Resourcefulness of homeless young people who practise sex work in Pakistan: a qualitative study

Keywords: capacity-building, cultural practices, developing world, homeless, Pakistan, resourcefulness, sex work, street youth.

Homeless young people (HYP) tend to have lives characterised by a lack of resources like shelter, food, money, and social networks that provide support and care.¹ Experiences of joblessness contribute to HYP’s decisions to engage in sex work, which remains highly stigmatised, both in conservative societies and in many high-income countries.^2–4 In countries where sex work is illegal (like Pakistan), sex workers experience discrimination and abuse, reducing their capacity to access adequate health care and putting them at an increased risk of HIV and other sexually transmitted infections (STIs).⁵

Despite their illegality and stigmatised nature, HYP in Pakistan practise sex work and sexually suggestive dancing^A to generate the income needed for survival.^6,7 For example, a survey of 1175 HYP in 10 major cities of Pakistan found that 83% were sexually active, and 53% reported exchanging sex for money.⁸ Similarly, another study showed that 40% of HYP reported sex work.⁹ HYP are also at far greater risk of HIV infection compared to their stably housed counterparts, largely due to a lack of access to HIV prevention strategies and a higher likelihood of engaging in injecting drug use and condomless sex.^10–13 The major focus of health promotion strategies with sex workers in Pakistan (homeless or otherwise) has been to encourage condom use. These programs rarely provide opportunities for skill-building that may generate pathways out of homelessness or alternative forms of work.

Homelessness and sex work tend to be viewed as deviant, pathological, and leading to victimisation and poor health.^14–16 This is partly because HYP and sex workers are often thought about and discussed in terms of moral, physical, or mental deficits and risks and being incapable of helping themselves or others. This framing obscures the potential resources, skills and knowledge of young people which allow them to survive or create pathways out of homelessness.

Some researchers have adopted strengths-based approaches that orient policymakers and practitioners to the positive attributes of HYP to be harnessed in interventions aimed at enhancing HYP’s strengths.^17,18 Strengths-based approaches highlight ‘promotive factors’ – assets and resources – that build HYP’s resilience, further enabling them to survive in adversity.¹⁹ This approach has allowed researchers to show that HYP are capable of learning novel skills that help them to deal with problems.^19,20 There is evidence that HYP’s resilience is positively associated with their sense of connectedness to peer networks.^21,22 Specifically, some social researchers use the concept of social capital to demonstrate how HYP, through their peer network or connection with services, obtain material and symbolic resources that improve their life conditions.^1,23–25 Although HYP experience difficulty in securing formal jobs, they can generate incomes through street economy activities like panhandling, sex work and drug dealing.²⁶ Although sex work can place HYP at risk for HIV/STIs, HYP who are more resilient are less likely to engage in risky sex.^27,28 In high-income countries, the identification of HYP’s positive attributes has led health practitioners to design change strategies aiming at ensuring HYP’s social inclusiveness.^29–31 Our study builds on this strengths-based research to reorient attention to the capabilities of HYP in Pakistan, so that they can be supported and encouraged in policymaking and programs.

The overarching aim of the study was to identify ways in which HYP work to manage homelessness and mitigate adversity. We adopted a qualitative approach to highlight how HYP draw on novel skills and existing material resources to practise sex work for income generation, in ways that reduce their risks for HIV/STI acquisition.

The study was conducted in Rawalpindi – one of the major urban centres in Pakistan where a considerable number of HYP reside.³² It is estimated that a total of 3000–5000 ‘street children’ reside in Rawalpindi.⁸ Other pragmatic reasons to select Rawalpindi as a study site were the lead researcher’s experience of conducting research with homeless families and existing connections with local organisations in the city. ‘Homelessness’ is defined here as a broad concept that encapsulates various social conditions: rooflessness (i.e. rough sleeping), houselessness (i.e. couch surfing), and having temporary or substandard housing.³³ People experiencing these conditions are often categorised as ‘literal homeless’ or ‘precariously homed’.³⁴ Young people aged 16–25 years who did not have a permanent dwelling were therefore eligible to participate in the study.

We conducted semi-structured interviews with 29 participants. Because identifying HYP and asking them about their sexual practices were challenging tasks, we sought help from a community-based organisation (CBO) with the recruitment process. The CBO staff advertised the study during health education sessions with HYP. If a HYP expressed interest, a meeting between the first author and the potential participant was held at the CBO’s office to arrange a private interview. It is not considered appropriate for male researchers to interview female participants in Pakistan, so a local experienced female interviewer was employed. The interview guide consisted of four sections including demographic information, reasons for homelessness, experiences of street life, and sexual practices. We provided each participant with PKR 800/AUD10 as compensation for their time and travel-related expenses.

