Researchers at Harvard Medical School and Yale School of Public Health: stop scapegoating sex workers for the spread of COVID-19 in India!

In May 2020, a controversial study entitled ‘Modelling the Effect of Continued Closure of Red-Light Areas on COVID-19 Transmission in India’ was released without being peer-reviewed, and quickly went viral on Indian media outlets. It recommends that shutting down red-light areas in Mumbai, New Delhi, Nagpur, Kolkata, and Pune during and beyond the lockdown can reduce the number of new COVID-19 cases by 72% and deaths by 63%, and suggests keeping them closed indefinitely. For a critique of this study and its implications, please read this article by our Postdoctoral Research Associate, Dr. Shakthi Nataraj.  

To combat this harmful study, a group of activists and academics including Meena Seshu (SANGRAM), Aarthi Pai (SANGRAM), Siddharth Dube, Sundar Sundararaman, Mona Mishra, Tripti Tandon (Lawyer’s Collective), and Shyamala Nataraj (SIAAP), Prabha Kotiswaran and Shakthi Nataraj at the Laws of Social Reproduction Project, drafted the below statement of concern that was shared with the deans of Harvard Medical School and Yale School of Public Health, and the Vice-President for Research at Massachusetts General Hospital. The statement so far has over 140 signatories, including former health secretaries of the Government of India, leading policymakers and civil society leaders, sex worker collectives, and academics. The statement has been effective already, leading the dean of Yale School of Public Health to initiate an investigation into the study, and media outlets to publicly denounce the study in India. Scroll down to read our statement and sign our open letter. 

To:

Dr. George Q. Daley, Dean of the Faculty of Medicine, Harvard Medical School

Gretchen Brodnicki, JD, Dean for Faculty and Research Integrity, Harvard Medical School

Dr. Harry W. Orf, Senior Vice President for Research, Massachusetts General Hospital

Dr. Sten H. Vermund, Dean, Yale School of Public Health

Dr. Melinda Irwin, Associate Dean of Research, Yale Medical School

7 July 2020

Subject: Statement of concern regarding a study urging permanent closure of India’s red-light areas, published by researchers at Harvard Medical School, Massachusetts General Hospital, and Yale School of Public Health

Dear Dr. Daley, Dr. Brodnicki, Dr. Orf, Dr. Vermund, and Dr. Irwin,

We write as a group of concerned decision-makers, academics, activists and representatives of sex worker collectives, regarding the recent study entitled ‘Modelling the Effect of Continued Closure of Red-Light Areas on COVID-19 Transmission in India’ (2020) authored by Sudhakar V. Nuti of Harvard Medical School and Massachusetts General Hospital, along with Jeffrey P. Townsend, Alison P. Galvani, Abhishek Pandey, Pratha Sah, and Chad Wells at the Yale School of Public Health.

The study recommends that shutting down red-light areas in Mumbai, New Delhi, Nagpur, Kolkata, and Pune during and beyond the lockdown can reduce the number of new COVID-19 cases by 72% and deaths by 63%, and recommends keeping them closed indefinitely. We strongly denounce this study for its lack of rigorous methodology and transparency, misleading assumptions about sex work, and egregious disregard for the rights of the urban poor in India. We equally strongly denounce the sensationalistic and suspect way that the study has been publicly promoted in India, leading to dozens of news reports with headlines such as this one: “Keep red light areas closed post- coronavirus lockdown: Yale School of Medicine.” We demand that this paper be retracted until it has been peer-reviewed and made publicly available to other academics for critique.

The study has been released without being peer-reviewed, and the research methods have not been made transparent. The authors claim that 522 stakeholders in RLAs were interviewed in the past few months, with two rounds of research. Yet there is no detail on the ethics approval for the study, the informed consent and recruitment procedures, or the partner organizations that facilitated the research. It is not clear that informants were told about the objectives of the study or its possible risks for them, including the closure of RLAs and threats to their livelihood. Moreover, lockdown in India has been in place since 24th March 2020 and international research boards have mandated that all human subjects research be virtually conducted. In this case, the study was conducted illegally, making the findings inadmissible. Because of lack of transparency, the findings are also impossible for third parties to verify. Were the authors not aware of the risks posed by their own research?

The findings of the study, moreover, need to be triangulated with the findings of other research studies and consultations with civil society organisations before making policy recommendations. It is unethical and irresponsible for big-name institutions such as Harvard Medical School, Massachusetts General Hospital, and Yale School of Public Health to influence policy in the Global South without consulting sex worker collectives. This is particularly so in India, where sex workers have been leaders and equal partners in combating the HIV/AIDS epidemic for three decades. The authors ignored multiple requests from academics to make the findings available, as well as bypassed civil society organizations completely, sharing the key findings directly with media outlets and politicians even in the absence of peer review. This action smacks of prejudice, not science, ultimately scapegoating marginalized sex workers for the government’s failure to halt the spread of COVID-19.

