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Promoting Safer and Healthier Sex as an Element of Linking HIV and SRH 联合艾滋病预防工作和生殖健康工作：

UNFPA International Workshop on HIV Prevention Targeting Sex Work in China, 2 – 3 April 2007, Beijing, PR China. Promoting Safer and Healthier Sex as an Element of Linking HIV and SRH 联合艾滋病预防工作和生殖健康工作： 推广健康和安全的性行为. Chaiyos Kunanusont HIV/AIDS and STI Adviser, UNFPA/CST Bangkok.

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Promoting Safer and Healthier Sex as an Element of Linking HIV and SRH 联合艾滋病预防工作和生殖健康工作：

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  1. UNFPA International Workshop on HIV Prevention Targeting Sex Work in China, 2 – 3 April 2007, Beijing, PR China Promoting Safer and Healthier Sex as an Element of Linking HIV and SRH 联合艾滋病预防工作和生殖健康工作： 推广健康和安全的性行为 Chaiyos Kunanusont HIV/AIDS and STI Adviser, UNFPA/CST Bangkok

  2. Why Promoting?为什么要促进这项工作 To increase number (proportion) of population who practice safer behaviours  to reach critical mass  to change societal norm 增加采取安全性行为的人数（或人口比例） -〉这些人数达到一个足以改变社会规则的决定性规模 -〉改变社会规则 What is needed?需要什么 Increased coverage逐渐增加覆盖面

  3. Current programme coverage目前项目覆盖面 Source: UNAIDS 2005, A scaled-up response to AIDS in Asia and the Pacific

  4. Review of sex work and interventions 回顾脆弱人群如性工作者的干预 A framework for priority linkages:Linking HIV and AIDS with SRH 在预防艾滋病工作中加入性生殖健康的内容 Comprehensive right-based approach for HIV/STI prevention in sex work: 在性工作者中开展以权力为基础的艾滋病/性病预防综合模式 Reducing vulnerability降低风险 Meeting the special SRH needs满足特殊需要 Building supportive environment建立支持环境 Content 内容

  5. Important issues要点 • Sex work happens in a wide range of settings in urban areas while it might not be well identified in rural areas. 性工作（暗娼）广泛存在于城市，也可能不为人知地存在于农村地区 • Most sex workers are highly mobile. 大多数性工作者属于高度流动群体 • Trafficked sex workers in brothels are likely to get HIV in the first six months. 性工作者在性工作场所的最初6个月最容易感染 HIV • Sex workers usually have regular partners and condom use is very low.性工作者通常有固定的服务对象（熟客），且安全套使用率很低 • Concerted interventions are needed. 需要采取协同的干预

  6. The 100% CUP百分之百安全套 Linked with STI service system, supported by National AIDS Programme 与性病服务结合，由国家艾滋病项目支持 • Elements: Enforcement and coverage. • 要点：执行与覆盖 • Highly effective for brothel-based EE. • 对固定性工作场所的性工作者很有效 • Replicable, scaling up difficult具有可推广性，但有一定难度 % 21 yo Thai men reported visited SW and % condom use, in the last 12 mo. Source: WHO, 100% CUP in entertainment establishments

  7. Sonagachi印度的例子 Linked with local STI clinics, supported by INGO, donors and the government 与当地性病门诊结合，由国际非政府机构、捐赠人、政府部门支持 • Reliance – Respect – Recognition • 依赖-尊重-认可 • Peer educators and friendly STI services • 同伴教育与性病亲情服务 • Resulted in Empowerment of SW • 性工作者权利赋予的结果 • Replicable, scaling up difficult 具有可推广性，但有一定难度

  8. What have we learned?学到了什么 • Successful HIV prevention programmes among sex workers were linked with STI services i.e. “respond to needs”. 成功的性工作者HIV预防项目包含了性病服务 • In order to create impacts, good coverage of interventions is needed. 保证干预的覆盖面才能产生好的项目效果 • For sustainability, collaboration among staff of government and community organizations must be in place. 保证和政府、其他组织的良好沟通，才能使得项目可持续发展

  9. Recommendation建议 • Combined – community led interventions 由社区牵头的干预 • Promote leadership among sex workers 促进性工作者中的领导力 • Team building and capacity building 团队和能力建设 • Economic supports 经济支持 • Ensure adequate education and nutrition 开展适当的教育，保证合理的营养 • Involve sex workers, gate keepers, community leaders and local authorities in designing interventions 邀请项目各方共同参与干预设计 • Include safer sex interventions for clients 应当包含对“客人”的安全性行为干预 • Ensure medical services for all　保证医疗服务 • Coverage　保证覆盖面

