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. 2025 Aug;50(4):668-681.
doi: 10.1007/s10900-025-01452-y. Epub 2025 Mar 10.

The Impact of the COVID-19 Pandemic and Lockdowns on Sex Workers in West Bengal, India

Katherine A Lewis  1 , Protim Ray  2 , Emma Janibekyan  3 , Niharika Kaushik  4 , Darshna Anigol  5 , Denise Tieu  3 , Zhenyi Luo  3 , Leonel Hernandez  3 , Asim Sen  2 , Suchith Kumar  6 , Anne E Fehrenbacher  1 , Dallas Swendeman  7
Affiliations

The Impact of the COVID-19 Pandemic and Lockdowns on Sex Workers in West Bengal, India

Katherine A Lewis et al. J Community Health. 2025 Aug.

Abstract

India's COVID-19 lockdowns were among the strictest globally, and sex workers were uniquely impacted. Extremely limited literature has examined pandemic consequences on sex workers. We use a qualitative approach to examine the impact of the COVID-19 pandemic and lockdowns on the lives and livelihoods of sex workers in urban West Bengal, India. Cisgender female and male, and transgender female sex workers (N = 40) participated in individual in-depth interviews. Interviews were coded using inductive thematic coding. Nine themes arose from the data: (1) COVID-19 pandemic and lockdowns, (2) Social isolation, (3) Lack of customers, (4) Financial stress, (5) Decreased negotiating power, (6) Food insecurity, (7) Receiving support, (8) Providing support, and (9) Mental health. We propose a Gendered Stress Proliferation Model incorporating Pearlin et al.'s 1997 conceptualization of stress proliferation and Swendeman, Fehrenbacher et al.'s 2018 gendered stress process model. In this model, primary stressors of COVID-19 pandemic and lockdowns proliferated into secondary stressors across multiple domains (social isolation, lack of customers, financial stress, food insecurity, reliance on support, decreased negotiating power). All of these pathways were shaped by pre-existing vulnerabilities and systems of intersectional marginalization. These stressors had significant mental health impacts including feelings of depression and anxiety. Food insecurity has implications for physical health outcomes, and financial stress coupled with decreased negotiating power has implications for sexual health, potentially placing sex workers at increased risk of sexually transmitted infections and HIV. Gendered Stress Proliferation may be a useful framework to examine how marginalized populations uniquely experience population-level crises.

Keywords: COVID-19; India; Qualitative; Sex Work; Stress Proliferation.

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Conflict of interest statement

Declarations. Competing Interests: The authors have no competing interests to declare. Ethics Statement: All research protocols were reviewed and approved by the University of California Los Angeles IRB (IRB#21-001402) in Spring 2022. The leadership team of Durbar Mahila Samanwaya Committee reviewed and approved the research and agreed to rely on the UCLA IRB. Informed Consent: All participants provided voluntary informed verbal consent for study participation. Verbal consent was used because of low literacy rates in this community and greater confidentiality protection compared to signed consent forms.

Figures

Fig. 1
Fig. 1
Gendered stress proliferation model for sex workers in India during COVID-19 pandemic and lockdowns
See this image and copyright information in PMC

References

    1. Reza-Paul, S., Kumar, P. N., Lazarus, L., Pasha, A., Ramaiah, M., Paul, M. R., Lorway, R., & Sundararaman, S. (2022). From vulnerability to resilience: sex workers fight COVID-19. Health Dimensions of COVID-19 in India and Beyond. 10.1007/978-981-16-7385-6_15
    1. Platt, L., Elmes, J., Stevenson, L., Holt, V., Rolles, S., & Stuart, R. (2020). Sex workers must not be forgotten in the COVID-19 response. The Lancet, 396(10243), 9–11. 10.1016/S0140-6736(20)31033-3 - PMC - PubMed
    1. Lyons, C. E., Schwartz, S. R., Murray, S. M., Shannon, K., Diouf, D., Mothopeng, T., Kouanda, S., Simplice, A., Kouame, A., Mnisi, Z., Tamoufe, U., Phaswana-Mafuya, N., Cham, B., Drame, F. M., Aliu Djaló, M., & Baral, S. (2020). The role of sex work laws and stigmas in increasing HIV risks among sex workers. Nature Communications, 11(1), 1–10. 10.1038/s41467-020-14593-6 - PMC - PubMed
    1. Deering, K. N., Lyons, T., Feng, C. X., Nosyk, B., Strathdee, S. A., Montaner, J. S. G., & Shannon, K. (2013). Client demands for unsafe sex: the socioeconomic risk environment for HIV among street and off-street sex workers. Journal of Acquired Immune Deficiency Syndromes,63(4), 522–531. 10.1097/QAI.0B013E3182968D39 - PMC - PubMed
    1. Vaghela, G., Hermoso, C., Ahmadi, A., & Lucero-Prisno, D. E. (2021). Sex workers should be included in COVID-19 vaccination efforts. The American Journal of Tropical Medicine and Hygiene, 105(6), 1462. 10.4269/AJTMH.21-0438 - PMC - PubMed

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