Creating an enabling environment for HIV prevention in sex work

1. Creating an enabling environment for HIV prevention in sex work 赵鹏飞高级技术官员 世界卫生组织驻华代表处 Dr. Zhao PengfeiSenior Professional Officer WHO China Office Tel: 010-65327189 Fax: 010-65322359 E-mail: zhaopf@chn.wpro.who.int Website: www.wpro.who.int/china International Workshop on HIV Prevention targeting Sex Work

2. Challenges for sex work in the era of HIVAIDS • Low level of condom use during sex work • High HIV and STI prevalence among sex workers (SW) • Vulnerability: women more vulnerable than men, SW more vulnerable than their clients • Clients and business driven behavior • SW have limited power to negotiate safer sex with clients • Social stigma International Workshop on HIV Prevention targeting Sex Work

3. Creating an enabling environment Definition? An enabling environment is a set of attitudes, policies and practices that stimulate people to take action, coup with challenges and facilitate their success. International Workshop on HIV Prevention targeting Sex Work

4. Create an enabling environment • Government support & commitment • Social legal framework • Institutional arrangements • Building capacity of implementers • Available resources International Workshop on HIV Prevention targeting Sex Work

5. Create an enabling environment • Government support and commitment is essential International Workshop on HIV Prevention targeting Sex Work

6. RESOLUTION OF THE NATIONAL AIDS COMMITTEE CONCERNING THE APPROVAL OF THE NATION-WIDE EXPANSION OFTHE 100% CONDOM USE PROGRAMMEIN THAILAND (14 August 1991) “The governor, the provincial chief of police and the provincial health officer of each province will work together to enforce a condom-use only policy that requires all commercial sex workers to use condoms with every customer. All concern ministries will issue directives that comply with this policy. In case of Bangkok, the Bangkok Metropolis Administration and the Police Department are the operating agencies.” International Workshop on HIV Prevention targeting Sex Work

7. KINGDOM OF CAMBODIA NATION RELIGION KING “I would like to ask the Excellencies, Delegates of the Royal Government and Governors of all provinces and municipalities to efficiently apply the 100% Condom Use Programme countrywide.” Phnom Penh, 14th October 1999 PRIME MINISTER HUN SEN International Workshop on HIV Prevention targeting Sex Work

8. China: Political Commitment & Policy Madam Wu Yi’s Speech: “[The 100% CUPs in Hubei and Hunan] … have proven to be measures that have significantly decreases the incidence of STDs and played an active role in prevention and control of HIV/AIDS, and are worthy of further expansion to other communities. Such measures as the promotion of condom use and distribution of condoms in public places where some high-risk populations like to aggregate, including the installation of condom vending machines is to be encouraged as a measure to cut down the sexual transmission of HIV/AIDS”. International Workshop on HIV Prevention targeting Sex Work

9. Mongolia: Political Commitment & Policy Prime Minister’s decree: (21 April 2005, Meeting of Public Health National Committee) Approval for the expansion of the 100% target condom use in paid sex in the whole country. A decree has been issued where the Minister of Health is requested to expand the strategy in collaboration with other governmental and non-governmental organizations. Expanded from 1 site in 2002 to 11 sites in 2006 International Workshop on HIV Prevention targeting Sex Work

10. Create an enabling environment • Social legal framework International Workshop on HIV Prevention targeting Sex Work

11. “Disabling” Environment There are still barriers to condom promotion, particularly in countries where, due to socio-cultural norms, some leading groups block the promotion and use of condoms International Workshop on HIV Prevention targeting Sex Work

12. Enabling Environment China: AIDS Regulation issued by the State Council of the People’s Republic of China, effect 1 March 2006: Articles 29 & 61: “Condoms shall be widely available in entertainment establishments. Failure to comply, the managers may be imposed a fine of RMB 500 – 5000, or termination of license or business” International Workshop on HIV Prevention targeting Sex Work

13. Enabling Environment Viet Nam: The harm reduction strategies (including NEP, MMT, condom promotion) are included as main effective approaches for HIV/AIDS Prevention in AIDS Law (effect from 1 January 2007). International Workshop on HIV Prevention targeting Sex Work

14. “Disabling” Environment Most common argument: “Sex work is illegal. Therefore, we are unable to work with sex workers” International Workshop on HIV Prevention targeting Sex Work

15. Enabling Environment •100% CUP, peer education, and community based outreach programmes are the key to success in dealing with HIV risk among sex workers…•“No condom, no sex” is the key message to get across… International Workshop on HIV Prevention targeting Sex Work

16. “Disabling” Environment In many places, condoms are still used as an evidence of prostitution, allowing law enforcement personnel to arrest women/MB who are carrying condoms, or mangers making condoms available in establishments International Workshop on HIV Prevention targeting Sex Work

17. Enabling Environment “Condom will be no longer an evidence of sex work”: China, Myanmar, and a few others countries • A good practice from Mongolia: • Green card for sex workers participating in the project. • Purpose of the green card: • Access to STI services • and other information • Reduce harassment from • police Testing Card Code Name of the test Y/M/D Signature of tester Blood Microscopic Expiry date of the result: until Y/M/D Stamp from health department and the NGO Remember Use condom prevent HIV/AIDS International Workshop on HIV Prevention targeting Sex Work

18. 100% CUP: Myths and Realities • MYTH: The programme works where sex work is legal • Reality: Sex work is illegal in most countries, but the programme works • MYTH: The programme works only with brothel based sex workers; • Reality: It works with all types of sex work • MYTH: The programme works against the rights of sex workers • Reality: It empowers and promote rights of sex workers. International Workshop on HIV Prevention targeting Sex Work

19. Create an enabling environment • Institutional Arrangements International Workshop on HIV Prevention targeting Sex Work

20. Responsible sectors implementing sex work targeted programmes A. Health sector: 1) Condom procurement and supply 2) STI services 3) Health education and information to target groups 4) Collecting data on condom use from STI clients 5) Report of non-cooperative sex establishments to the responsible team B. Police sector: Management of non-cooperative sex establishments through a consensus process (i.e. condom committee) C. Local administration sector: Coordination among all sectors Management of non-cooperative sex establishments International Workshop on HIV Prevention targeting Sex Work

21. Other sectors involved in the implementation of programs targeting SW A. Sex business sector: owners, managers, sex workers, etc. B. Government sectors: social welfare, culture, entertainment industry registration, family planning C. NGOs: Condom social marketing, sex worker self-help group, other SW concern organizations D. Media-has to be cautious! E. Donors International Workshop on HIV Prevention targeting Sex Work

22. Create an enabling environment • Building capacity of implementers - Implementing effective programmes- Coordinating between programmes and sectors- Strengthening M&E- Providing STI services- Working with stakeholders, particularly business owners and sex workers International Workshop on HIV Prevention targeting Sex Work

23. Create an enabling environment • Available resources- Money- Manpower- Materials: condoms International Workshop on HIV Prevention targeting Sex Work

24. Examples from China • Calling meetings/seminars with all stakeholders, including health, police, business owners/managers International Workshop on HIV Prevention targeting Sex Work

25. Involving police in supervision and monitoring activities • Building up self-confidence of sex workers International Workshop on HIV Prevention targeting Sex Work

26. Involving beneficiaries and civil society in condom promotion and safer sex education International Workshop on HIV Prevention targeting Sex Work

27. THANK YOU! • Working with police is KEY to preventing HIV transmission through sex work • Condom use is a right for life security • We must promote the concept of “no condom, no sex” International Workshop on HIV Prevention targeting Sex Work