Answer

UNAIDS and the World Health Organisation define sex workers as “female, male and transgender adults aged over 18 years who sell consensual sexual services. In 2022, the Supreme Court recognized sex work as a profession, emphasizing equal protection and dignity for sex workers under Articles 21 which was passed after using special powers under Article 142 of the Constitution.

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Reasons for Mental Health Challenges 

• Societal Rejection: Despite legal recognition, pervasive social stigma alienates sex workers, leading to depression and anxiety. Their work is often conflated with immorality, fueling discrimination.
  For example: NGO DURBAR’s film-project, Tales of the Night Fairies, records the life stories of sex workers in West Bengal’s slums, highlighting their struggles against social stigma.
• Exposure to Violence: Frequent physical, emotional, and sexual violence leaves sex workers with post-traumatic stress disorder (PTSD) and chronic anxiety.
  For instance: A global review in 2014 identified a prevalence of physical, sexual, or combined workplace violence against women sex workers—from 45% to 75%.
• Economic Insecurity: Irregular income and lack of social security deepen financial stress, directly impacting mental well-being.
• Trafficking Trauma: Many sex workers, especially trafficked individuals, experience severe psychological distress, including depression and suicidal tendencies.
• Healthcare Barriers: Fear of judgement and lack of access to mental health services discourage sex workers from seeking medical support.

Intersection of Social Stigma, Economic Vulnerabilities, and Healthcare Access

Social Stigma

• Exclusion: Stigma alienates sex workers from society, depriving them of community support.
  For instance: The Sex Workers Project’s 2009 report shows how brothel raids often lead to public exposure of sex workers, resulting in their isolation from families and communities.
• Education Barriers for Children: Stigma extends to children, affecting their access to quality education.
  For example: Children of sex workers in Mumbai’s Kamathipura often face bullying in schools, forcing many to drop out prematurely.
• Institutional Discrimination: Sex workers are often denied housing and other essential services due to societal judgement.
• Limited Job Mobility: Due to societal prejudices, sex workers face challenges in transitioning to alternate careers.

Economic Vulnerabilities

• Irregular Income: Dependency on client availability creates income uncertainty, causing chronic financial stress.
• Exclusion from Social Welfare: Lack of formal identification often excludes sex workers from government welfare programs.
• Debt Cycles: Many sex workers rely on informal loans with exploitative terms, trapping them in debt.
  For example : A study Street Corner Secrets: Sex, Work, and Migration in the City of Mumbai, reveals how rural migrants in Mumbai’s slums are drawn into exploitative debt cycles to survive in the city.
• Exploitation by Intermediaries: Pimps and brothel managers often take a significant share of sex workers’ earnings.
  For instance: In some cases, intermediaries may take up to 50% of a sex worker’s income, leaving them with minimal earnings.

Healthcare Access

• Stigma in Healthcare Settings: Discrimination by medical professionals deters sex workers from seeking necessary care.
  For example: Sampada Grameen Mahila Sanstha (SANGRAM) NGO adopts a rights-based approach, promoting insider community participation to develop non-intrusive healthcare models that ensure dignified and stigma-free medical access for sex workers.
• Limited Access to Sexual Health Services: Services often focus on HIV prevention, neglecting broader health needs.
  For example: According to the National Network of Sex Workers (NNSW), instances have been reported of pregnant sex workers being denied admission to hospitals, forcing them to seek unsafe alternatives for delivery.
• High Out-of-Pocket Expenses: Lack of affordable healthcare options forces sex workers to bear high treatment costs.
• Mental Health Neglect: Most health initiatives for sex workers fail to address mental health challenges.

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Comprehensive Policy Measures

• Inclusive Welfare Programs: Extend social security schemes like pensions, insurance, and housing to sex workers.
  For example: In 2016, a rehabilitation program under the Davis Peace Projects Award was implemented to support homeless and trafficked individuals living at railway stations in Cuttack and Bhubaneswar.
• Legal Reforms: India should come up with a constructive law or amendment to the Immoral Traffic (Prevention) Act of 1956 governing the act of prostitution which should deal with forced prostitution and wilful prostitution differently.
• International efforts : The Palermo Protocol adopted by the UN General Assembly in November 2000 serves as a supplement to the UN Convention against Transnational Organized Crime to prevent crimes, protect and assist victims of human trafficking.
• Healthcare Integration: Provide stigma-free, affordable healthcare, including mental health services, through dedicated programs.
  For example: NACO’s community clinics have improved HIV management for sex workers.
• Skill Development and Livelihood Support: Offer vocational training to diversify employment opportunities for sex workers.
• Awareness Campaigns: Conduct nationwide campaigns to combat stigma and promote acceptance of sex work.
  For example: Brazil’s “Red Umbrella” initiative raised awareness and improved societal perceptions of sex workers.

India must adopt global best practices like New Zealand’s Prostitution Reform Act and SEWA’s inclusive welfare models to ensure the dignity and well-being of sex workers. Aligning these measures with SDG-10 (reducing inequalities) will create a pathway for their holistic inclusion and empowerment.

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