Sex work presentation 9.18.13a

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This is the first phase (qualitative) of the current project we are working on with the supervision of University Malaya and Yale School of Medicine.It will be publish as IBBS 2013 by end of the year. …

This is the first phase (qualitative) of the current project we are working on with the supervision of University Malaya and Yale School of Medicine.It will be publish as IBBS 2013 by end of the year. This slide is just a rough picture of what we are doing at the moment. This is copyright protected!

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  • 1. HIV TRANSMISSION 101 THINGS THAT CAN TRANSMIT HIV • UNPROTECTED VAGINAL OR ANAL SEX WITH SOMEONE WHO IS HIV-POSITIVE • UNPROTECTED ORAL SEX WITH SOMEONE WHO IS HIV POSITIVE IF THERE ARE SORES/ULCERS IN THE MOUTH • INJECTING A NEEDLE AFTER SOMEONE WHO IS HIV- POSITIVE HAS INJECTED WITH THE SAME NEEDLE THINGS THAT CANNOT TRANSMIT HIV • HUGGING/KISSING SOMEONE WHO IS HIV- POSITIVE • DRINKING AFTER SOMEONE WHO IS HIV- POSITIVE • SEXUAL INTERCOURSE BETWEEN TWO PEOPLE WHO ARE HIV-NEGATIVE
  • 2. HIV IS SPREAD BY ADDICTIONS AND ERECTIONS WHO IS AT RISK FOR INFECTION? • INJECTION DRUG USERS WHO SHARE INJECTION EQUIPMENT • INDIVIDUALS WITH MULTIPLE SEXUAL PARTNERS • INDIVIDUALS WHOSE PARTNER HAS MULTIPLE SEXUAL PARTNERS *HIV MUST BE PRESENT IN A SEXUAL NETWORK FOR THOSE WITHIN THE NETWORK TO BE AT RISK WHO IS NOT AT RISK FOR INFECTION? • INJECTION DRUG USERS THAT DO NOT SHARE THEIR INJECTION EQUIPMENT • MONOGAMOUS COUPLES/ABSTINENT COUPLES • SEXUAL OR INJECTING NETWORKS WHERE HIV IS NOT PRESENT Credit: Elizabeth Pisani
  • 3. WHO ARE SEX WORKERS? • SEX WORKER: SOMEONE WHO PROVIDES SEXUAL OR SEXUAL-RELATED SERVICES IN EXCHANGE FOR MONEY, DRUGS, OR OTHER GOODS/FAVORS • FEMALE, MALE, OR TRANSGENDER • DEROGATORYTERMS: PROSTITUTE, HOOKER, WHORE, MONEY BOY, • MULTIPLE PARTNERSHIPS PUT AT RISK FOR HIV • “BRIDGE” TO GENERAL POPULATION
  • 4. TRAFFICKING OR SEX WORK: SEX TRAFFICKING • FRAUD/TRICKERY • COERCION • CAN BE UNDER 18 • NO INCOME SEX WORK • CHOICE • CONSENT • OVER 18+ • RECEIVE INCOME WHAT IS THE DIFFERENCE? See: The Working Group on Sex Work and Human Rights. “Sex Worker Myths vs Reality.” Urban Justice Center. http://sexworkersproject.org/media-toolkit/downloads/08-Myths.pdf
  • 5. DRIVERS OF SEX WORK ENGAGEMENT Sex work Casual Supplemental Income Social Pressure Addiction Survival
  • 6. ECONOMICS OF SEX WORK • FAST CASH • BEST INCOME OPTION • ALWAYS A DEMAND SUPPLY AND DEMAND High Demand + “Reusable” + Low Maintenance = High Returns
  • 7. NOT ALL THAT GLITTERS IS GOLD •THE TROUBLE WITH ILLEGAL ACTIVITIES: • EXPLOITATION • POLICE BRUTALITY • RAPE AND THEFT • VERBAL AND PHYSICAL ABUSE • TRAFFICKING UNDERREPORTING OF VIOLENCE, MISREPORTING OF TRAFFICKING
  • 8. THE SPECTRUM OF VIEWS ON SEX WORK ABOLITION • ALL SEX TRADE ACTIVITY IS TRAFFICKING • OTHER OPTIONS FOR INCOME • POLICING REDUCES SEX WORK • HUMAN RIGHTS ISSUE: ENGAGING IN SEX WORK • SEX WORK LEADS TO VIOLENCE/CRIME EMPOWERMENT • SEX WORK IS WORK, TRAFFICKING IS SLAVERY • BEST OPTION FOR INCOME • POLICING DRIVES SEX WORK UNDERGROUND • HUMAN RIGHTS ISSUE: CHOOSING SEX WORK • SEX WORKERS SHOULD BE PROTECTED FROM VIOLENCE/CRIME VS IS THERE MIDDLE GROUND?
