Though this is an excellent article, the [him] moderator has to disagree with U Myint Swe of Ratana Metta:
"While there are no reliable statistics, I would say about 50 percent of sex workers are infected with HIV,” U Myint Swe said".
There are problems with sampling sex workers in Myanmar's sentinel surveillance. But eight hundred women in five sites in 2008 were tested and 15.5% to 23.6% seropositivity was found. The figure from the sentinel serosurveillance data is the best we have. Why double it without evidence?
[him] moderator
++++++++++++++++++++
A new frontier in HIV prevention
Sandar Lwin
Myanmar Times
August 2 - 8, 2010
The members of Khit Thit Kyal (Modern Star) are holding a meeting in a one-storey thatched building provided by Aide Médicale Internationale (AMI), a French non-government organisation, to elect a facilitator, or leader, for their group.
The two women, whom the meeting members refer to as Sayama (Miss), are helping and guiding them, explaining in full-mouthed language the qualifications and skills a facilitator should have.
Khit Thit Kyal was formed eight months ago by a group of sex workers from Dala township in Yangon Division as a means of supporting each other against the stigma that has been attached to their line of work.
“We are now seeing some positive responses to our attempts to reduce the social stigma attached to sex workers and people living with HIV and AIDS. Reducing discrimination against them is one way to help prevent the spread of HIV/AIDS,” said Dr Sid Naing, the country director of Marie Stopes International, an NGO focusing on reproductive health-related issues, on July 3.
“But it is just the very beginning. We have to do a lot more,” he added.
U Myint Swe, chairman of the Rattana Metta Organisation and National NGO Network on HIV and AIDS (3N), agreed the situation was slowly changing for the better.
“In recent years sex workers have come out openly to some extent so they can get assistance, such as anti-retroviral treatment (ART) [for HIV],” he said. “But the number of those who has come out openly is still very small in comparison with the total number of sex workers.”
Sex work is not the only career that suffers from social stigma in Myanmar – traditionally, butchers, undertakers and travelling performers were all viewed negatively in society.
But while the stigma attached to those professions has receded significantly or even disappeared, calling someone by one of the many slang words for a sex worker is still a grievous insult.
Myanmar people still often refuse to communicate with sex workers – even those who regularly frequent them, said Dr Sid Naing, who has given many talks and written articles about stigma and discrimination.
“People usually think that these girls are bad, rather than thinking that they have slipped into this kind of career unintentionally, accidentally or unfortunately – often because of somebody else’s greed. People think that these girls’ morality is the problem and they are not like them; that their daughters, nieces and friends are not like them either,” he said.
This stigma against sex workers, which has existed for centuries, is fuelling a thoroughly modern phenomenon: the spread of HIV/AIDS.
I’m made to feel inferior and isolated in my community, says Ma Cho, who is one of 45 members of Khit Thit Kyal. “I can’t build normal relationships. When I walk down the street, people always gossip about me behind my back,” she says.
“I dare not even let them people know if I have an illness. If I do, they’ll gossip that I’m suffering from A,” she says, using a colloquial reference to AIDS.
“I do this work in secret because people look down on us [sex workers],” says Thi Thi, another member of Khitthit Kyal.
NGOs working in the sector say Ma Cho and Thi Thi’s responses are typical of those heard from sex workers and it is a major challenge in controlling the spread of HIV/AIDS.
“The situation of sex workers in relation to HIV infections here is, generally speaking, not good. While there are no reliable statistics, I would say about 50 percent of sex workers are infected with HIV,” U Myint Swe said. “And the sex workers who are infected with HIV are always discriminated against at least twice as much as a non-sex worker with the disease.”
“Consequently, they don’t come out openly because they want to keep their normal relationships. They don’t contact health care officers and take safety measures. In this way they are often a safe niche for the virus,” he said.
Even more difficult, NGOs say, is reaching the clients of sex workers to provide them with health knowledge.
“Although it is difficult to reach sex workers, we can still find some of them. To find their clients is much more difficult,” said Dr Sid Naing. “So until now we still haven’t been able to effectively break the link of virus transmission between the primary client, who is HIV-infected, to sex workers and then to other clients,” he added.
Dr Sid Naing said most people now have some basic knowledge about HIV transmission but the fact infections are still occurring showed that organisations need to focus on encouraging behaviour change.
Sex workers are one of three main channels for HIV transmission in Myanmar, according to organisations in the field, along with injecting drug users and men who have sex with men. He said the discrimination meted out to these three vulnerable groups is leading to new infections.
“Transmission is no longer due to the ignorance of people about the disease … even most people who have little education and live in remote areas have heard about HIV, understand to an extent how it is transmitted and how to protect against it,” he said.
“It is clear that we can’t rely only on improving knowledge alone [to prevent HIV transmission],” he said. “We have to support people to live in more healthy ways for the benefit of both themselves and others. To reduce social stigma and discrimination is a key tool to attaining that goal. Only when we can reduce the discrimination sex workers and other people living with HIV face, will they be in a position to protect themselves and others.”
“When people feel like they are cornered and can’t improve their lives, that’s when they get careless about things like health,” agreed U Myint Swe.
Reducing this stigma, which has existed for hundreds of years, is no small task. Dr Sid Naing said while globally some gradual progress has been made, he thought it would be impossible to completely eradicate a society’s aversion to sex workers.
“We can only try to reduce the social stigma and discrimination [sex workers face] for the sake of public health. It is impossible to eradicate it completely,” he said.
For the members of Khit Thit Kyal – which is thought to be one of just 10 such groups in Myanmar – it’s a matter of safety and support in numbers.
“We aim to raise the moral and social standards of girls facing the same problems as us. I hope we can get support from organisations to be able to change our careers or at least to reduce our workload,” said Ma Ni Ni, the newly elected facilitator of Khit Thit Kyal, whose responsibilities include organising regular medical checkups for members and distributing medical knowledge.
“I have noticed the behaviour of the members of Khit Thit Kyal has changed since they formed the group last year. At that time, they quarrelled a lot but now they work together,” said Ko Khine Shwe Tun, a health education officer at French organisation AMI.
Reducing the stigma t
hese women face is still only one aspect of the fight to control HIV, Dr Sid Naing said.
“Of course we have some other solutions. The simple, relatively easy and effective solution is the condom,” he said.
“If you ask me what I desire most in HIV/AIDS prevention, my answer will always be to promote the habit of using a condom, to create favourable conditions for using a condom any time, every time.”
Editor’s note: The names of sex workers in this article have been changed to protect their privacy.
http://mmtimes.com/2010/news/534/news013.html
