How Efrah is improving the lives of sex workers in Delhi’s Madanpur Khadar

Dimple (name changed) works as a cook during the day and comes to Madanpur Khadar in South East Delhi at night for sex work. 

“She’s moved here from Kathiawar, you are  meeting the Gangubai of Delhi!” joke the other women sitting around, who all share a small room in the slum waiting for calls from clients. 

“I want to save up money for myself. The amount I earn cooking goes to support my family,” explains Dimple.

While the residential localities and Okhla Industrial area in Delhi are quite familiar, this part of the city feels different. 

Madanpur Khadar, the resettlement colony, is home to people from Uttar Pradesh, Assam, Bihar, and other states, many of whom work as domestic help, labourers, vegetable sellers, or ragpickers for the affluent areas of southeast Delhi. Yet, they struggle to access basic amenities like electricity and water. It was in these narrow lanes that I came across Efrah–a non-profit working to support women and children in the area. 

Founded in 1997, Efrah’s mission was to help the urban poor and the disadvantaged by improving their access to basic amenities and education.

Over time, the organisation’s work has expanded to focus on livelihoods, healthcare, and addressing issues related to domestic and sexual violence for women and children. 

Since 2008, Efrah has partnered with the National AIDS Control Organisation (NACO) to raise awareness about HIV/AIDS among women involved in sex work. 

Sudha Sinha, the Project Manager, is a trained nurse who joined Efrah in 2008 as a counsellor to work on a government project. Over the years, Sinha and her team have come across many cases in the community.  

“Many of the women engaged in sex work here see it as a quick way to earn more, out of both necessity and aspiration. Their families don’t know that this is how they earn,” she says. Some women, like Dimple, are employed in various other jobs as well. 

Efrah’s office operates as a drop-in centre, with a clinic where women can come for check-ups, medicines, and contraceptives, which is funded by NACO. In addition to these services, Sinha and her team organise meetings to educate women on safe sexual practices. 

“Awareness and knowledge is the best way to prevent HIV and the spread of STIs,” she says.

Overcoming challenges 

“When we started, we mostly saw married women doing this work. Their husbands would drink and not go to work, which made this a way for them to earn daily,” says Sinha. 

Recounting the early days of the project, she says, the team conducted door-to-door surveys to identify women’s health concerns. Through discreet questioning, they could identify women with symptoms of sexually transmitted infections (STIs), and offer them free treatment and HIV testing. 

By emphasising on confidentiality and free treatment, they could get a few women to admit they were doing sex work. Many of them also became peer educators to spread the word about Efrah’s services. 

“It took us three years to get women to come to us and accept our help,” says Sinha. Through street plays, video screenings, and placing condom dispensers in public toilets, NACO has been able to help spread awareness about HIV. 

But some residents of Madanpur Khadar started objecting to the videos and condoms in public toilets. The stigma around HIV was rampant around 2000. “Back then, even telling our own families that we work on HIV, that too with sex workers, was scary,” says Sinha.

There were some other challenges as well. Women were wary of interacting with Efrah workers for the fear of being seen and stigmatised. Over time, more women began seeking help. But for many, hiding their work from their families made it difficult to seek treatment or get tested.

Raising awareness

“If they don’t want to use protection, I simply shoo them away,” says Saroj (name changed). “I have had a difficult life. I’ve been in contact with Efrah for two years now, and I know why money is not worth more hardship.” 

Sinha and her team regularly talk to women about the toll that pregnancy, HIV, and STIs can have on their health, and that no amount of extra money can make up for the physical and emotional harm. 

The outreach workers are also a point of contact and support for these women, especially in times of crisis. They visit the women every day and get them tested for HIV testing at nearby centres. 

The women say they walked almost five kilometres as autorickshaws did not reach such remote pockets. The long walks were through littered roads and sites where ragpickers segregated waste.

Situations of violence or extortion are also common. Once, a group of people claiming to be from the Crime Branch extorted a large amount of money from these sex workers. Being a resettlement area, many of these women lack documentation, making them even more vulnerable.

Sinha’s team has also worked with minors as young as 13, and this has been challenging. 

She mentions that in cases where sex workers are minors, all services have been provided to them, but without registering them on any record. “We are mothers ourselves, and it’s difficult to see these cases. Providing them with the education and support they need is more crucial at that moment, and to guide them towards alternate career options.” 

Supporting the community

While Efrah’s current project focuses on health, it also offers vocational training and education programmes for girls enrolled in CBSE Open School, helping them explore alternative careers. 

So far, Efrah has helped 6,820 women by registering them to NACO’s beneficiary portal, being in contact and accompanying them for regular HIV testing. Today, 96% of these women are HIV free, with only 27 active cases. 

From this year, the organisation will expand its focus to include injecting drug users — identified as another vulnerable group by NACO, for HIV awareness and treatment. 

Efrah’s success can be attributed to its continued efforts in working with the community, and viewing residents not just as recipients of services but as active partners. 

The outreach workers calculate the requirements for contraception and medicines based on the needs conveyed by the sex workers. The organisation relies on the network and relationships to maintain and track progress, ensuring women get the care they need.