  10. Review of sex work and interventions 回顾性工作与干预 A framework for priority linkages:Linking HIV and AIDS with SRH 在预防艾滋病工作中加入生殖健康的内容 Comprehensive right-based approach for HIV/STI prevention in sex work: 在性工作者中的预防艾滋病/性病 综合模式 Reducing vulnerability降低风险 Meeting the special SRH needs满足需要 Building supportive environment建立支持环境 Content 内容

  11. Key linkages关键结合点 SRH生殖健康 HIV/AIDS 1. Learn HIV status了解ＨＩＶ局势 2. Promote safer sex促进安全的性 3. Optimize the connections between HIV/AIDS and STI services 促进HIV和STI工作的结合 4. Integrate HIV/AIDSwith maternaland infant health 促进HIV和母婴保健工作的结合 • Family Planning计生 • Maternal and infant care母婴保健 • Management of sexually transmitted infections性病工作 • Management of other SRH problems其他生殖健康工作 • Prevention预防 • Treatment • 　　　　治疗 • Care • 　　　　关爱 • Support • 　　　　支持 The “Framework”　框架

  12. Key linkages关键结合点 HIV/AIDS SRH生殖健康 1. Learn HIV status了解ＨＩＶ局势 2. Promote safer sex促进安全的性 3. Optimize the connections between HIV/AIDS and STI services 促进HIV和STI工作的结合 4. Integrate HIV/AIDSwith maternaland infant health 促进HIV和母婴保健工作的结合 • Family Planning计生 • Maternal and infant care母婴保健 • Management of sexually transmitted infections性病传播感染管理 • Management of other SRH problems其他生殖健康工作 • Prevention预防 • Treatment • 　　　　治疗 • Care • 　　　　关爱 • Support • 　　　　支持 Key linkages关键结合点

  13. Framework for Linkages结合点的框架 Four key areas四个关键的方面 Advocacy倡导 Services服务

  14. Promote safer and healthier sex 促进安全和健康的性工作 Advocacy倡导 • Develop policy that supports dual protection　倡导更健全的保护政策 • Policy on comprehensive safer sex services　倡导安全性服务政策 Services服务 • Broaden SRH services to reach key populations including through outreach　通过包含外展的一系列方式拓宽生殖健康服务的渠道 • Promote condom use for dual protection　促进安全套的使用 • Provide a full range of SRH services, including prevention for and with PLWHA　对受艾滋病影响的人群提供全程生殖健康服务 • Empower women and girls to negotiate safer sex　加强女性的性主动权，以采取更安全的性行为 • Include services that address GBV, offering emergency contraception and HIV PEP　提供包含关注性别暴力、紧急避孕和预防艾滋病职业暴露的一系列服务　

  15. Comprehensive condom programming综合安全套项目 Creating a supportive environment 创造支持环境

  16. Male and Female condoms 男／女用安全套 Comprehensive condom programming 综合的安全套项目 User’s Perspective on Condom Use High Transportation difficulties, Cultural barriers　障碍 It is essential that interventions are at bothindividual and community / society levels 从社会和个人两方面入手的干预才能获得成功 Myths, Misperceptions 误解 Opportunity 机遇 Condom use rate 安全套使用率 Capacity 能力 Gender equality Empowerment Training 性别平等培训 Motivation 激励 Availability, Affordability HIV/AIDS awareness Self risk, self efficacy 对ＨＩＶ的认识 Social support and community acceptance 来自社会的支持 Low Pre- contemplation 思考前 Contemplation 思考 Preparation 行动准备 Action - Maintenance 行动－保留 Behavioural change and maintenance 行为改变与维持

  17. To make impacts产生影响 Need to scale up effective interventions需要扩大有效干预 • Covering more people, geography and mandates.覆盖更多人、地理范围和要求 • More partners更多的伙伴 • Work harder! 　工作更努力

  18. Review of sex work and interventions 回顾性工作与干预 A framework for priority linkages:Linking HIV and AIDS with SRH 在预防艾滋病工作中加入生殖健康的内容 Comprehensive right-based approach for HIV/STI prevention in sex work: 在性工作者中的预防艾滋病/性病 综合模式 Reducing vulnerability降低风险 Meeting the special SRH needs满足需要 Building supportive environment建立支持环境 Content 内容

