Asia HIV prevention programmes fail to reach sex workers

by Thin Lei Win | @thinink | Thomson Reuters Foundation
Friday, 15 October 2010 13:05 GMT

BANGKOK, Oct 15 (AlertNet) - National AIDS programmes in Asia often fail to prioritise those most of risk of infection and need to work on more targeted HIV prevention schemes to stop the disease from spreading, the regional director of the UN agency in charge of HIV/AIDS prevention said.

Aid agencies say sex work is one of the main drivers of AIDS in the region, home to the second largest number of people living with HIV after sub-Sahran Africa.

Sex workers are extremely vulnerable, with HIV prevalence among this group reaching 20 percent in some countries even though adult HIV prevalence in Asia is less than 1 percent for all countries except Thailand.

"In Asia, national AIDS programmes often fail to prioritise those most at risk of infection," Steve Kraus, regional director of UNAIDS, told AlertNet. Â?Hardly any country is devoting significant resources to programmes with sex work, for men who have sex with men and drug users.Â?

In a first for the region, government officials from eight countries and staff from United Nations agencies this week joined sex workers in Pattaya near Bangkok to hear first-hand experiences and look at ways to review policies and laws that keep sex workers from accessing HIV services.

A 2008 report by the Asia Commission on AIDS highlighted the potential scale of the problem. It said an estimated 10 million women sell sex to 75 million men in Asia, who have intimate relations with a further 50 million people.

Yet, only one out of three sex workers are reached by HIV prevention programmes. This is partly because financial resources on such programmes are shockingly low.

UNAIDS say programmes targeting sex workers and their clients account for between 0.1 and 10 percent of money spent on AIDS between 2007 and 2009 in six countries (Cambodia, Fiji, Indonesia, Myanmar, Pakistan and Thailand).


Sex work has been called the oldest profession in the world, yet it is also one of the most discriminated and criminalised.

Â?The ongoing reality of stigma and discrimination are driving the epidemics in this region,Â? Kraus said. Â?Sex workers face discrimination from so many angles and actors and this is a serious barrier to their accessing programmes.Â?

Kay Thi Win, chair of Asia Pacific Network of Sex Workers (APNSW) and programme manager of the Targeted Outreach Programme in Myanmar, said despite clear policies stating law enforcement officials cannot use condoms as evidence to arrest sex workers, in reality, the reverse is true.

Â?So sex workers no longer dare to carry condoms around with them even if they wanted to. They think if they have condoms, they will get arrested,Â? she told AlertNet.

Worse, UNAIDS is concerned what little money spent on HIV programmes for sex workers is being reduced further both internationally and nationally despite evidence that targeting sex workers is one of the most cost-effective ways of preventing HIV.

It said in Cambodia, the figure decreased from 5 percent of total AIDS spending in 2007 to 2.2 percent in 2008. In Pakistan it was 10 percent in 2008 but fell to 9 percent in 2009.

Targeted programmes, such as the one in Myanmar, can be very effective in reducing HIV infection rates because they involve the community.

The programme, which is part of Population Services International, started with 10 sex workers as peer educators. Now they have 350 peer educators and 18 centres all over the country, providing outreach, clinical services and HIV care and support.

Â?When our programme started in 2004, HIV infection rate among sex workers was over 20 percent,Â? Win said. Â?But the rate is less than 10 percent now.Â?


Â?(The success) is because of community involvement Â? they know how to persuade amongst themselves and they understand and trust each other. Sex workers know very well what issues they face, they just never had the authority to act,Â? Win said.

Â?IÂ?d like the non-governmental organisations (both national and international) to help sex workers so they have the authority to act and make their own decisions.Â?

But it is a challenging task to get everyone on board to establish focused programmes.

Â?It is a very polarised debate and people have different viewpoints where they position themselves on a moral high ground and they wonÂ?t move,Â? Carol Kidu, Papua New GuineaÂ?s first female cabinet minister, told AlertNet.

Â?So you try different tactics, new pathways that are less controversial... There is lots of work to be done to advance the agenda,Â? she said.

The meeting in Pattaya this week was organised by UNAIDS, the United NationÂ?s Population Fund UNFPA and APNSW.

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