2-day National Consultation on HIV & Sex Work
By Jawaid Ali
A two-day National Consultation on HIV & Sex Work was organized by National AIDS Control Program (NACP) in collaboration with United Nations Population Fund (UNFPA) and Interact Worldwide recently at a local hotel in Karachi. It was organized
to review the current situation with regards to HIV/ AIDS in Pakistan and to discuss various challenges in the implementation of services and formulate appropriate response to address the epidemic by designing long-term and sustainable programmes in Pakistan.
On the first day of the Con-sultation, Dr. Hasan Abbas Zaheer, National Program Manager, National AIDS Control Program (NACP) informed that there is need to do lot of work to identify the vulnerability. The changing current political and economical climate in the country is likely to increase the risk and problems associated with HIV prevalence among the Female Sex Workers (FSWs) groups. We must be incorporated with FSWs interventions as a priority in our next strategy framework.
He further said that we all need to work very hard to further strengthen our activity in the area. We need to understand group reality and situation and strengthen the lessons learnt in previous 5 years and also to look into more opportunity for research and surveillance and increase the geographical expansion of our interventions.
There is also need to develop unified monitoring evaluation system and integrated with the rest of monitoring evaluation system of the national and provincial AIDS programs, he added. This consultation is an attempt to move forward and it will go a long way in achieving the goal.
Dr. Hasan Abbas Zaheer briefed the participants about HIV situation and response among FSWs. He said that FSWs are no more confined specific geographical area with cities which emphasized the need for strategic placement of service delivery packages.
He informed that in HASP Round 2 number of FSW per spot have reduced from 8.7 to 6.5 which indicate wider spreading out of sex work and FSWs seeking clients independently.
He also recommend of scaling up SDPs identification of gaps in services delivery and capacity building as way forward.
Dr. Ali Razzaque, Project Director, Provincial AIDS Control Program Punjab & Chairman, Sub-Committee on Vulnerable and High Risk Groups said that this consultation is more appropriate to discuss the existing working definition of FSWs. We must reach consensus on operational definitions which are acceptable to all and are applicable to our local context as well.
This is the time to discuss as we are stepping into next five years of implementation i.e. 2009 to 2013 of enhanced HIV/AIDS Control Program in which prime importance would be given in scaling up of HIV prevention services among vulnerable population groups all over the country in term to access to these marginalized sub-group as well as geographical expansion of the services.
Recalling the data indicated by HASP for home-based sex workers which is the largest junk of FSWs that there is about 33000 out of 76000 FSWs in the country.
There is a need to design and relook to identify structural barriers which impede access and enhanced the reach of services to this population. We should discuss critically for existing population in service provision. It must be critically evaluated that all sub-types of FSWs are operated in a clean manner. We hope that sharing of knowledge at this consultation shall be reflected in improvement of quality services.
Abid Attique, Country Program Advisor, Interact Worldwide stressed the need for beneficiaries. Civil society need to be applauded for new critical lost and progress. Now it is time to scale up and avoid duplication and mistake.
The involvement of FSWs is very important in our work. He also requested to conduct the session manually.
Dr. Daniel B. Baker, Representative, UNFPA said that in our experience on repro-ductive health, UNFPA support broad spectrum of mediate and long term initiative of sexual trans-mission of HIV.
Protecting sex workers from HIV infection benefit them directly, but it also has a large potential for HIV prevention for other segments of the population as well.
HIV prevention program with sex workers are highly cost-effective and evidence shows that keeping HIV level low among sex workers slow the spread of HIV/AIDS epidemic.
A great deal can be done to control the spread of HIV and to ease personal suffering, if we have acknowledged the existence of sex workers and respond to the need of HIV prevention, treatment, care for all of those involved. In many places, sex work is highly stigmatized where its existence is even denied.
In addition to service pro-vision, we must also address structural barriers including policies, legislation and customary practices that prevent access to appropriate HIV prevention, treatment, care services for all those who need them including FSWs, MSMs and IDUs.
The risk of infection is highest among sex workers because they are powerless and enable to negotiate or insist on the use of condoms by their clients. We need social and structural efforts to reduce the violence in sex work setting and this is appropriate.
It is vital to ensure that sex work participate in the development, implementation monitoring of the services including prevention and care directed for the benefit.
Linking HIV prevention program with relevant welfare services is essential for creating a supporting environment. Therefore a wide range of legal, economic and social services for sex workers are needed. This consultation will help us in addressing the issues and will come up with standard services that will help us in reducing HIV prevalence among this community.