Upon closer readings, it is also clear that the study suffers from enormous methodological shortcomings and flawed assumptions. The estimates of the number of sex workers in India are based on highly variable sources, and the secondary literature is outdated, citing studies from Pune in 1996 and Surat in 2003, reflecting little understanding of the current realities of sex work in India. Sex work, defined as the provision of sexual services, is provided in a range of locations in India, and only a very small percentage of it takes place in brothel settings. Most sex work takes place on highways, railways, construction sites, bus stations, farmlands, lodges, and residential homes, and sex workers frequently migrate between these settings. Caste-based sex work is also practiced in certain parts of India, where large sections of a village might practice sex work. Major red-light areas now only exist in three states in India: Delhi, West Bengal, and Maharashtra. Even in these states, brothel-based sex work has sharply declined since the 1990s, with the rise of abolitionist anti-trafficking movements, police crackdowns, and real-estate redevelopment interests. Much sex work has migrated to streets or become internet- and phone-based.

In India, the dwindling of brothel-based sex work means that today, red-light areas are not distinguishable from urban slums, where sex workers reside alongside other marginalized members of the urban poor, including migrant workers , street vendors, pavement-dwellers, sanitation workers primarily from oppressed castes, and disadvantaged transgender-identified persons. The authors’ statement that “social distancing is impossible while having sex” misses the point. In India, 40% to 50% of urban residents live in dilapidated conditions in slum areas, where thanks to a lack of facilities, water supplies, and overcrowding, social distancing is impossible regardless of residents’ sexual activity. The authors of the study draw comparisons to countries such as the Netherlands, Germany and Australia, where sex work is regulated in specific jurisdictions, and therefore “shutdowns” are possible. Given the mixed-use nature of urban Indian slums, however, they cannot be “shut down” in the same way as RLAs in Western countries. In India, moreover, brothels inhabit an ambiguous legal position, since the term is defined broadly to include a range of areas inhabited by sex workers and the urban poor. The recommendations of this study essentially invite the state to use its coercive powers— police raids and evictions— to victimise the most marginalised of slum-dwellers in the name of public health.

The study model, moreover, assumes but does not substantiate the claim that RLAs are a major source of COVID-19 infection. The authors assert that the states with the highest number of sex workers are also those with the greatest numbers of COVID infections, thereby positing a causal link between the two. However, in the absence of widespread testing and contact tracing, there is no clear evidence that sex workers are a point-source for the spread of COVID-19. The same could be hypothetically claimed of any close-contact occupations where distances of 2 meters cannot be maintained, including shop owners, domestic workers, care workers, waste-pickers, sanitation workers, bus conductors, street-vendors, delivery personnel, NGO workers, and, for that matter, even field researchers. In fact, there has been virtually no business in RLAs since 24th March 2020, when the lockdown was enforced, yet COVID-19 cases have been rapidly climbing. This shows that brothels are not contributing to the spread of COVID-19 at all. The steep climb in cases is a matter to be investigated, but it must not be arbitrarily blamed on the most marginalised communities in India.

Given the deeply harmful measures proposed by this study, the section on ameliorative measures is underdeveloped and impracticable. The suggestion that sex workers be rehabilitated and channelled into alternative occupations is naïve, since ample research demonstrates that most sex workers already have experience in other occupations such as domestic work and petty trading. Most choose sex work because it pays substantially more. Evidence from the past thirty years of HIV/AIDS prevention interventions also clearly demonstrates that coercive strategies such as raiding brothels and placing sex workers in “rehabilitation homes” violate the human rights of sex workers, and are also economically unsustainable in today’s neoliberal economy. The authors acknowledge that most sex workers lack government documentation and bank accounts. Yet they still vaguely suggest that that sex workers be given cash transfers and credit access from the government, without suggesting at all how this might be achieved. No government agency has, till date, spoken of relief measures for sex workers. It preposterous to think that the Indian government will provide alternative livelihoods for a segment of the population that the state does not even acknowledge. The authors’ suggestion that “reintegration expenditures could be offset by profits generated via the redevelopment of RLAs” amounts to pushing for greater gentrification, violent “slum clearances”, placing sex workers and poor residents in precarity and at greater risk for police harassment. The push to “redevelop” RLAs appears to be driven not by science but by a morally charged abolitionist condemnation of sex work itself.

For the above reasons, we the undersigned, demand that the study be retracted in full until the findings have been made available for peer review by academics, activists, and sex worker collectives.

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