Battered bodies and minds: invisible diseases of women in prostitution 

Grizelda Grootboom,  a prostitution survivor, is suffering from a life-threatening infection. Her knee hurts and she feels breathless as she talks -- perhaps a side-effect of hundreds of injections a pimp gave her in her legs in initial years of prostitution so that she could not retaliate. 

The medicines she takes for this severe infection that she probably acquired from one of her customers, pushes her digestive system to the limit and makes her run to toilet every half an hour. 
Grizelda was gang-raped by a group of boys in her village when she was 9. Her mother remarried  and left Grizelda to fend for herself. She was forced to live on the streets of her village near Cape Town.

At 18, she moved to Johannesburg where one of her friends promised to help her find a job. But instead she was trafficked on arrival in Yeoville, a Johannesburg suburb.    

The pimp she was handed over to kept her tied up in a dark room for two weeks to force her into sex slavery. 

There are millions of women like Grizelda. A 2014 report by Scelles, a French charity foundation, says that there are about 40 million sex workers across the world-- most are victims of human trafficking, lured, duped or forced into sexual slavery by pimps and traffickers, largely due to their poor socio-economic status.

They work in brothels, massage parlours, strip clubs and find it hard to escape. 

Most of them are bruised emotionally and physically and suffer from a number of diseases -- a result of repeated sexual assaults. But unfortunately, concerns about their health have been limited to protection against unwanted pregnancies.  

Jackie Lynne, 64,  from Canada, for example,  starts her day by popping up a handful of coloured tablets and capsules. While she is suffering from a host of diseases, what bothers her most is the complex Post-Traumatic Stress Disorder (PTSD), a neurological condition. "It happens to people who experience trauma over a long period. At times I feel that my mind would blow up," says Jackie. 

Her mother was into prostitution. Jackie was a child when she was first raped . "All the men and women in my surroundings were into sex trade. I was repeatedly raped and was made to believe that I was good for prostitution only," she says, looking at a bird sitting on a tree at India International Centre, Delhi. Jackie and many other prostitution survivors were in Delhi recently for the Second World Congress against the Sexual Exploitation of Women and Girls  organised by CAP International (Coalition Abolition Prostitution) and Apne Aap Women Worldwide.

"My mother tried to save me but she couldn't. I took to drugs to forget the pain that came with each sexual assault," she says, her eyes still fixed on the bird. "There was no way I could escape prostitution, so I gave in. I had no choice." 

At 20, Jackie decided that she didn't want to continue as a sex worker. "I have been undergoing psychotherapy and taking anti-depressants for 40 years but it seems impossible to return to health. There is one part of me that still cries and asks why it happened to me," she says. "But at the same time, I feel lucky that I could escape." 

Women in prostitution often face physical violence at the hands of  pimps. "They used to bang my head on the wall if I resisted. I didn't suffer from a serious head injury but there were many who did," she says. 

Sex workers not just sustain severe injuries but also contract deadly infections, suffer from unwanted pregnancies, undergo unsafe abortions. Majority of them also suffer from drug addiction and alcoholism. The constant stress also leads to number of metabolic diseases and deficiencies. They suffer from severe joint pains as most of the time they are forced to wear high heels. 

At times, pimps use tranquilizers and other drugs to break their resistance, as they did in Grizelda's case. "Every time they wanted me to entertain a client, they would give me a shot in my leg. It was painful and I lost control over my own body," says Grizelda. 

Once they took her to a dark room, where they made her bleed to terminate her pregnancy. "They used some instruments and medicines. Post abortion, they stuffed my vagina with sponge to soak the bleeding," says Grizelda . "They even forced me to have sex with a client that very night and when I refused, I was brutally beaten up. They severely hit my legs; I got multiple fractures and it took me months to recover," she says. 

Such assaults don't just devastate these women physically but also emotionally, says Shanie Roy, a 25- year- old survivor from Canada. 

 Shanie was sexually exploited at 14 . Stress affected her cognitive abilities and she lost focus in studies. It was at that time that  she sought security in a relationship with a man much older than her. He took advantage of her emotional vulnerability and sold her to a dance bar. 

"I wanted to run away but there was no exit."  

Six years on, Shanie is studying law. "I want to reconstruct my life once again. But that is not an easy task," she says, dressed nattily in a white and black dress. 

"The worst part is that my past has been documented in all my electronic health records. Whenever I see a doctor for any health problem, he gets to know that I was into prostitution. At times, they make sexual advances towards me. It is difficult to deal with it," she says. No wonder then, Shanie dreads consulting a new doctor.  
She is not an exception. Women in prostitution do not have easy access to healthcare. One of the major problems , Shanie says, is the fact that most organisations working for women in prostitution feel that contraception is all they need. 

In fact, there is a high prevalence of depression and other behavioural and psychiatric disorders among these women. "When organisations talk about harm reduction, it should not just mean reducing unwanted pregnancies. These women need holistic healing that can take care of their emotional, psychological, physical well-being," says Sarah Benson, president, CAP International, a coalition of 14 abolitionist NGOs working for women in prostitution.