Street Life,Street Death

Here's an interesting Economist article about HIV/AIDS management in critical areas.It reveals how a derogatory attitude  hampers the fight to curb the spread of AIDS.

Pedram

At a glance, the calf-length cape that a good-looking young model swirled around on stage appeared to be made of shaggy sheepskin, wildly inappropriate for the tropical climate of Pattaya, a seaside resort in Thailand. In fact its composition was more apt, if no less uncomfortable: hundreds of dangling prophylactics. Pattaya has one of Thailand’s highest concentrations of go-go bars, massage parlours and other shop windows for the sex trade. Parts of it call to mind Sodom-on-Sea. But this “Condom Fashion Show” was not part of the sleaze. It was staged at a recent United Nations-led “consultation”. The theme—sex workers and HIV, the virus that causes AIDS—was deadly serious, and the effort to turn it into burlesque rather heroic.

The consultation differed in more fundamental ways from the usual run of international conferences. Several dozen sex workers from eight countries (Cambodia, China, Fiji, Indonesia, Myanmar, Pakistan, Papua New Guinea and Thailand) attended as full-fledged participants, not just models in the fashion show. Sex workers are on the front line in the struggle against an epidemic that in Asia still claims 350,000 new infections each year. A 2008 report prepared for the United Nations by an independent commission confirmed that “men who buy sex are the single-most powerful driving force in Asia’s HIV epidemics.” It is thought that about 10m Asian women sell sex to 75m men, who in turn have a further 50m regular partners.

A simple and effective way to cut HIV transmission is to ensure that sex workers have access to condoms, know how to use them and always do so. Yet the UN estimates that only a third of Asia’s sex workers are reached by HIV-prevention programmes. And in some countries possession of condoms is taken as evidence of involvement in prostitution, and hence a cause for harassment, extortion or detention.

Yet sex workers themselves are normally excluded—or exclude themselves—from the air-conditioned conference halls where officials and NGOs discuss their plight. One reason is a poor grasp of English, a language, one male Thai sex worker complained, that “we learned only from our clients”. More importantly, sex workers often suffer from official disdain or condescension and are seen as the problem, not the solution.

Of course, the sex industry has not been ignored in the battle against AIDS. Thailand’s early successes are perhaps best-known. It was the first country in Asia to launch a “100% condom-use programme” in the early 1990s, and it managed to cut HIV prevalence sharply. The danger now is of complacency.

The best prevention schemes involve sex workers themselves. As a Chinese delegate put it, given the chance they do a far better job of educating and helping peers than do the UN or government. Myanmar, not normally cited as an outpost of progressive policy, has an HIV-prevention scheme seen as a model. Population Services International, an international NGO, has set up a “peer-to-peer” network with 18 drop-in centres around the country. There, 350 staff, mostly former or present sex workers themselves, dispense advice, discounted condoms and treatment for sexually transmitted infections. HIV prevalence among sex workers dropped from over 30% in 2000-06 to 18% in 2008.

Still, a Burmese sex worker made a passionate intervention at the conference lamenting the stigma her profession carries. In Myanmar as elsewhere, sex workers suffer at the hands of the authorities. And the worst perpetrators are often the police and other official protectors. Take Cambodia, recognised for bringing down HIV prevalence, partly through a condom-use programme. In 2008 a law on “the Suppression of Human Trafficking and Sexual Exploitation” led to the closure of brothels and a shift of the sex trade to bars and other places, complicating measures to prevent HIV. Worse, Human Rights Watch says, it has helped the police to beat, rob and rape sex workers “with impunity”.

A group of Cambodians wrote: “Our lives and our industry have been ruined by the anti-trafficking industry. We used to work in a brothel where we have safety and solidarity… Now we are scattered on the street where it is more dangerous.”

This is an extreme example of two problems besetting efforts to help sex workers. One is that, in most places, sex work is illegal, and almost everywhere frowned upon. Indonesian delegates complained that a new “Puritanism” accompanying a slow Islamisation of public life is forcing the sex trade underground and so making it more dangerous. As our debate showed, arguments for and against decriminalising prostitution are fierce and complex. But as long as it remains a criminal act, sex workers will be vulnerable to arbitrary abuse.

Second, the debate about sex work has become drowned in a campaign against human trafficking. That campaign, however justified its goals, fosters an assumption that all sex workers ply their trade against their will. Yet most migrant sex workers have left home for good reasons of their own—among them a desire to work away from their families, and to earn more money.

Parts of the debate, such as terminology, are as old as the oldest profession. One side regards “sex worker” as a dangerously obfuscatory euphemism. The other sees “prostitute” as degrading and derogatory. One sees those who sell sex inevitably as the victims of exploitation. But those seeking to be heard in Pattaya wanted recognition as independent actors who have made their own choices. They demand to be treated with basic human dignity just as they are.