades like snake-charming and street acrobatics. This was largely because these types of professions did not conform to the British idea of "civility." With little way to make money, the women began working in the sex trade, a practice that continues openly today. "This is our traditional work. We have always done this work," explained one elderly Perna woman.
In my research with the Perna, I found that these women believed that sex work was their duty and tradition. But some younger Perna women have come to question the fairness of this idea, given that most men in the community did not work and squandered money on alcohol and gambling
I came away from these two research visits with a new understanding of the complexity of sex work, of how there is a thin line between empowerment and oppression. There were sex workers who found their profession to be a valid way to make their way in the world. And there are some who argued that keeping women in NGO facilities for rehabilitation against their will is exploitation.
Women in the Perna community told me that to criticize what they were doing was unfair when other women in the community were sexually unfaithful to their spouse. Members of the public agreed: "This happens in regular people's homes too. A woman sleeping with a neighbor's husband" reasoned one man who lived near the Perna community.
We must be conscious of how we judge women who are in the sex trade, because each story is complicated and nuanced. And they all need immense courage to get through every day.
As a doctor, I felt that the women in both NGO facilities and those in the Perna community were in true need of health care services — sexual health interventions, family planning support, mental health support and primary care.
And I learned how we are failing these women by focusing too much on the sexual nature of their work rather than seeing them as people with basic needs for survival. When one Perna woman was asked if she knew about HIV or using condoms, she responded, "No one has told us about this at all."
Abraar Karan is a physician and public health researcher at the Harvard T.H. Chan School of Public Health. He has worked on global health endeavors with marginalized populations in Asia, Latin America, and Sub-Saharan Africa. Contact him @AbraarKaran