Prostitution or commercial sex work, the practice of providing sexual services in return for payment, is one of the oldest professions of the world. Every civilisation mentions the presence of prostitution in some form in their respective literature. Moreover, with the change of time, the face of prostitution has changed a lot with varied consequences. The commercial sex workers have moved out of a confined wall of brothels to streets so as to attract customers. Sex work as a profession is not a natural choice for the most sex workers but they are put into the profession either by force, human trafficking, or are victim of economical or social injustice. However, research advances in this field, though not new, has been very scant. The present study attempted to study the consequences of sex work in terms of perceived stress, loneliness and wellbeing. A total of 115 active female commercial sex workers from different cities of India were requested to participate in the present study. Measures of Perceived stress, loneliness and PGI wellbeing was used to get the responses from the respondents. Using a 2 (level of age) x 3 (levels of number of clients per day) factorial design results were achieved. The ANOVA results indicated a significant effect of number of clients on the measure wellbeing. However, only interaction of age and number of clients was found to be significant on the measure of perceived stress among the commercial sex workers. Furthermore, main effects were not found to be statistically on the measure of loneliness. In addition, correlation results indicated a negative relationship between number of clients per day and well being. Interestingly, a negative correlation between perceived stress and age of the respondents suggesting aging relives from stress arising out of the profession was observed. The measure of loneliness revealed no relationship between any of the measure under study. The results have been interpreted and implications have been discussed the light of available literature and contemporary theoretical approaches.
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Introduction
Prostitution is widely described as the world's oldest profession. Prostitution, the practice of selling sex for cash or other immediate compensation, has existed across cultures and times from the ancient Greeks, through religious servitude, to today's sex scandals that have rocked several countries. Prostitution also crosses class lines, from the poor 'streetwalkers' with their stereotyped drug habits and abusive pimps to the high-class brothel and escort service workers with their designer clothes and stylish apartments.
While the prostitute technically sells a service, namely sexual intimacy, the ways in which prostitution is discussed suggest that, at least to modern sensibilities, she is selling far more than that. Common euphemisms for prostitution in English include 'selling her body' and 'selling herself', conflating the body and the self with sexual intimacy indicates that sexual intimacy both defines and controls the body and the self.
Buyers of sex are not restricted to any one class or clan; however, throughout the world mobile populations of men form a large proportion of sex consumers. Transport workers, seafarers, businessmen and men who are separated from their families and communities either by migration or by joining the armed forces are regular clients. Nevertheless, sex work remains criminalized in many countries and sex workers are subject to human rights violations in many more.
Most analyses of prostitution suggest that both men and women enter prostitution, either professionally or temporarily, as relative amateurs, for economic and monetary reasons or are forced to indulge in sex work profession. Certainly, through most of history there were few professions open for women, especially if they had little or no family support or they lacked the education or class status to aspire to the few professions that respectable women could participate in. Conversely, many people who advocate a departure from the shame culture surrounding sex in a variety of arenas, including sex work, argue that some prostitutes work in order to challenge repressive gender roles which restrict women's sexuality to a romantic ideology and oppressive patriarchal marriages. As these activists are also working to change women's opportunities and thus eliminate prostitution as a forced, last-ditch option for staying alive, they are not simply romanticizing prostitution but complicating it by forcing the world to consider the positive choices of sex workers.
More so, females in their early teens are more vulnerable and get lured into the profession not by choice but more due to immaturity. However, adult women may also be vulnerable to economic, social and psychological pressures leading to the choice of sex work profession. There is nothing magical about a girl's eighteenth birthday that guarantees that she can make free and unpressured choices. What seems more important in the context of prostitution and the controversy over 'choice' is the individual's ability to manage power hierarchies and to retain an element of control within them (WHO, 2001).
Nevertheless, very little is known about the demand for sex worker services. Sexuality is not a subject that is much discussed in India. Contrary to cultural ideals that stress chastity before marriage and fidelity within it, men commonly stray from this norm. While this behaviour is generally not as pronounced as in societies in East and Southeast Asia there is consistent, although largely anecdotal evidence to indicate that a large minority of men are clients of sex workers. Mobile groups of men: male migrants in the cities; truck drivers; those in the armed forces; and travelling businessmen are frequently cited as important client groups. Many young men are initiated into their sexual lives by prostitutes (UNFPA, 2001). Rapidly escalating prevalence rates for HIV indicate that monogamy is not necessarily practised (Lousie, 2000). This applies to men from all social classes.
Threats to physical and psychological wellbeing come from working conditions, as well as from clients, the public, and the police encountered in the working environment. Both the public and the police use harassment and violence to monitor sex workers' behavior. Besides, street-based sex workers are subject to constant attention, scrutiny, and harassment. In contrast to street-based workers, sex workers who operate in other venues are relatively invisible but are still likely to be the subject of harassment and assault leading to depleted state of well being.
