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Empowering Young People Through Comprehensive Sexuality Education
Models, Magic, and Meaning: Integrated Sexual and Reproductive Health and HIV Services
This speech was given by Ricky Swuanpyae from the Asia Pacific Network of Sex Workers (APNSW) on June 22, 2010 as part of the plenary session.
My name is Ricky and I am a male sex worker from Myanmar. I started to work as a sex worker when I was 18 to help pay for my schooling costs. I was at the time working as a housekeeper in a hotel. In fact, one night as a sex worker, I earn the same as a month as a housekeeper.
However when I first started as a sex worker I had no knowledge about STI and HIV and did not know how to insist on condom use. So I developed STIs. I only got to understand HIV and STIs when I was introduced to a Clinic where HIV and STI related health services are available. From such centres I and my friends learned from our peer sex worker about the risks of getting STIs and HIV. It was also there that I made a decision to be also be a peer sex worker to ensure others like me have access to prevention information and services. So increasing accessibility to such centres where one can get information and awareness about HIV and STIs is much needed.
Ladies and Gentlemen.
The reports of the Commission on AIDS in Asia and Commission on AIDS in the Pacific [links download a PDF document] have been fundamental in recognising sex work as a central driver of the HIV epidemic in the region. The Asia report calculates that up to 10 million women in Asia sell sex to an estimated 75 million men, who in turn have intimate relations with a further 50 million people. HIV prevention coverage reaches only one third of all sex workers in the region and programmes to reduce the demand for unprotected paid sex are simply not adequate. Coverage for male sex workers is unknown as they are rarely dissagregated from MSM statistics.
As a result of discriminatory laws and social practices, sex workers experience debilitating stigma and discrimination that undermine their ability to protect their health and well-being. Hence a crucial component of Sexual and Reproductive Health services must be identifying mechanisms for encouraging respect and acceptance of sex workers.
Sexual and reproductive health information and services must recognise the sex worker as a whole man, woman or transgender person. We have to acknowledge that female sex workers have sexual reproductive issues like other women but also understand they have special needs as sex workers as well. For example the need for more frequent pap screening. Further, SRH services for all sex workers must cover sexual and reproductive health issues such as access to a full range of contraceptives, including emergency contraception, and abortion; and screening and treatment for STIs including hepatitis.
Male and transgender sex workers need STI services that are equipped to diagnose and treat anal, oral and genital STIs. While stopping work when an STI is present is ideal, many sex workers may not be able to afford to do this. Male sex workers can be encouraged and taught to provide services that do not transmit STIs, for example not offering receptive an anal sex while they are being treated for an anal STI. Transgender sex workers may need access to specialist services that can address their HIV and sexual health needs alongside the issues created by use of hormones and sexual reassignment surgery.
All sex workers need access to competent and caring health care workers that are free from judgement, stigma and discrimination.
The basic idea of the 100% Condom Use (CUP) program was to increase use of condoms to 100% of the time, in 100% of risky sexual relations, in 100% of sexual acts taking place within sex entertainment establishments. Sex workers who do not comply with the requirements of the programme, and are discovered to be infected with HIV or and STI, usually face severe consequences, such as being dismissed from brothels, thus depriving them of income and healthcare.
The 100% condom programming continues to be used as a justification for the State to police and arrest sex workers and to justify compulsory testing.
In Myanmar, the 100% CUP is being implemented in 51 townships supported by UNFPA and WHO and National AIDS Program providing STIs treatment, VCT servicesand free condom distribution . In 2009, National AIDS Program reached only about 5000 sex workers all over the nation and distributed 14 million condoms. Sex workers are afraid to use Government facilities as the police continue to harass sex workers and arrest based on claiming that condom as evidence of sex work. On the other hand, NGOs with by sex workers as peer educators are reaching much larger number of sex workers. In view of their impact the Government and UN have finally renamed the programme “Targeted Condom Program”.
Law that does not allow selling or buying of sexual services, operating sex businesses and many anti-trafficking measures prevent female, male and transgender sex workers* from accessing safe places to work, health and social services and benefiting from legal and civil protections..
I urge Member States to support calls for the removal of punitive laws, policies and practices that block effective responses to HIV and progress towards the Millennium Development Goal. We need protective law enforcement practices and UNAIDS can help facilitate regular dialogue between sex worker groups and Ministries of Health, Justice and Interior, Parliaments, Judiciaries and police, and AIDS Authorities. There will be a decision point related to this at the PCB meeting under Non Discrimination of AIDS Responses and I urge Member States to support it.
Approaches to condom programming needs to address the power differentials which often exists between sex workers and police, government officials, health authorities and brother owners. The power given to police and brothel owners in the 100% CUP design reinforces already exploitative power dynamics, leaving sex workers open to further abuse and corruption. Condom programming must pay attention to clients and sex worker’s intimate partners, as well as male and transgender sex workers.
Here in Asia Pacific region, there is a need for comprehensive condom programming. Access to good quality condoms and water-based lubricants is essential. While there has been 100% condom use programme in place, there remains the problem of supply, lack of access and a failure to include sex worker organisations and sex workers in the design, implementation and evaluation of these programmes.
Finally I would like to conclude that, we, the sex workers community would ask for those present here help us demand that UNAIDS and co sponsors include sex workers in the design, implementation and evaluation of all programmes with sex workers and that we shift from a 100% CONDOM USE programme to a 100% CONDOM ACCESS programme at country level.
*The word “transgender” here acts to third-gender trans women and men. Most transgender men and women identify in a binary way, though in public health discourse trans women are lumped in with MSM. – editors’ note