Tuesday, July 20, 2010

Informal Sex Trade Threatens to Undercut Gains in HIV

On a muggy evening, a handful of men in suits were quickly getting drunk in a beer garden here in the Cambodian capital. One man rested his hand on the thigh of a slender woman sitting uncomfortably in a short skirt.

A sign above the table read: "Be responsible. Use a condom."

"The customers play around with us all the time," said Neang, glancing at the scene unfolding at the next table. "They touch my breasts, or put their hands on my thigh while I’m sitting down. I don’t like it, but I have no other choice."

Beer promoters like Neang and others who work in places where Cambodia’s informal sex industry can be found are a growing concern for health experts in this South-east Asian country, as sex work shifts from traditional settings like brothels to informal ones in the entertainment sector.

Women who work in karaoke bars or beer gardens like this one may not identify as sex workers, but some occasionally sell sex to top up their meager earnings.

Neang, who asked that her full name not be used, said she recently decided not to have sex with her customers after she got married. In the past, though, many of the men who propositioned her would refuse to use a condom.

"The NGOs tell us to wear condoms properly to prevent HIV infection," she said. "But in the past, when I slept with customers, some insisted it was not necessary. It is hard to refuse."

Cambodia is seen as a success story in HIV prevention. It has managed to reduce its HIV prevalence rate among adults from a high of two percent in 1998 to an estimated 0.7 percent last year. If this trend continues, Cambodia will be on track to meet its Millennium Development Goals (MDG) for cutting HIV prevalence rates by 2015.

But critics say the government’s drive to stamp out human trafficking has actually exacerbated HIV risks for sex workers because it is forcing many to go underground. Without a renewed emphasis to reach those in the informal sex trade, Cambodia could face a stumbling block in meeting its MDG target on HIV.

Authorities have targeted suspected brothels as part of their crackdown on human trafficking. But advocates say the raids have resulted mainly in the arrest of sex workers, many of whom were driven to the trade by poverty, not trafficking.

The end result has been to push sex workers into hiding – and away from the reach of HIV prevention programmes.

"The more crackdowns, the more people will be pushed underground and disappear," said Tea Phauly, the most at- risk populations adviser with the Joint U.N. Programme on AIDS (UNAIDS) in Cambodia. "And it is very difficult to structure a response to reach these people."

Government studies here have shown that brothel-based sex workers are more likely to use condoms than women who sometimes sell sex in entertainment establishments.

But advocates say they now have difficulty reaching sex workers, many of whom have ended up in beer gardens and karaoke bars. "We can approach them, but not like before. They remain hidden," said Ly Pisey, a technical assistant with the advocacy group Women’s Network for Unity.

Ly says outreach workers used to be able to easily access brothels and talk to sex workers about HIV prevention and health care. "But now if you go … and ask, ‘Are you a sex worker?’ they say no," she said.

In March, Cambodian Prime Minister Hun Sen delivered a speech that was interpreted by police officials as an order to intensify a crackdown on human trafficking. Within two weeks, raids on suspected brothels sent more than 280 sex workers into hiding, according to a local non-government group that tracked the enforcement.

Police actions have eased up in recent weeks, but the raids are a cyclical part of a longer-term trend that has helped change the nature of Cambodia’s sex industry.

Bith Kimhong, director of the Ministry of Interior’s anti- trafficking bureau, said: "We shut down clubs that are related to sex trafficking. We want to eliminate such sayings that Cambodia is a place for sex tourism."

Sex workers, he says, are not the targets of such enforcement. "We know when closing such establishments, there are more people losing their jobs," he said. "We cannot avoid this. The benefit is that we want to guarantee safety and security for our country."

UNAIDS and Cambodian authorities are developing a plan to ensure that sex workers – especially those in entertainment venues like the beer garden Neang works in – are able to access HIV education and health care. Officials hope such a plan will include broad community partnerships, particularly with police officers.

"What we don’t want to see is a second (HIV) epidemic," said Tony Lisle, the UNAIDS country coordinator in Cambodia.

In 1996, the HIV prevalence rate for female sex workers was well above 40 percent. Ten years later, this rate had dropped to around 14 percent, according to the last countrywide survey.

"There’s been an enormous amount of work done in reducing both incidence and prevalence of HIV," Lisle said. "But we have to be mindful that if we don’t continue to roll out innovative, effective, scaled programmes in prevention and continue to normalise condom use, if we don’t keep the pace up and the intensity up with populations at risk for HIV, we could well see a reemergence of an epidemic - which we don’t want.


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Violence against women is a worldwide yet still hidden problem. Freedom from the threat of harassment, battering, and sexual assault is a concept that most of us have a hard time imagining because violence is such a deep part of our cultures and lives.