Dr. Safdar Kamal Pasha, HIV & AIDS Officer, UNFPA presented the objectives and expected outcome of the Consultation. He said “ we have gathered here to review the current situation response to HIV epidemic among sex workers and to discuss various issues around definition and should reach to consensus.”
He shared the outcome of the project as consensus on various definition of sub population and recommended comprehensive service delivery packages and modalities of implementation.
Dr. Saleem, Monitoring and Evaluation Programme Officer UNAIDS/Pakistan provided a detailed overview of global AIDS situation and HIV transmission dynamics in Asia. He presented data till 2007 and informed that data of 2009 will be announced around the next World AIDS Day.
He said that after Africa, Asia will be the largest number of HIV/AIDS infection. He also said that life span of concerned HIV people would increase as in upcoming years and we taught ourselves the difference between the low pre-valence concentrated and generalized epidemic.
Uzma Athar, National Surveillance Officer, HASP-NACP presented special report of network of FSW in Kothi Khana and private homes. She said home-based FSWs are more empowered now.
Dr. Farhan Emmanuel, Chief Technical Officer, Canada-Pakistan HIV/AIDS Surveillance Project (HASP) presented over all situation of sex work in Pakistan. He identified gaps in programs and also suggested a way forward. He said that it is a high time that sex work’s clients needed are focused by the program.
Chaiyos Kunanusont, Technical Adviser on HIV/AIDS, UNFPA APRO, Bangkok presented UNAIDs guidance note on HIV and Sex Work. He pointed out that sex work means sex worker’s client and economy of a country. He informed that portion of male client sex worker determine epidemic trends in a country.
Mirza Aleem Baig, President, Gender & Reproductive Health Forum presented their project report. He shared the delay of funds of trans-mission and low nodding demand for screening camp and mobile population as challenges.
He said that, we have to empower FSWs community to carry on with the task of safeguarding themselves against this infection. He said FSWs demand vocational trainings.
Ms. Iram Shahzadi of Contech International Health Consultants presented contech interventions of 5 year FSWs project enhanced program. She told that they used clients for condom use and surety.
Dr. Noor Ul Zaman, Project Manager, CSC presented community support concerned project in Multan funded by Interact Worldwide. He said that this project is a model project for scaling up integrated and link SRH and HIV response with vulnerable community in Multan, Punjab.
Shukria Gul, President, Pak Plus presented the report of UNFPA funded project. She said that provision of ARD, CD Por and viral load facility and low enforcement agencies as biggest challenge.
Panjal Khan Sangi, Chairman, Mehran Welfare Trust presented HIV funded Mehran Welfare project. He shared that FSWs are risk of HIV testing and home-based FSWs prefer GPs for STIs services compared to STIs clinics.
Haji Muhammad Hanif, General Secretary, AIDS Prevention Association of Pakistan (APAP) provided the details of Tameer project as well as EBHR supported project. He informed the participants that they have formal CBOs and trained 100 FSWs.
Habib Ur Rahman, Director, Population Service Inter-national, Myanmar facilitated the discussion and make the participants to reach to consensus. He said FSWs have different venues.
Discussion at the end revealed around mobility of FSWs between different psychology. It was recommended that other then brothel based, Kothi Khana based, Home-based and Street based, FSWs category should be added as one of the sub-group.
On the second day of the consultation, Dr. Hasan Abbas Zaheer said that this workshop discussion and acknowledge sharing is a step forward to improve the quality of services delivery package for Female Sex Workers. In the end, he also offered vote of thanks.
Dr. Safdar Kamal Pasha read the written message of Joint UN Team of Osama Tawil. “Our strong commitments to support the national and provincial authorities and the civil society partners in their ongoing activities to scale up HIV prevention, care and support for most at risk population.
Multiple efforts in the country have been made on the issue of HIV prevention among IDUs, this workshop is a part of similar consultation addressing most at risk population already identified in national strategy framework on HIV. It is essential that in efforts to reach most at risk population we do not inadvertently contribute to the social marginalized and stigma of those involved but rather we seek ways to reduce
their isolation and subsequence discrimination that we face. As it is dismarginalisation that reduce their access to information and service and their work and vulnerability. Particular attention should be paid to reinforce the content and coverage of HIV prevention, treatment, care and support.
Dr. Ali Razzaque said that the different service delivery packages which are implemented through lesson learnt are extremely important.