  • 9. ARE SEX WORKER RIGHTS HUMAN RIGHTS? SEX WORKERS RIGHTS? • TO HAVE CONTROL OVER WHAT THEY DO WITH THEIR BODY? • TO ENGAGE OR NOT ENGAGE IN SEX WORK WITH A CLIENT? • TO HAVE ACCESS TO CONDOMSAND LUBRICANT? • TO HAVE A SAFE WORKING ENVIRONMENT? • TO NOT BE BEATEN/HARASSED FOR BEING A SEX WORKER? HUMAN RIGHTS DECLARATION • ARTICLE 23: (1) EVERYONE HAS THE RIGHT TO WORK, TO FREE CHOICE OF EMPLOYMENT, TO JUST AND FAVOURABLE CONDITIONS OF WORK AND TO PROTECTION AGAINST UNEMPLOYMENT. • ARTICLE 23: (3) EVERYONE WHO WORKS HAS THE RIGHT TO JUST AND FAVOURABLE REMUNERATION ENSURING FOR HIMSELF AND HIS FAMILY AN EXISTENCE WORTHY OF HUMAN DIGNITY, AND SUPPLEMENTED, IF NECESSARY, BY OTHER MEANS OF SOCIAL PROTECTION • ARTICLE 5: NO ONE SHALL BE SUBJECTED TO TORTURE OR TO CRUEL, INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT United Nations. “Universal Declaration for Human Rights.” http://www.un.org/en/documents/udhr/
  • 10. SEX WORK IN MALAYSIA • LARGELY UNTOUCHED BY RESEARCH • SUSPECT STATISTICS/METHODOLOGY • ~60,000 SW TOTAL* • ~8,000 IN KL & ~12,000 IN SELANGOR = ~20,000 IN KLANG VALLEY • HIV PREVALENCE = ~4.2%+ • 10% IN SELANGOR *Lim, H.; Ang, C.; Teh, Y.; “SIZE ESTIMATION FOR LOCAL RESPONSES IN MALAYSIA FOR HIV PREVENTION IN SEX WORK.” Unpublished. August, 2010. +IBBS, 2012.