Regarding sexual and physical health, the sex workers are at a high risk of sexually transmitted disease (STD). Undeniably, the importance of the link between sexual abuse injuries and STIs has been recognized. Specially, in the context of the trafficked, they are often victims of repeated sexual abuse and coercion into involuntary sex acts, which may include vaginal rape, forced anal and oral sex, forced unprotected sex, gang rape, sex during menstruation, and sex accompanied by violent or degrading ritual, which not only have physical consequences but also affects the psychological state of the victims. Moreover, the dimensions of coercion and violence within the given situation also increase women's risk of infection by limiting women's ability to negotiate how sex takes place and whether condoms are used. Gynecological complications are the most common health problem faced by trafficked women as a result of the abuse context, which may be in terms of tearing of the vaginal tract and genitals, sexually transmitted infections, unwanted pregnancy, risks to reproductive and sexual health and above all HIV/AIDS.
Above all social stigma the sex workers face is more enduring and affects them more psychologically and is devastating for them. However, they still continue to indulge in the profession for various reasons. Stress and loneliness is one of the consequences accompanied with shattered wellbeing which may be observed among the sex workers.
In view of these beliefs, numerous authors have been interested in exploring sex workers' sexual health. However, the psychological exploration in the lives of sex workers in Indian context could not be seen. Within this backdrop, present study attempted to explore the consequences of sex work in terms of perceived stress, loneliness and wellbeing.
METHOD
Sample: A total of 115 active female commercial sex workers from different Red light areas and prostitution belt, located in cities of India, were requested to participate in the present study. Looking at the extent of study and the difficulty in finding participants for the study, purposive sampling method was used to select the sample. Respondents were female sex worker in the age range of 14-45 years.
Tools: Apart from including demographic items in the interview schedule measures pertaining to perceived stress, loneliness and wellbeing was used to get appropriate responses, suitable to the objectives, from the respondents.
Perceived Stress Scale (PSS): Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983) was used to understand the stress pattern of the respondents.PSS included 14 items to be rated on a 5-point Likert type scale ranging from never (0) to very often (4).
UCLA Loneliness Scale: The UCLA Loneliness Scale (Russel, 1996) was included to assess subjective feelings of loneliness of the respondents (commercial sex workers). The items in the scale were to be rated on a four point scale ranging from "never' to "often."
PGI Wellbeing Scale: PGI Wellbeing scale developed by Verma, & Verma, (1989) included 20 items intended to measure the subjective wellbeing of the respondents. Forced type 'yes/no' response was to be put against the items and a high score on the scale indicated high degree of wellbeing.
The interview schedule was supplemented by actual observation of the situation.
Procedure: Initially, all the respondents were contacted at their workplace and objectives of the study were explained. With great difficulty the respondents agreed to participate in the study. Data was collected from different Red light areas and prostitution belt, located in various cities of India. All the respondents were assured of confidentiality of their location and responses and were thanked for their participation in the study.
RESULTS AND DISCUSSION
Using a 2 (level of age) x 3 (levels of number of clients per day) factorial design results were achieved (Table 1).
The ANOVA results pertaining to perceived stress have been shown in table 2. No statistically significant effect of the main effects of age (F (1, 109)= 0.246; p>.05) and number of clients (F (2, 109)= 2.785; p>.05) on the perceived stress is observed. The mean results, however, revealed that the respondents of younger age (M= 29.61) perceived more stress than their upper age (M= 27.12) counterparts. With regard to number of clients per day, it was revealed that the respondents dealing with 5 or more clients (M= 28.41) were more stressed than their other counterparts dealing with 3 or less clients (M= 28) and with 4 clients (M= 27.29) per day.
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Conversely, interaction of age and number of clients (F (2, 109) = 7.732; p<.01) was found to be significant on the measure of perceived stress among the commercial sex workers (Figure 1). The mean results depicted that the respondents belonging to the younger age group of below 20 years and having 5 or more clients (M= 29.61) were more stressed than their counterparts. On the other hand the respondents of same age group and having 3 or less clients per day (M= 22.00) were found to be least stressed in all groups under study. Further, in the higher age group respondents dealing with 3 or less clients (M= 29.50) were most stressed. The result seems to indicate interesting fact age the sex workers age they become more accustomed and adjusted with their profession and that less number of clients, for them, means less income and hence more stressed. Similarly for younger age sex worker 5 number clients on daily basis is not only difficult to manage but also stressful. The vast majority of women who become sex workers do so because of dire economic circumstances. Young aged getting into this sector of work dealing and with much number and tolerating them due to certain circumstances perceive stress more than any other age group. This result is also important since the situation is thought to be especially acute in this part of the world where a combination of poverty and the low status of females contribute to their exploitation in the sex industry (CCDT, 1999). Stress is one of the major experience as a consequence of this profession.
