(P33) Impacts of COVID-19 Pandemic and Lockdowns on Sexual Health and Livelihoods of Sex Workers in India

Background: The COVID-19 pandemic has undermined HIV prevention efforts globally, with dire consequences for key populations in low- and middle-income countries. We aimed to understand the impacts of the COVID-19 pandemic on the livelihoods of sex workers in India as well as their sexual behaviors and HIV-related service utilization.

Methods: From June to September 2022, we conducted a survey (N=279) and in-depth interviews (N=40) with female, male, and transgender sex workers in West Bengal, India regarding their experiences before and during the COVID-19 pandemic. Frequency distributions for sexual health, HIV/STI testing, service utilization, and income-related variables were compared pre- and post- pandemic using chi-squared tests. Interview transcripts were thematically coded and analyzed using an inductive approach.

Results: No significant changes in condom use were observed before versus during the pandemic. HIV testing and service utilization declined sharply during the first lockdown in India from March to May 2020 but rebounded following the lifting of restrictions in June 2020. However, most respondents reported significant or total declines in the average number of weekly clients during the first lockdown from a mean of 13 to 1 clients/week, which have yet to return to pre-pandemic levels (current mean=10 clients/week). Furthermore, 92% of respondents reported no rate increases to compensate for the lower number of clients. As a result, the majority of respondents experienced significant loss of income (25-30%) sustained over two years. Participants described how inability to maintain stable income has led to severe financial strain, food insecurity, reliance on external support, emotional distress and isolation, and exploitation.

Conclusion: Our findings indicate that the COVID-19 pandemic has contributed to significant financial losses among sex workers in India. Although self-reported condom use behaviors were maintained consistently throughout the pandemic and HIV/STI testing frequency rebounded following the first lockdown, the prolonged economic impacts of the pandemic plunged many sex workers into debt. Over the long-term, these structural conditions may subject sex workers to increased exploitation or lead to sexual risk-taking, such as engaging in condomless sex for additional income, which may consequently heighten the potential for HIV and STI transmission.