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HIV/AIDS and Sex Workers: Implications for Policy

HIV/AIDS and Sex Workers: Implications for Policy. Carol Jenkins Alternate Visions Bangkok September 15, 2005. “..communities, like individuals, cannot respond to the challenges of HIV unless they can express the basic right to be involved in decisions

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HIV/AIDS and Sex Workers: Implications for Policy

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  1. HIV/AIDS and Sex Workers: Implications for Policy Carol Jenkins Alternate Visions Bangkok September 15, 2005

  2. “..communities, like individuals, cannot respond to the challenges of HIV unless they can express the basic right to be involved in decisions that affect them.” -- Jonathan Mann HIV/AIDS and Sex Workers: Implications for Policy

  3. What Is Sex Work? • “Provision of sexual services or performances by • one person (prostitute or sex worker) for which a • second person (client or observer) provides • money or other markers of economic value” • Priscilla Alexander,Sex Work and Health: A Question of Safety in the Workplace in JAMWA vol 53, no. 2. The term “sex work” was coined by Carol Leigh (aka Scarlot Harlot) in 1979

  4. Commercial Sex Trade • Commercial sex is central to many of the the HIV epidemics of the region • Big business, organized, protected • But sex workers usually the easiest group to work with, respond quickly to respect

  5. Females • Biologically more susceptible than male partners • Stigma, external and internalized • At high risk of violence and sexual coercion • Little social power, education

  6. Males • Large numbers sexually active with both males and females • Highly stigmatized • Greater likelihood of risk-taking as part of masculinity

  7. And Transgenders • Transgenders occupy an important role in sexual transmission in many countries • Nearly always have higher HIV levels than any other group of sex workers • Gender-benders, cultural challenge

  8. Where epidemic driven by sex trade, large impact possible. Few countries cover more than 20% of SWs. Few programs reach all types of sex workers. Personal partners, clients, part-timers, suburban and rural SWs often missed. Condom use can rise very high if clients also addressed. Sustainable if group norms change but vigilance is required. Violence, rape, police harassment undermine effectiveness Improving social capital, social inclusion has impact on condom use. Best set of components Peer outreach Build social group Quality STI treatment Condom (M/F/Lub) sales Summary of Key Issues

  9. Components of Effective HIV Prevention

  10. Peer Outreach • Requires training, supervision • Requires payment • Training : technical knowledge, communication skills, safer sex, gender & society, working safety, legal rights, counseling skills, fitness, health, & beauty, M&E • HIV support group

  11. Exposed vs non-exposed: % MSW using condoms by type of exposure to intervention All effects p=.000

  12. Exposed vs non-exposed: % MSW showing condoms and seeking STD treatment last time by type of exposure to intervention

  13. Exposed vs non-exposed: Sex with personal partners:% MSW having all last anal sex with condoms and any last oral sex with condoms p=.000

  14. Dhaka Street Sex Workers-syphilis, condom use and STD treatment - 1999-2004

  15. Violence against Sex Workers-Bangladesh -2004

  16. Prevalence of gang rape among sex workers in Phnom Penh, Cambodia (n=1003)-2004

  17. Conditions at last gang rape among sexworkers in Phnom Penh, Cambodia

  18. Drug Use at last gang rape among sexworkers in Phnom Penh, Cambodia

  19. HIV Prevalence among injecting drug users and sex workers - Kathmandu

  20. Who Makes Policy? • Governments, politicians? • Protectors, NGOs? • Self-help groups of marginalized people?

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