When 2x3 ANOVA was applied to the measure of Loneliness, neither did age (F (1, 109)= .329; p>.05) nor did the number of clients per day (F (2, 109)= .327; p>.05) reveal any significant effect. Similarly, the interaction effect (F (2, 109)= 2.784; p>.05) also was not significant. However, it was the younger respondents (M= 29.67) who perceived loneliness more than their counterparts (M= 28.77). Conversely, respondents dealing with 4 clients daily (M=29.18) experiences loneliness more than their counterparts dealing 5 or more (M= 28.80) and 3 or less (28.20) clients on daily basis. Ordinarily, loneliness exists because of the isolation people feel in them. The isolation can come as a result of loss of someone or something people are dearly attached with and when it is taken away experience of loneliness creeps in. It's usually because of this separation that creates the feeling of loneliness. However the result seems to indicate that loneliness is experiences similarly across age group of the sex workers and that number of client is also not important.
A 2x3 ANOVA was applied to see the effect of age and number of client on wellbeing. The results indicated a significant effect of number of clients on the measure wellbeing (F (2, 109) = 3.55; p<.05). in addition, the mean results indicate that less the number better is the wellbeing, i.e., dealing with 3 or less clients (M= 8.00) instills less threat to wellbeing of the commercial sex workers than dealing with 4 clients (M= 7.88) and 5 or more (M= 7.12) clients per day. Dealing with high number of clients in sex work demand usually extra time and efforts in terms of mental and physical efforts, which may not be conducive for a woman's physical and psychological health. The results seem to indicate the same. Main effect of age and interaction effect were not found to be significant.
The correlation results (table 2) indicated a negative relationship between number of clients per day and well being. It suggests that number of client is a potent source of good or depleted wellbeing among the commercial sex workers. Interestingly, a negative correlation between perceived stress and age of the respondents. This result seems to suggest that with aging these sex workers are more adjusted to the daily demands of the work they do and consequently are more relieved and hence less stress. Furthermore, the measure of loneliness revealed no statistically significant relationship between any of the measure under study once again suggesting that the feeling of loneliness is not affected by either age or number of clients and also it is not statistically related to stress or wellbeing for the commercial sex workers.
Conclusion
Socio-economic factors such as financial handicap, trafficking, unemployment and peer influence are the major factors encouraging the growth of the sex industry in India. Stress as a function of age and number of client is an important factor was used in the present study but revealed no significant effects. However, client's number was significant with wellbeing. Age and number of client was also not significant with the measure loneliness. Some of the other studies have documented an association between sex trading and multiple traumas and other characteristics associated with psychological distress (El-Bassel et al., 1997; Fullilove, Lown, & Fullilove, 1992; Kelly, et al., 1992).
This finding should be viewed in the light of two limitations. First, because of difficulty in finding the respondents random or systematic sampling procedure could not be used, thus, the conclusions may not be representative of all women in this trade. Second, the present study did not consider stressful life events, such as trafficking, socio-economic conditions prior to entering flesh trade, childhood abuse, and domestic violence, etc., that could confound the relationship between sex trading and perceived stress among this population. These associations notwithstanding, the question as to what extent psychological distress and loneliness is a consequence of commercial sex work and its possible relationship with various other psychological variables remains unanswered by this study. Future studies are needed to examine culturally relevant appraisals, coping style, psychological symptoms and their consequences on the commercial sex workers. Knowledge of psychological factors can be used to develop interventions for this population. Despite these limitations, this study has implications for assessing and possibly providing possible intervention for mental health problems of sex workers. The level of perceived psychological stress among sex workers highlights the need to assess their need for psychological interventions.
The feeling they have of being stigmatized because of the nature and status of their work likely contributes to their stress (Fullilove, Lown, & Fullilove, 1992) and shattered wellbeing because the wellbeing results were slightly at the lower side. More so, for the majority of commercial sex workers, commercial sex constitutes their major source of income and it was revealed that given a chance they would like to leave the profession. In this line, women who are ready to leave this profession should have some policy from the government addressing their rehabilitation and alternate source of income generation.
Gaining access to public assistance may enable some women to reduce their dependency on sex trading. Those who are not willing or able to leave sex trading need training to develop strategies to reduce the dangers of their work. By and large, high number of partners and inconsistent risky sex conditions among these sex worker, as reported, indicate that these women will continue to become infected with STDs, if not yet affected, and get into drug abuse as well. Thus, government and providers of public health must intensify their efforts to bring them into the mainstream of the country.
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