  • 11. WHERE IS IT HAPPENING? PRETTY MUCH EVERYWHERE. Female Transgender Male
  • 12. METHODOLOGY • Locations of SW • Concerns for SW • Access to clients for qualitative Meet with Key Informants • Social Network (size, heterogeneity, locations) • Health Seeking Behaviors • Health Concerns of Community • Experiences of Violence, Stigma, Discrimination QualitativeInterviews with Female, Transgender,and Male Sex Workers • Survey on sex work, health, substance use, etc. • HIV, G/C, and syphilis screening Respondent-Driven Sampling for Biobehavioral Surveillance
  • 13. WHERE ARE WE NOW? • 19 INTERVIEWS AND 1 FOCUS GROUP • 8 TRANSGENDER, 11 FEMALE • AGE RANGE: 25 – 63 • MALAY (10), MALAYSIAN INDIAN (6), INDONESIAN (2), MALAYSIAN CHINESE (1)
  • 14. WHAT HAVE WE LEARNED? • HIGHLY MIGRATORY • EVERYONE EXPERIENCES VIOLENCE • DIFFERENT MOTIVATIONS • VARIOUS DESIRES FOR INTERVENTION • DESIRE TO CONTINUE • VARIED CONDOM USE, HEALTH CARE ACCESS, HIV AND STI SCREENING • UNSAFE „PREVENTION‟ BEHAVIORS
  • 15. SEX WORKERS TELL ALL: RESULTS FROM A FOCUS GROUP OF 5 SEX WORKERS FROM A SEX WORKER ADVOCACY NGO “I say don't talk about sewing machines... [an NGO] gave sewing machine…That is not changing [us], you know. People want [us] to change, [they] must ask what [we] want.” [We need to reduce discrimination for transsexuals. I have always been discriminated against so I would like to stand for it. There is no freedom to work. We cannot do anything, but others, they can do everything. They talk bad about us, they punish us, they keep on blaming us.] -translated from Malay [Sex workers like me, a woman, even though I get a different job, I will work for 3-4 months to get enough salary but then I will want to go back to sex work to get more money.] -translated from Malay [I was caught a few years ago and put in lock-up. They forced me to get naked and do 10 push-ups in front of all the men and everyone saw my breasts. At that moment, I felt so embarrassed. Very sad.] -translated from Malay [We Malaysians get free first-line ARVs but have to pay for second and third line ARVs. But you have to understand that we have clients who are homeless migrants and can get deported. We must find a way to get them their medicine.]
  • 16. WHAT SEX WORKERS WANT “FREEDOM!” “Health Care Treatment for All” “No Violence to Sex Workers” “Support us, don‟t punish us” “We know our rights for protection and safety. We want these things” “I want to learn English and learn how to type” “I want salon classes and how to do massage” “I‟m tired of being homeless. I want a proper home to stay in.” “I don‟t want counseling. I don‟t trust anybody.” “I want a loan to start my own business.”
  • 17. “ ” WHEN PEOPLE KNOW I AM A SEX WORKER, THEY THINK I AM DIRTY AND CHASE ME AWAY. BUT I AM NOT DIRT. I AM A HUMAN, JUST LIKE YOU. FEMALE SEX WORKER, CHOW KIT WHAT WE‟VE LEARNED: SEX WORKERS ARE GOOD PEOPLE. THEY EACH HAVE THEIR OWN STORIES AND STRUGGLES, JUST LIKE WE DO. THEY DESERVE TO HAVE BASIC HUMAN RIGHTS. THAT MEANS ACCESS TO HEALTH CARE, FREEDOM FROM DISCRIMINATIONAND STIGMA, AND TO BE HIV-FREE OR LIVING POSITIVELY WITH HIV.
  • 18. WHY WE ENGAGE THE COMMUNITY • THEIR STORIES ARE IMPORTANT • THEY TEACH US WHAT TO ASK AND HOW TO ASK IT • IT ALLOWS THE COMMUNITY TO SPEAK FOR THEMSELVES • INFLUENCE PUBLIC VIEWS BY PROVIDING HOLISTIC PICTURE • MUST ENGAGE COMMUNITY TO GET PARTICIPATION IN RESEARCH • RESEARCH INTEGRITY
  • 19. TERIMA KASIH! NANDRI! XIE-XIE! THANKS! • A BIG THANK YOU TO THE FOLLOWING: • OUR COMMUNITY PARTNERS: PAMT, WAKE, PT FOUNDATION, AND THE GLOBAL FUND • OUR RESEARCH PARTNERS: CERIA AND YALE UNIVERSITY AIDS PROGRAM • PROF. ADEEBA, PROF. RUSLI, PROF. RICK, AND DR. JEFFREY WICKERSHAM • MY ABSOLUTELY AMAZING STUDY COORDINATOR, DR. RUBY BAZEER • AND OF COURSE, OUR PARTICIPANTS!