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Disparities in the Cost of Living Adjusted Earnings of Female Sex Workers in India, Thailand, and the USA: A Need to Create an Equitable Economic Survival of Female Sex Workers

Financial necessity and desperation is the primary reason for females to enter into sex work. The health and well-being of female sex workers (FSWs) depend on the balance between their earnings and the cost of living in their local environment. Therefore it would be of value to examine the comparative cost of living adjusted earnings of FSWs in different countries to gauge equity or its absence in their financial state. Data about per client per encounter earnings for FSWs in Pune, India was taken from primary research conducted by the first author. Equivalent secondary data was acquired for the US and Thailand from an online literature review. Earnings after converting to US dollar values were adjusted against the cost of living in the respective environments of the FSWs and then compared. An FSW in India, (Pune) earned on the average US $4.40 after adjusting for the cost of living locally, while in Thailand (Bangkok) the equivalent earning was US $18.77 and in the US (Washington DC region) it was $101.79. These results suggest that an FSW in the US earns 23 times more, and a Thai FSW earns 4 times more than an FSW in India. There are numerous variables that affect the earnings of an FSW and the limited defined scope of this paper based on available data does not permit detailed analyses of causal or intermediate influencing factors. Nonetheless, it can be said with reasonable confidence that much needs to be done and can be done to mitigate the earning disparity, particularly in an emerging economy like India as shown in this small study, and that can perhaps be done best under the umbrella domain of a “harm reduction approach.”


Introduction
Female prostitution is universal and global, whether legalized or not. 1 There are many reasons why females engage in prostitution. Broadly these are poverty due to widowhood or separation, family debt, lack of education, limited economic opportunities, lack of family support, lack of legal or social protection, negative social circumstances in life, vulnerabilities due to migration, sex trafficking, or even cultural tradition like "Devadasi" (The tradition was widely practiced in Southern parts of India, it is a ritual that involves the dedication of young girls "temple dancers" to gods for marriage in temples. After reaching adulthood, they work as temple servers, combining dancing and other artistic functions with sexual services to clients) until as recently as 1998, 2 and less commonly out of personal choice. [3][4][5][6] There are numerous variables that affect the earnings of a female sex worker (FSW). In India prostitution is not technically illegal although numerous laws impose different degrees of restrictions on sex work. 7 In the USA (for most of the country except part of the state of Nevada) and Thailand prostitution is illegal. 8,9 India has more numerous FSWs (3 million in a population of 1400 million) than the USA (1 million in a population of 331.2 million) or Thailand (0.3 million in a population is 69.95 million). 1,[9][10][11] In India, the mean age of an FSW is 30 years whereas in the USA the average age is around 20 years and in Thailand around 24.6 years. 1,5,8 The literacy among FSWs is comparable in the 3 societies though it seems somewhat more in India. 1 Location of prostitution (where the FSWs solicit the potential clients) is more defined in India, whereas in the USA it is undefined, while in Thailand, the status is somewhere in between. 1,5,8 In India an FSW entertains about 7 to 9 clients a day whereas in the USA the number is about two clients and in Thailand about 5.41 clients per day. 1,5,8 What seems common though in all 3 societies is that economic survival is the primary driver behind entering into sex work for all FSWs.
Outside of the discussion related to prostitution, there is substantial discussion and pertinent literature about "living wage," 12 "poverty wage," 13 "minimum wage," 12 or "subsistence wage" 12 in the fields of economics and political economy. 12 Despite criticism, and ambiguity in defining and measuring them, these constructs provide a broad standardization or a benchmark of a sort around which public policy debates and decisions can be made.
FSWs work in their local environment which determines their economic survival. 12 A decent economic survival primarily depends on the balance between earning on 1 side and the cost of living on the other. 14 Along the line of discussion around "wage" as above, it could be of value to examine if FSWs earn equivalent money all over the world to attain economically decent survival in their respective environments. One way to find that out is to compare and contrast per client earnings of FSWs after adjusting their charges or fees by the cost of living index in their respective locales.
The first author of this article conducted research in 2015, in the city of Pune, Maharashtra, India, wherein earnings of an FSW per client were examined. 15 This article attempts to find out, using the above data, and other secondary data from the USA and Thailand, how the per client earning of the FSW in Pune, India stood in comparison with their counterparts in the USA and Thailand, after adjusting the incomes of the FSWs in the 3 countries of interest for the cost of living index. The article also comments on possible reasons for disparities in earnings and discusses solutions to ameliorate them to make economic survival feasible and equitable for FSWs globally.

