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In 2006, the United Nations Joint Programme on HIV/Aids stated that 5.7 million people in India were living with HIV, the highest number in the world at that time. Many HIV prevention programmes in India have associated the spread of HIV with sex work and have been implemented with a health-focused approach. Global organisations, such as UNAIDS and the World Bank, have given large amounts of money for HIV intervention programmes to local NGOs working with sex workers, to reduce the vulnerability of women to HIV and the incidences of new HIV infections. Despite such programmes, HIV interventions have failed to reduce the number of people living with HIV/Aids in India.
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Salla Sariola's book Gender and Sexuality in India: Selling Sex in Chennai is an important and refreshing analytical perspective on sex work and the HIV prevention industry in Chennai, India. Based on ethnographic fieldwork in Chennai, Sariola analyses the lives of sex workers alongside the medicalised perspective of HIV prevention programmes. Sariola's conversations with women engaged in sex work in Chennai, highlight the multiplicity and diversity of women's everyday lives and experiences that are concealed from the HIV debate, which emphasises control and prevention as the means to reduce the spread of the virus. Sariola argues that the medicalised view of sex work and HIV is limited and disconnected from the everyday lives of sex workers. This therefore leads to ineffective policies that are based on inadequate and distorted evidence. Framing sex work as an epidemiological category does not consider the socioeconomic actualities of sex workers, which are shaped by traditional concepts of women's sexuality.
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Despite the difficulties Sariola expressed in researching female sex workers, the book persuasively shows that selling sex is a complex entanglement of poverty, desire, women's oppression, and motherhood. Sariola maintains that sex workers should not be viewed as victims but as women who are able to negotiate conditions of subordination and patriarchal structures that control and circumscribe female sexualities in India. Sariola's interviews and interactions with sex workers in Chennai signify that the actualities of women's everyday lives, which are shaped by broader socio-political and economic structures, are central to the discourse on HIV prevention.
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The focus on the health aspects of sex workers assumes that HIV transmissions occur through sexual contact. Sariola, however, challenges this by forcing us to consider concepts of sexuality and gender and representations of ideal womanhood in India. The ideals of Indian womanhood are framed by concepts of purity and chastity and women who do not conform to these ideals are stigmatised due to their 'loose' nature. Sariola questions existing understandings about sex work that are overly concerned with epidemiology, by asking how are we to understand the existence of sex workers 'when conservative ideals of sexuality and discourses of purity and chastity prevail'? (p. 19) The epidemiological focus ignores that India is a highly patriarchal country, in which the prevalence of poverty makes economic survival difficult, where violence against women is common, and established norms do not enable women to have a say in matters of sexuality.
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Many HIV prevention programmes, in Chennai and elsewhere in India, have attempted to educate sex workers in safer sex practices but are ineffective as they have failed to address the poverty and gender power inequalities that force women in to sex work. Sariola's interviews with sex workers indicate that poverty was the main reason for women entering the sex work industry. The job opportunities for unskilled and/or illiterate women are limited and opportunities that do exist, do not provide enough money to meet the needs of a family with children. Whilst not happy about being in the sex industry, many women stated that sex work is a quick and easy way to get money and, as Sariola suggests, an incentive to remain in the industry.
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As sex workers lack any formal rights and social value, many women said it was difficult to initiate condom use with their clients. The power dynamics between men and women significantly reduce the ability of women as sex workers to exercise any control over men in the use of condoms. In some instances, the sex workers told Sariola that their material needs and responsibilities for their children forced them to put their financial needs before their own health and wellbeing. For this reason, women often agreed to have sex without a condom when a client offered more money. Due to the power relationship between the client and the sex worker, some women said that they had to adjust to the requests of men, even if they did not want to. The women revealed to Sariola that some sexual practices were preferred over others that were more dehumanising. While some women were able to negotiate these contexts better than others, many women said that they would consume alcohol to reduce the pain of intercourse and the shame and stress associated with the work.
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Sariola's research on sex workers in Chennai forces us to question the way in which global organisations design and implement HIV prevention programmes on the basis of a perceived epidemiological relationship with sex work. The ethnographic approach to her research reveals that local contexts are not taken into consideration by global organisations that fund HIV programmes in India, due to their western biased guidelines that are insensitive to local norms and structures. The HIV discourse is grounded in western norms that cannot be imported to the Indian context, where conceptions of gender and sexuality are markedly different.
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This book offers an important perspective on current HIV interventions and a renewed approach to programming that aims to reduce HIV incidences in countries such as India. Until interventions address the wider inequalities of the general population in relation to gender, sexuality and economic status, any opportunity to curb the disease will be limited. As Sariola asserts 'it is ironic that only a social analysis that extends beyond the context of HIV brings out problems in HIV prevention and shows how the failure of HIV prevention is related to (gender) inequalities in the Indian society' (p. 138).
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