Sex work and HIV/AIDS-related stigma in Bangladesh Rehana Akhter A Thesis in The Department of Special Individualized Program Presented in Partial Fulfillment of the Requirements for the Degree of Master of Arts (Special Individualized Program) at Concordia University Montreal, Quebec, Canada September 2011 © Rehana Akhter, 2011 CONCORDIA UNIVERSITY SCHOOL OF GRADUATE STUDIES This is to certify that the thesis prepared By: Rehana Akhter Entitled: Sex work and HIV/AIDS-related stigma in Bangladesh and submitted in partial fulfillment of the requirements for the degree of Master of Arts (Special Individualized Program) complies with the regulations of the University and meets the accepted standards with respect to originality and quality. Signed by the final examining committee: Chair Dr. David Howes Examiner Dr. Peter Stoett Examiner Dr. Eric Shragge Examiner Dr. Maria Nengeh Mensah Thesis Supervisor Dr. Viviane Namaste Approved by Dr. D. Howes, Graduate Program Director September 2, 2011 Dr. Graham Carr, Dean School of Gradute Studies ii ABSTRACT Sex work and HIV/AIDS-related stigma in Bangladesh Rehana Akhter This paper explores the stigma surrounding HIV/AIDS and sex work and its effect on female sex workers in Bangladesh. In order to identify the roles of two sex worker organizations (Durjoy and Nari Mukti) and to develop the recommendations for them, I conducted my MA thesis in Bangladesh in 2009. In Bangladesh, there is a need for more research on social issues related to HIV/AIDS. Hence, this study’s exploration of both stigma and AIDS issues is valuable. To collect information on these issues, I interviewed eight individual sex workers and conducted six focus group discussions; in total there were 39 participants. I also conducted ethnographic field observations in a brothel and four drop-in-centres (DiC) for sex workers. I developed two case studies of individual sex workers, who experienced severe stigmatization due to their work and the misconceptions surrounding the transmission of the HIV virus. I also interviewed an HIV positive man to identify the marginalized position of people living with HIV/AIDS (PLWHA) in Bangladesh. I used content analysis and qualitative descriptive methods in order to analyze my data. I concluded that sex work and HIV/AIDS issues are highly stigmatized in Bangladesh and offered the participants’ recommendations and my own for enhancing the organizational capacity of Durjoy and Nari Mukti to fight stigma and promote human rights for sex workers. I presented possible implementation strategies for these recommendations for the organizations as well as their partner NGOs and the government of Bangladesh. The findings might be helpful for the sex worker organizations in order to ensure social justice for their members. iii ACKNOWLEDGEMENTS I would like to acknowledge the many contributions of my supervisors (Viviane Namaste, Eric Shragge, and Peter Stoett) for their strong support, thoughtful suggestions, encouragement, and guidance throughout this project. I owe Ruth Stanton (a learning specialist at Concordia) and a group of writing assistants at Concordia, a huge debt of gratitude for editing my work. Their suggestions helped me express my thoughts. Next, I would like to thank the vulnerable and marginalized sex workers and people living with HIV/AIDS in Bangladesh and the staff of the NGOs who allowed me to interview them in order to conduct this sensitive study. I would also like to express my heartfelt gratitude to my friends Mahmud, Kalam, Mashihur, Allysha, Sibona, and Tareque, whose valuable suggestions and cooperation encouraged me to proceed. Finally, I am in debt to all of my family members, who encouraged me to complete my study. Special thanks go to my son, Rohan Mahbub, and my niece Farhana Mustafa, who always showed their patience and extended their support as I worked on this project. I highly appreciate all of the time and dedication that all of you have put into my work. It is true that without your support I would have been unable to complete my work. iv TABLE OF CONTENTS Introduction 1 The statement of the problem 5 The purposes of the research 6 The theoretical framework 6 The definition of terms 8 Stigma 8 Human Rights 9 The human security approach 10 Community 10 Community organizing 11 Sex work community 12 Sex worker organizations 13 Community development process 13 Chapter 1 The problem 14 1.1 The background of Bangladesh 14 1.2 The political system 14 1.3 The socio-economic situation 15 1.4 Poverty 16 1.5 Health care services 16 1.6 Women’s position 17 1.7 Sex workers’ issues 18 1.8 Sex worker organizations 19 v 1.9 Brothel-based sex work 20 1.10 Street-based sex work 21 1.11 HIV/AIDS issues 22 1.12 Stigma related to HIV/AIDS and sex work 24 1.13 Human rights for sex workers 26 1.14 Community organizing processes of the SWOs 26 1.14.1 About Durjoy 27 1.14.2 About Nari Mukti 27 1.14.3 