The ethical implications of culture: challenges in the care of female sex workers in India

Abstract

Cultural considerations call into question the frameworks of traditional ethical judgments. In India, cultural female sex worker communities depend on women for economic gain, but also justify their practices as "tradition". The care of these patients is complex, particularly because of limited interactions with the healthcare system, and poor negotiation power for the prevention of sexually transmitted infections. In this commentary, I confront a woman from the Perna community, a sex worker tribe in Northern India where wives are pimped by their husbands and mothers-in-law. As a physician treating Salma, you diagnose her as HIV-positive, but disclosure of her status will likely result in her death from her family. However, as a female sex worker, she is at high risk of transmitting HIV to other members of the local public, a number of whom are also your patients. How do we as clinicians navigate a challenging ethical situation as it pertains to the safety of an individual patient, the threat to public health of a community, and the need to understand the cultural challenges of unique but oppressive systems that are in place in countries around the world?