We used a thematic data analysis technique to analyse the interview transcripts.³⁵ We adopted this technique because it was sufficiently flexible to allow us to organise information, as well as identify new or unexpected patterns in the data.

The process of analysing the data began at the fieldwork stage – after transcribing the first four interviews, we identified themes by reading and rereading the transcripts. The coding process began with importing all the interview transcripts into NVivo (ver. 10) software (QSR International). Each interview was then read, and patterns of data were assigned headings/nodes. We used Bourdieu’s theoretical concepts of capital, social fields, and habitus to organise themes within the transcripts.³⁶ Upon completion of the coding frame by the lead researcher, the other authors examined and helped refine it. At this stage, the team looked at whether similar codes could be collapsed under larger thematic areas. This allowed tightening up the analysis in congruence with the Bourdieusian concepts. The coding frame then provided us with a basis to interlink and reorganise various concepts and enabled us to structure the findings of the research. For example, we identified what contributed to participants’ engagement in dancing and sex work (i.e. need to obtain financial capital), the skills needed to practise them, and the material resources they mobilised (i.e. the acquisition of cultural capital). In describing the study results, we replaced participants’ names with pseudonyms to maintain confidentiality.

This research was approved by the Human Research Ethics Committee (HREC) of the University of New South Wales (UNSW) (reference: HC16261).

Twenty-nine HYP participated in this study, including nine cisgender heterosexual men, six cisgender heterosexual women, seven cisgender gay men, and seven transgender heterosexual women. Participants’ mean education level was 5.8 years of formal schooling, although some (n = 6) had had no formal education. Almost all the participants reported living in temporary or transient accommodation (i.e. living with extended family members, friends, and peers) and one reported living on the street. Although many of the cisgender heterosexual and some gay male participants reported casual jobs like labouring, scavenging, and rickshaw driving when they first moved to Rawalpindi, many subsequently practised sex work, to increase their income. Although participants did report how much money they generated through sex work, they described it was enough to meet their everyday needs. At the time when the interviews took place, all of the cisgender and transgender heterosexual women (n = 13) and cisgender gay men (n = 7) engaged in dancing and sex work, and a few cisgender heterosexual men (n = 4) practised sex work.

Before leaving their family homes, participants described establishing connections with relatives, peers, and friends in Rawalpindi. These connections provided the initial support like accommodation and food that participants needed to establish themselves in the city. Through their networks in the city, participants met and built relationships with street-based young people who were deriving income from dancing and sex work. Some participants became involved in a specific genre of entertainment, locally referred to as mujra – a sexually suggestive dance performed to please male audiences.³⁷

To engage in mujra or sex work, participants needed to develop skills related to beautification, dancing, communication, and sexual services. These skills were important assets that participants learned from peers to be able to generate income in circumstances in which they faced discrimination and unemployment. Hassan valued his makeup skills, so he could prepare for and dance at events:

I learned how to do makeup after living with my peers. Over time, I improved in makeup skills because practice makes us perfect. I became so skilled that I could independently apply makeup on myself before performing at dance shows (Hassan, Cisgender gay man, aged 23 years).

Many participants described how senior and more experienced peers helped them to learn their dancing skills. For Qausar, learning mujra dance was not possible without support from her group leader, locally referred to as guru:^B

Because my sister was already living with them, I knew about what they do. I ask my sister that I want to join her. She then introduced me to her group leader who taught me dancing and this is how I came into this field. The group leader initially saw if I could dance. I did one song and then she kept me. She assigned me functions and events after making sure that I knew exactly how to dance (Qausar, Cisgender heterosexual woman, aged 16 years).

Qausar was deeply obliged to her group leader who taught her the skills necessary for this work. Indeed, it was her leader’s responsibility to make sure that she looked ‘physically attractive’ and exhibited the ‘social skills’ (good manners) necessary to navigate higher-class social settings.

Some participants received training in communication styles that made it easier to interact with male clients for sex work. For instance, Qasim described how he interacted with his potential clients through eye contact:

It depends on the way you look at people. Having eye contact with them is important. Suppose I am in a market, and I want to catch a client, I target one and look into his eyes for a while. It makes him recognise me as a sex worker and if he is interested, he can then talk to me or ask for my mobile number (Qasim, Cisgender gay man, aged 24 years).

Vaqas talked about how peers helped each other to acquire these communication skills:

I learned it from my friends. They openly discussed everything with me, dealing with clients, negotiating on money etc. I imitate them in terms of dealing with my clients. I stand near the roadsides and try to become girlish. I look at men, wink and sometimes give them kisses from far. Sometimes I try to talk to men passing by me like hello, what you are up to, how big is yours, do you like sex etc. I have no problems doing such things. Those who are interested come and talk to me or take my mobile phone number to contact me later (Vaqas, Cisgender gay man, aged 17 years).