About the SWNOB 28 1.15 Conclusion 29 Chapter 2 Literature review 32 2.1 Social theory 33 2.2 Reports by Human Rights Watch 34 2.2.1 Abuse by the police in India 35 2.2.2 Abuse by the police in Bangladesh 36 2.3 Survey findings about abuse by the police in Bangladesh 37 2.4 Research on feminist ideologies 38 2.5 SWOs to fight against discrimination 39 2.6 Sex workers’ vulnerability 40 2.7 Sex workers’ children’s rights and the international child rights 40 2.8 Lack of access to health care for sex workers 41 2.9 HIV/AIDS and sex work-related social issues 41 2.9.1 Sex work and HIV/AIDS 41 2.9.2 HIV/AIDS status in Bangladesh 42 vi 2.9.3 HIV/AIDS issues in Bangladesh 43 2.9.4 Sources of HIV/AIDS-related stigma 43 2.10 Research on partnership and feminist models 44 2.10.1 The “standpoint” theory and the ruling power 44 2.10.2 The dominating power and sex workers’ resistance 47 2.11 Human rights, gender, and poverty 48 2.11.1 Human rights, gender, and poverty 48 2.12 Community organizing processes and development 50 2.12.1 Study of activism and community organizing 50 2.12.2 Community organization 51 2.12.3 The democratic capacity building process 51 2.12.4 Community organizing against oppression 52 2.12.5 Models and theories of community organization 52 2.12.6 Social action and legalization 54 2.12.7 Community organizing and social movements 54 2.12.8 Community organizing practices 54 2.12.9 Community organizing for social change 55 2.13 Conclusion 56 Chapter 3 Methodology 61 3.1 Qualitative descriptive research method 62 3.1.1 Nature of a descriptive qualitative method 63 3.1.2 Characteristics of a descriptive qualitative method 64 3.2 Qualitative versus quantitative methods 66 3.3 The pre-test sessions 66 vii 3.4 Data collection procedures 67 3.5 Data collection through focus group discussions 68 3.5.1 Advantages 69 3.5.2 Disadvantages 69 3.5.3 General overview of focus group questions 70 3.5.4 Specific overview of focus group questions 71 3.5.5 Reasons for using focus groups 71 3.6 Differences between focus groups and individual interviews 72 3.7 Data collection through face-to-face interviews 73 3.7.1 General overview of face-to-face interview questions 73 3.7.2 Different types of face-to-face interview questions 73 3.7.3 Specific overview of face-to-face interview questions 74 3.7.4 Reasons for using individual interviews 74 3.8 Data collection for developing case studies 75 3.8.1 Advantages 75 3.8.2 Disadvantages 75 3.9 Data collection through ethnographic field observations 76 3.9.1 General overview of ethnographic observation questions 78 3.9.2 The ways I conducted ethnographic field observations 78 3.9.3 Reasons for using ethnographic field observations 79 3.10 Data management procedures 80 3.11 The structure of questionnaires 81 3.12 Sampling method 82 3.12.1 Stratified sampling 83 viii 3.12.2 Purposive sampling 83 3.13 Research variables 84 3.14 Research reliability and validity 84 3.14.1 Research reliability 84 3.14.2 Research validity 85 3.15 Data analysis procedures 85 3.15.1 Focus group data analysis 86 3.15.2 Data analysis of the ethnographic field observations 87 3.15.3 Face-to-face interview data analysis 87 3.16 The content analysis approach 88 3.16.1 Advantages of content analysis 89 3.16.2 Disadvantages of content analysis 89 3.16.3 Basic elements of content analysis 90 3.17 Usefulness of social research and other research models 90 3.17.1 What is social research? 90 3.17.2 The action-based social research 91 3.17.3 The research models that I used 91 3.17.4 The feminist action-based research model 92 3.17.5 Participatory action-based research model 93 3.17.6 Partnership-based research model 94 3.17.7 Community-based research model 96 3.18 The research participants 98 3.18.1 Roles of partner NGOs 98 3.18.2 Gender issues 99 ix 3.18.3 Potential risks attached to the study 99 3.18.4 Potential benefits from the study 99 3.19 Ethical issues 100 3.20 Research on culturally sensitive topics 101 3.21 Knowledge transfer 102 3.22 The limitations and assumptions 103 3.23 Conclusion 104 Chapter 4 Results and discussions 107 Basic socio-demographic information of sex workers 108 4.1 Information on prostitutes’ socio-demography 109 4.1.1 Age and length of service 109 4.1.2 Income, expenditure, and savings 110 4.1.3 Marital status 111 4.1.4 Number of children 111 4.1.5 Educational status 111 4.2 Information on executive members of Durjoy and Nari Mukti 112 4.2.1 Age 113 4.2.2 Length of service 113 4.2.3 Income, expenditure, and savings 113 4.2.4 Marital status 114 4.2.5 Number of children 114 4.2.6 Educational status 114 4.3 Information of the non-members of the SWOs 115 4.3.1 Age 115 x 4.3.2 Length of service 115 4.3.3 Marital status 116 4.3.4 Number of children 116 4.3.5 Educational status 116 4.3.6 Income and expenditure 116 4.4 Information on members of the SWOs 117 4.4.1 Age 117 4.4.2 Length of service 118 4.4.3 Marital status 118 4.4.4.