At a National Dialogue on HIV Prevention in Sex Work organized by United Nations Population Fund (UNFPA) recently at Bhurban, UNAIDS Country Coordinator, Arkadiusz Majszyk, said that HIV/AIDS is not only a medical problem but its is a social and economical problem.
Arkadiusz Majszyk was Chief Guest on the occasion. In his opening remarks he said that Pakistan is one of the country where reform of UN is taking place and because of that we will be soon be one family, one program, one project and be possible one house. We want to be one because almost 19 UN Agencies program delivery programs near to $400 million and to be more productive, we started to think about it how to do it better.
He said that UNAIDS is a joint program, trying to coordinate with other ten UN organization who are working within very complex areas of HIV/AIDS. We have a history of about 10 to 12 years but I think experiences of our jobs are giving chance to use, to be used in the reform. UNFPA is one co-sponsoring organization of UNAIDS. It is mainly responsible for the areas of HIV/AIDS and sex work.
We are here to review the current situation of commercial sex workers in the country, to share and discuss experiences and lesson learnt from HIV prevention on commercial sex workers and to identify key-barriers, challenges and strategies to work on HIV prevention in sex work group. Primary National Dialogue on HIV/AIDS means to have gatherments with donor, civil societies, and all other who are interested. As you all know that HIV/AIDS is not only a medical problem but its is a social and economical, we can share it more and more and in the future. I would appeal to all of you to expand this group of all others who can influence on this work.
Earlier, Dr. Safdar Kamal Pasha, Project Officer HIV & AIDS, UNFPA in his welcome address said that UNFPA main focus on sexual and reproductive health providing information and services related to HIV prevention with the contact of youth education, family planning, maternal and child health as well as management of sexually transmitted diseases. The other areas of HIV/AIDS prevention, UNFPA include the HIV prevention among young people, as well as linking sexual and reproductive health. This National Dialogue for HIV prevention is an opportunity for different stake holders including government, donor agencies and NGOs to learn from the experience of each other. It is a goof opportunity to learn from experiences.
Dr. Ayesha Rasheed of NACP said that PNACP has been providing services through association with provincial programs. All you will agree with me that there are still some gap in the system that still exists. And we are unable to cover those gaps and I am sure that this National Dialogue with help use in identifying those gaps.
Dr. Muhammad Saleem, Monitoring & Evaluation Programme Officer, UNAIDS Pakistan in his presentation on ‘Overall situation of epidemic in the country’ said that more than 96% news HIV infection cases are in low and middle income countries. About 1200 are in children under 15 year of age. About 5800 are in adults aged including both male and female. Almost 50% is women. 5700 death occur in a day in 2007.
Global summary of AIDS epidemic (December 2007) shows that estimate Number of people living with HIV in 2007 includes total 33.2 million
Globally HIV epidemic is classified into stages i.e. low prevalence, Concentrated and Generalized epidemic. Pakistan moved into a Concentrated Epidemic in 2004 in which Injecting Drug Users were 15.8%; Female Sex Workers were <1.0%; Male Sex Workers were 1.5 %.
Despite twenty five years of experience and knowledge in developing responses to the HIV pandemic, around the world, HIV prevalence among sex workers remains high, with less that one in three sex workers receiving adequate HIV prevention services.
There are many factors that lead people into sex work i.e. Poverty; Gender inequality; Indebtedness; Low levels of education; Mobility and migration. All this factors are present and prevalent in Pakistan.
Talking about Asia Epidemic Module, he said that Asia epidemic scenario is different from African epidemic scenario. Asia has more risk population as compare to Africa. An average Asian Epidemic Scenario shows that clients of sex workers are 10% of males, Females sex workers are 0.4% of females with one client per day, 30% condom use, Injecting drug users-0.5% of males, epidemic begins 1995, Men having sex women or men-2.0% of males. In Asia, prevention is focused then it will give us a big impact in future.
Ms. Uzma Tahir of Nai Zindagi giving her presentation on ‘DruguUse among sex workers’ said that there are some internal reason for initiating sex work like poverty, family break-up, drug use or injecting drug use spouses, trafficked, sold, broken marriages, tradition of inherited sex work etc.