Participants became familiar with the sexual fantasies of their clients and tried to meet their expectations. Indeed, participants believed that meeting clients’ sexual needs was their ‘moral responsibility’ (Omar, Cisgender gay man, aged 24 years) and that meeting their needs would make clients return in the future. Hassan talked about new sexual positions that he learnt to satisfy his clients:

I did not even know about some positions which I learned from people. My clients often suggest weird ways of doing sex. I am not sure how to tell you. Some want to bend me down, some want to use a sofa or a chair, some like doggy style or any other way they feel comfortable with (Hassan, Cisgender gay man, aged 23 years).

Many participants, however, appeared to have feelings of regret regarding sex work. Sohail said he would not engage in sex work if he had adequate resources:

If I had money, I would not be into this stuff, but I am helpless, I have no other choice (Sohail, Cisgender heterosexual man, aged 16 years).

Many participants aspired to stop dancing and sex work, as both forms of work were illegal and heavily stigmatised in Pakistan:

I cannot stop doing sex work because I am not an educated person and that is why I cannot get a job. But if I could save some money out of it, then in the future, I could start a business (Vaqas, Cisgender gay man, aged 24 years).

In summary, jobs like dancing and sex work meant that participants needed to be adaptable and multiskilled. When participants decided to engage in this work, they could not do so without learning the skills needed to do it well. Here, peer groups functioned as an informal ‘institute’ that equipped participants with the skills needed to become successful dancers and sex workers. Nevertheless, to be more efficient and to ensure physical safety while practising this work, participants also needed to mobilise various material resources.

Most participants talked about how they needed certain material resources for dancing and sex work. Makeup and clothes were seen as essential items to achieve the required standards of attractiveness for dancing and sex work. Peer groups ensured that a constant supply of these items was available so that dancing and sex work were not interrupted if participants temporarily lacked income. It was the role of group leaders to ensure that participants had the makeup and clothes they needed for their work:

The group leader manages everything related to my dance functions. She is the one due to whom I entered this field. She provides me with clothes and shoes for dancing (Qausar, Cisgender heterosexual woman, aged 16 years).

Many participants who practised sex work described the resources they needed for this work. Some participants, for instance, feared visiting clients at their homes (in case of violence or theft), so they rented rooms to provide sexual services to clients. Although this accommodation setting provided participants with some degree of housing stability, they often had to change rooms as their sex work became known to people in the neighbourhood. Qausar described how she felt safer by practising sex work at an apartment her group leader rented:

I do it where we live. I do not go to others’ places because clients cannot behave badly here but if I am at their places, they can beat me and rape me as well. Here, I have a sense of protection that if someone is being problematic, my group leader can handle him (Qausar, Cisgender heterosexual woman, aged 16 years).

Emad’s interview indicated how he protected his money by not attending clients’ homes:

I do not go to clients because you are not always sure about their choices. Suppose if a client visits but rejects me, I do not care because I do not have to travel. It saves time and transport cost. Also, I think it is not safe to visit others. The main insecurity is related to money, what if I give a client my services and he refuses to give me money. I believe earning less money is better than being in a risky situation (Emad, Cisgender gay man, aged 25 years).

Omar, however, did visit some clients whom he trusted at their homes. At the time of his interview, Omar had done sex work for almost 4 years, enabling him to save enough to buy a motorbike, which facilitated his sex work:

My clients know that I have a bike. When they ask me to come, I can easily go to their offices, homes, or hotel rooms (Omar, Cisgender gay man, aged 24 years).

Many participants described how possessing mobile phones helped them to contact their clients and negotiate costs before they met, as Hassan described:

I finalise everything on a phone call before my clients come to me, especially, negotiating on the money. I meet them if they can pay what I demand (Hassan, Cisgender gay man, aged 23 years).

As most participants received some sexual health education from CBOs, they often possessed condoms to reduce their risk of HIV/STIs:

Using a condom is a must nowadays because you never know who is infected and who is not. I always use condoms with clients no matter what. This is what I learned from a friend who works for an organisation. She told me not to have sex without condoms ever (Washma, Transgender heterosexual woman, aged 22 years).

In short, through peer networks, participants accessed material resources (i.e. makeup items, clothes, rented rooms, and condoms), and mobilised them to engage in dancing and sex work. Dancing and sex work then enabled participants to generate income. Because participants knew there was a risk of physical or sexual abuse and HIV/STIs attached to dancing and sex work, they used rented rooms, mobile phones, and condoms for their physical and sexual safety.