Methods
The first author's research included capturing information about the rates earned per sexual encounter. The details of this work are published elsewhere. 15 Equivalent data for the USA and Thailand were collected via, a literature review pertaining to the state of sex work in the USA and Thailand.
The relative income of FSWs in India, Thailand, and the USA was calculated using the following method: • • The author's study adopted a mixed-method design. It was conducted in the red light area of Pune city, Maharashtra, India. Information about the number of brothels and FSWs was not available, which made it challenging to calculate the sample size. To resolve this issue the red light area was mapped for the number of brothels and FSWs. This resulted in finding 2000 FSWs residing in 330 brothels. The list formed the population to calculate the sample size. A sample size of 80 was determined to be enough for statistical significance in this population. In the first step, brothels were selected by systematic random sampling, followed by the FSWs who were available and willing to participate. Interviews of the selected FSWs were conducted in the brothels. The Ethics Committee of Savitribai Phule Pune University approved this study. Written informed consent was obtained from respondents. FSWs who were able to write, signed the consent. Those not able to read and write gave verbal consent to an impartial witness who signed the consent form. • • Rates negotiated by FSWs per sexual encounter were identified from the USA and Thailand via literature search. Average rates earned by female sex workers on the streets and in brothels were collected. Similar studies were reviewed for Thailand and the US. • • The cost per sexual encounter in US dollars for the present year was calculated for FSWs in the 3 groups using Tom's inflation calculator. 16 It includes the Consumer Price Index for All Urban Consumers (CPI-U), Annual Average, from the US government. When assessing price inflation for products and services, or looking at how wages are keeping up with those prices, this data set is used. The tool helped calculate and standardize the earnings for the FSWs in India, Thailand, and the USA. • • Cost of living index of each country was identified. 17 The index was obtained from a website that gave data on the cost of living index by city (https://www.  (Table 1).

Results
An FSW in India earns on average 300rupees (INR) 15

Discussion
The earnings of female sex workers can be determined by many factors some of which are discussed below.

Characteristics of FSW
There is an evident linear relationship between age and money earned in sex work. 19 Sohn, the economist presented a monetary equation: a prostitute's hourly earning reduces by 4.5% for each year of age, he discovered that FSWs between the ages of 35 and 40 earned 52.8% less per hour than women under the age of 20. This paper's finding highlights that females enter sex work at a young age in the USA and Thailand in comparison to India. Sex work in brothels especially thrives on young FSWs. Studies in Mexico reported that 40% of women to enter sex work as minors. 20 In Thailand, a study also reported that 40% were below the age of 18 years. 5

Clients Entertained and Money Earned
The wide range of income for FSWs studied in this article highlights the meager earnings of the Indian FSWs in comparison to the 2 other countries. The profile of clients visiting FSWs may be varied in the 3 countries. People visiting Thailand as tourists, and engaging in pleasure-seeking activities are inclined to visit FSWs. In India, clients are hesitant of visiting FSWs, because of the social stigma attached to prostitution. 21 In the US earnings are higher in alignment with the cost of living in the country. Rates are also dependent on the services provided by the sex workers, time spent, and frequency of engaging in the activity. The acceptance of the profession in Thailand and the US boosts FSWs' self-confidence to negotiate higher rates with clients, which is lacking in India.
The issue of prostitution is complex. On one hand, there is the moral-ethical issue of whether prostitution is bad and totally unacceptable, on the other hand, it appears to be an inevitable reality of life since time immemorial. The moment one accepts the latter point of view then the income disparity as elucidated in this paper demands attention and solutions and the following questions arise: Should prostitution be fully legalized so as to provide rights and much needed multi-dimensional support systems to FSWs to enable them to earn a decent income for survival? Should more work be done to destigmatize sex work and educate FSWs so that income disparities may be minimized? Should sex work be made legally and socially acceptable as an entertainment industry, so that the market provides an equal opportunity for FSWs to earn more?

Limitations of the Study
The earnings per sexual encounter for the US and Thailand are calculated on the basis of a literature review only. There was literature available for India and the United States, however, due to a lack of research in Thailand, the support of the gray literature (Grey literature refers to research that has been published outside of commercial or academic journals. Grey literature may not resemble a regular book or article in appearance. It could be in the form of a PDF or a report, the sources government reports, research reports, preprints, and news bulletins. URL www.libguides.com.) is used in lieu. This study does not have detailed information on FSW net earnings which may be reduced by sharing profits with brothel managers/pimps/agents, etc. Additionally, other earning sources such as tips or gifts in cash/kind are not considered in this study.

Conclusion
In a perfect world, a woman should not have to go into sex work at all, however, this is not the reality. A "harm reduction approach" to complex problems like prostitution would not deny that reality, but on the contrary, make the inevitable safer and more equitable for sex workers. FSWs experience different risks including infection with HIV/AIDS, violence, stigma, debt, criminalization, trafficking, and more. However evidence of effective strategies such as education, empowerment, prevention, care, occupational health and safety, and decriminalization, have been able to help FSWs, 22,23 thus facilitating a conducive environment for sex work and opportunities to earn equal and adequate pay. The limited aim of this paper is to elucidate the income disparity that Indian FSW experiences for a similar service she provides to her clients when compared and contrasted against FSWs in the US and Thailand.
While the solutions are far from being easy, it is hoped that if a "harm reduction approach" is applied to FSWs in India, it is possible that they would earn more for the same service they provide, which in turn can improve health, security, and stability in their lives.
The documented population of 3 million FSWs in a lowmiddle-income country like India needs to be verified, and future research to map the correct number is recommended. Framing and execution of social safety net policies such as rehabilitation, vocational/professional skills training, and exploring platforms for sustained sources of income are needed at this time.

Author Contributions
Both the authors listed have contributed substantially to the conception, formulation, drafting, and revision of this submission. The authors take public responsibility for its content.

Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The author(s) declared potential conflicts of interest as the second author is a member of the editorial board of the journal.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.