  19. Principles and approaches　原则与方式 • UNAIDS 7 principles of effective HIV prevention 联合国艾滋病规划署关于有效预防艾滋病工作的７个原则 • Human rights and gender equality　尊重人权和性别平等 • Differentiated and locally adapted 适应差异化和本地化 • Evidence-informed　尊重事实和证据　 • Comprehensive　综合服务 • Long term and sustained effort　长期和可持续的工作 • Coverage, scale and intensity 　保证覆盖面，规模和深度　 • Community participation　社区参与 • Participation of sex worker organisations, networks and communities 　保证性工作者组织，网络和社区的参与

  20. 3 Pillars 三个支柱 • Reducing vulnerabilities and addressing structural issues related to HIV and sex work 降低风险，解决HIV和性工作中的结构性问题 • Scaling up HIV, SRH and other health and social services, and addressing barriers to access in the sex work context 扩大HIV、生殖健康和其他社会卫生服务，解决性工作者获得这些服务的障碍 • Building supportive environments to expand choices and opportunities for sex workers and their community 建立支持环境，使性工作者和性工作者社区有更多的选择机会

  21. Paradigm shift 事例HIV Prevention in Sex Work 性工作中的HIV预防 After以后 Before以前 During现在 Poverty贫困 Income Surplus多余的收入 ??? Mobility流动性 Clients客人 Events Vulnerability脆弱性 Gender inequality Lack of education 性别歧视 缺乏教育 Sex workers性工作者 • Quitsex work • 离开性工作 • Social support社会支持 • Medical Rx 医疗

  22. Pillar 1. Reducing vulnerabilities and addressing structural issues related to HIV and sex work支柱一：降低风险，解决HIV和性工作中的结构性问题 • Poverty, gender inequality, migration and mobility, displacement, gender-based violence, gender identification, lack of education, and injecting drug use are key drivers and heighten vulnerability to HIV. • 贫困，性别不平等，迁移与流动，基于性别的暴力，性别认同，缺乏教育，静脉吸毒是导致感染HIV的高危因素

  23. Pillar 2. Scaling up HIV, SRH and other health and social services and addressing barriers to access in the sex work context支柱二：扩大HIV、生殖健康和其他社会卫生服务，解决性工作者获得这些服务的障碍 Sex worker HIV vulnerability is heightened through: 性工作者之所以更加容易感染艾滋病是因为： • poor access to health, legal, social and other services 不易获得健康、法律、社会和其他服务 • violence and harassment, stigma and discrimination 暴力、骚扰、侮辱与歧视 • inadequate access to condoms and other HIV prevention measures 获得安全套和其他预防艾滋病的支持不够 • inadequate treatment and prevention of sexually transmitted infections. 获得预防性病和治疗性病的支持不足 • Sex workers living with HIV often lack treatment, care and support 受艾滋病影响的性工作者难以获得治疗、关爱与支持

  24. Pillar 3. Building supportive environments to expand choices and opportunities for sex workers and their communities支柱三：建立支持环境，使性工作者和性工作者社区有更多的选择机会 • Skills enhancements and economic incentives provide opportunities for alternative employment and livelihood for those who choose to leave sex work • 对于那些自愿 “从良”的性工作者来说，要提供技能培训，提高经济奖励。 • Sex workers who choose to return to their families and communities, or establish new lives elsewhere, should be free from stigma and discrimination and from further economic, cultural or social marginalisation • 对于那些回到自己家庭和社区，或者建立自己的新生活的性工作者来说，他们应该不被侮辱、歧视。而且不应当在社会地位、经济地位、文化方面受到忽视和排斥

  25. Conclusions结论 • Sex work includes sex workers, clients and socio-economic and cultural factors 性工作包含：性工作者，客人，社会经济状况及文化因素 • Sex work is dynamic性工作市场庞大 • Three pillars 三个支柱 • Poverty is the root cause 贫困是根源 • Combined – community led interventions with rights-based approach are needed 我们需要的是以社区团体为主，基于权利尊重的干预 • Friendly SRH service for STI screening and treatment, condom programming 开展亲情的生殖健康服务项目，对性病进行筛查和治疗，促进安全套使用 • Reduce stigma and discrimination 消除、降低侮辱和歧视 • Ensure coverage 保障项目覆盖面

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