This article is the first study to explore the strategies HYP in Pakistan use to practise dancing and sex work and to minimise their risks in doing so. We have taken a strengths-based approach to examine the extent to which HYP can be resourceful and capable in challenging circumstances. Consistent with studies from high-income countries,^22,38,39 we found that participants actively sought to learn new skills and mobilised resources through their peer networks to practise dancing and sex work and generate income while homeless.

Studies on HYP in Pakistan are generally problem-focused, highlighting issues such as illicit drug use, theft, violence, and unprotected sex in this population.^8,9,40–42 These studies largely focus on how sexual risk-taking of HYP increases their risk of HIV/STIs.^8,40 This problem-focused research has a role to play, as it orients health practitioners to deleterious factors that contribute to poor social and health outcomes among HYP.¹⁹ It is, however, important to draw attention to the capabilities that HYP possess, so that interventions can harness HYP’s strengths and contribute to their social inclusion.

The study findings problematise the view that sex work provides ‘easy money’.⁴³ Our participants described how they needed specialised training from senior peers to become competent sex workers and reduce the risk of sexual/physical abuse and HIV/STIs. Participants’ capabilities can be understood in terms of promotive factors¹⁹ that operated in opposition to certain risk factors (i.e. joblessness, the potential for sexual or physical abuse, and to some extent, risky sex). This analysis is consistent with some studies from high-income settings that suggest relationship-building, practising safer sex work, and generating income demonstrate HYP’s resilience.^38,44

However, our data also revealed how participants’ agency was constrained by broader social structures. Although dancing and sex work were believed to be the most viable options to generate income, this work was perceived as socially undesirable or unacceptable by the general public. This reinforced participants’ marginalisation and made them vulnerable to sexual risks and other forms of harm.

The sample size in this study was small. A multi-sited study with a larger sample size may have provided different insights. Many eligible participants refused to participate in the study as they learned they would have to discuss their sexual experiences. A study that could recruit peers as researchers could unearth more details about street-based sex work.

Our study provides insights into potential actions that may help to improve the lives of HYP in Pakistan. Although participants used certain skills and material resources to make dancing and sex work possible and successful, these works are illegal and are highly stigmatised.⁶ Importantly, being skilful in dancing and sex work does not mean HYP are prepared to enter the formal market, but it demonstrates their capacity to adapt to and navigate risky and complex situations. A multisectoral approach may help to produce conditions supportive of capacity-building that can improve HYP’s chances of securing jobs in the formal market.

Providing HYP with mainstream and technical education may help them engage in other work available in the formal market. A few CBOs in Pakistan enable vulnerable young people to become entrepreneurs by providing them with professional training in handicraft, dress designing, and beautification.^45,46 CBOs could consider linking HYP with vocational institutes that operate all over Pakistan and offer short courses related to beautification, dress designing and making, information technology, office management, and other technical and mechanical skills.⁴⁷ Indeed, a few CBOs in metropolitan cities like Karachi have been training HYP in the aforementioned skills, but the scale of their success is restrained due to limited resources.^48,49 The social welfare department could collaborate with CBOs and contribute to the skill-building of HYP. Conditional cash transfers could attract HYP to enrol in vocational courses, which could help them secure jobs that are more socially acceptable, further contributing to their social inclusiveness.

As many HYP engaged in dancing to generate income, connecting HYP who wish to seek a career in dancing to arts councils could be effective. Arts councils are not-for-profit organisations that work across Pakistan and promote music, acting, and (socially acceptable genre of) dance.⁵⁰ The CBOs that already work with HYP might need to collaborate with the arts councils to provide HYP training in various arts.

Programmatically, there is a need to ensure that condom supply among HYP who engage in sex work is uninterrupted so that their risk of HIV/STIs is reduced. Also, peer education interventions could increase HYP’s awareness regarding sexual health risks and safety.⁵¹ Globally, peer education has achieved good outcomes in health promotion among marginalised population groups.^52–56 Organisations in Pakistan could review the focus adopted by successful peer education programs when designing interventions for HYP.⁵⁷

The experiences of Pakistani HYP who practise sex work have not been adequately documented. Our study demonstrates that participants displayed agency within significant social structural constraints, and this reflects their resilience and efforts to improve their social and financial status. This is important to problematise commonly held assumptions about HYP as necessarily risky and unable to help themselves. Their abilities could be used for other forms of work that are more accepted in the sociocultural context of Pakistan. We have suggested some measures that policymakers, advocacy experts, and CBOs could take to improve the lives of homeless young people in Pakistan.

The qualitative data that supports the study findings are available on request from the corresponding author. The data are not publicly available due to privacy and ethical concerns.

The authors declare that they have have no conflicts of interest.

This research was jointly funded by the Higher Education Commission of Pakistan and the University of New South Wales, Australia, through the HEC-UNSW Joint Scholarship Program.