Drugs are also used in sex work for pleasure e.g. party drug as well as psychological pressures of un-wanted pregnancies, abortions and other sexual and reproductive health problems.
The external reasons include ethics of sex work to entertain the client in any case makes sex workers vulnerable not only to violence and drug use but also to different harms including HIV&AIDS.
Dr. Quaid Saeed, National Officer for HIV and AIDS, World Health Organization in his presentation on ‘Clinical health needs of Sex Workers’ said that over 75% of new HIV infections occur through sexual contact. Sex workers are frequently exposed to HIV and other STIs. HIV prevalence as high as 60-90%. Only 16% of sex workers are estimated to have access to HIV prevention services. Early in epidemics, HIV and STI prevalence frequently rises rapidly among sex workers and their clients, especially where condom use is low and access to health care services poor. In the absence of effective interventions, high rates of transmission in commercial sex and drug injecting networks continue to drive HIV epidemics.
Other health issues related to sex work includes Normal menstruation in sex workers- use of sponges; Use of chemicals to clean genitals after sexual act; Use of chemicals to dry and contract vagina; Anal hygiene and bladder hygiene to prevent infections; Avoid use of alcohol and drugs during sex work; bad personal hygiene because of nature of work,; and use of drugs; pregnancy and sex work.
Dr. Haris Ahmed, Senior Program Manager – MNCH, Greenstar Social Marketing expressing his views on ‘Prevention of STI/HIV/AIDS among Female Sex Workers – Hyderabad’ said that UNFPA launched a project in Serey Ghat, Hyderabad from April 2003-December 2004. The objective of the project was Prevention of HIV/AIDS/STIs among brothel based female sex workers in SereyGhat Hyderabad.
Earlier, Dr. Haris highlighted the role of Greenstar. Greenstar has diseases prevention strategy. It mainly focus on Access to STI/HIV/AIDS Products & Services; Enabling to environment for prevention activities; awareness and understanding of STI/HIV/AIDS; condom promotion and distribution.
Representative from NACP/HASP giving his presentation on ‘Situation of sex work in the country – including networking with IDUs’ said that the prevalence of HIV among IDUS in Karachi, that was 0.4% in January 2004, jumped to 26% by the year 2005, thus indicating shift from “low prevalence” to “concentrated epidemic”.
Current situation of HIV/AIDS show that there are 90,000 estimated and 3700 reported HIV positive cases in Pakistan and a substantial majority is in Sindh, approximately between 35,000- 45,000.
The number of reported HIV/AIDS cases till September 2007are 1982 which is near about 50% of the total cases (HIV positive -1838), (AIDS – 144). In Sindh 81% are reported from Karachi.
Representative from UNFPA in his presentation on ‘ UN Mandate for HIV prevention in sex work: HIV & Sex Work – A comprehensive rights based approach’ said that in April 2006 the Cosponsors Committee of the UNAIDS agreed to develop a comprehensive, rights-based and evidence-informed UN response to HIV and sex work “Unified approach by the UNAIDS Cosponsoring agencies to the reduction of HIV vulnerabilities in the context of sex work”.
Principles for Effective Prevention includes Promotion, protection and respect for human rights; Locally adapted responses; Evidence-informed; Comprehensive in scope; Long-term and sustained; Coverage, intensity and scale to make a critical difference; Community participation
Representative from UNICEF giving his presentation on ‘Overview of child sex in Pakistan’ said that Children engaged in commercial sex work are most at risk for HIV.
All child sex work is sexual exploitation. All sexual exploitation of children is sexual abuse. All children have the right to be free from neglect; violence and abuse -including sexual (CRC).
He said that 53% of the children reported they had been used for commercial sex i.e. Nowshera: 100%, Peshawar: 92%, Quetta: 87%, Karachi: 43%, Multan: 47%, Sukker: 32%, Hyderabad: 28%, Sailkot: 24%, Rawalpindi: 24%, Lahore: 21%.
In the end recommendation session was held in which participants were divided in four groups. The recommendations made on location/services centre, motivation/ female staff, law enforcement agency, local influential /gate keeper, advocacy. group loyalty, training of service providers, self help group, life skill and micro finance.