Table 2.

Summary of key themes in the context of sex trafficking and HIV vulnerability

Themes	Quotes
Theme 1: Sex-trafficked women and girls lack autonomy	“Two ladies asked her what was wrong and she told them that she needed a job. They told her that they knew a person who can get her a job in a garment factory, but the person is leaving today. So, she agreed to go with them. They reached Mumbai and told her that it was her sister’s house, but it was really a brothel on Grant Road.” “She met a lady at the bus stop who offered her a job of housemaid at Delhi. She trusted that woman and agreed to go. After reaching Delhi, that woman kept her in a house for a week, then sent her with another female, who took her to the brothel on G.B. Road.” “He [her husband] brought her to Delhi. She asks for him [her husband]. The gharwali tells her that he is no longer her husband. He sold her and now he is gone.” “He [the trafficker] sold her for Rs 40,000 to a gharwali. When she requested the gharwali to send her to her mother, the gharwali refused by saying that she had to repay the debt if she wants to go back.” “She was threatened that if she did not do the work, she would be kept there for 3 years instead of 1 year.”
Theme 2: Rape as a tool for initiation into sex work	“She said that she was completely lost and was just holding the woman’s [the trafficker] hand with fear. The woman went out and sent a man inside who pushed her to the bed, opened his clothes, removed his pant, and forced her to make love with him. She shouted and cried but no one came to help. She got scared that it was bleeding from her vagina, and requested the women [the gharwali] to give her some medicine. She says that she was forced in the above manner for about 4–5 days.” “She was gang raped by 5 persons and this heinous act continued until she gave her consent to be a prostitute.” “They handed her over to the gharwali. She was very cruel and rude. As soon as she was sent there, she was asked to dress herself and apply make-up. Then, four girls entered the room and held down her hands and legs and helped that man to have sexual intercourse with her. At that time, she said that she was crying out of stomach pain and fainted on seeing blood due to forceful intercourse.”
Theme 3: Chronic sexual violence and inability to refuse sex	“She says that she used to be beaten up when she wore full dresses.” “She got beats and scolding from the brothel keepers regularly. She is even burnt with the cigarette buds.” “When (she) would refuse to sleep with them [male clients], the gharwali would hit (her) properly.” “Refusal to carry on the work resulted in severe punishments and torture.”
Theme 4: Chronic sexual violence and inability to negotiate condom use	“The customers used to drink and some used to refuse to use condoms. As a result of this, she conceived three times.” “Some of the customers would refuse to take any precautions like using condoms. If she tried, the gharwali would hit her properly.” “When the blood result came, she understood that she is HIV positive. Then I asked whether she was using condoms. For this she replied that many customers never wanted to use the condoms and if she forced them they used to complain to the gharwali who in turn tortured her.”
Theme 5: Substance use	“He came there tied up her hands and legs and forced her to drink. The gharwali threatened her that she would throw her out of the building if she wouldn’t sleep. She was unconscious and was raped.” “She got addicted to alcohol and pan parag, as she was forced to drink along with the customers.” “She had to go with more than 15 customers per day, and during night time she had to entertain at least 2 men. Unable to bear the work pressure, she got addicted to alcohol and betel nut chewing.”
Theme 6: Inability to access health care	“She once fell sick and no one took care of her. She was thrown in a corner for about 15 days and none of them bothered about her.” “She always had health problems while her stay in the brothel, but she was hardly ever taken care of. Once she had severe stomach pain and she was crying, but the gharwali neglected it. Only when the pain went out of control was she taken to the doctor.” “Once, I had a high fever. I was unable to talk due to the fever. I was shivering with cold, and my throat was parched. Although I protested that I could not possibly do anything, I was forced to sleep with the customers.” “She got vaginal infection and started bleeding and the part got swollen. She refused, but the gharwali did not listen and sent her to the customers. After going with customers for about 10 days, there were lots of pimple type structures full of her puberty areas. For this, she struggled for about 6 months.”