Unsafe sex

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Discrimination against sex workers weakens HIV/AIDS prevention efforts


An expert advises her client on safe sex at a clinic in the central city of Da Nang. Vietnamese sex workers face many barriers accessing healthcare but the biggest one is stigma.

Hanh is scared to return to the clinic for her health check-up.

"The doctors there look down on me. I was hurt by the way they treated me," said the sex worker in Hanoi.

Hanh has joined a voluntary group of peer educators who have tried to encourage sex workers in the capital city to undergo periodic health check-ups. The group was founded two years ago and comprises of around 200 sex workers.

"It's always very hard to convince a sex worker to go to a clinic. The social stigma against them is everywhere and it's more evident in the hospitals," Hanh said.

She cited the example of a doctor who asked her group member if she was a sex worker in front of many people at the hospital.

"Since then I've never seen her return," the sex worker said.

Sex work in Vietnam is highly stigmatized and labeled as a social evil. It is viewed as immoral, damaging the nation's image and affecting national security, said Khuat Thi Hai Oanh, executive director of the Hanoi's Center for Supporting Community Development Initiatives.

In Vietnam, it is estimated that 9.3 percent of all female sex workers will be living with HIV in 2012. After injecting drug users and men who have sex with men, female sex workers have the third highest HIV prevalence rate, according to the United Nations.

Some NGOs argue that sex workers as well as their partners and clients should have a right to access comprehensive social and health services without discrimination.

[But] sex workers face many barriers getting the services they need, labor minister Nguyen Thi Kim Ngan said at a two-day workshop this week in the central province of Thua Thien-Hue.

"Some of these barriers are due to expense, convenience and knowledge, but most are a result of stigma, discrimination and fear," said Bruce Campbell, the UN Population Fund (UNFPA) representative for Vietnam.

The national Millennium Development Goals (MDGs) report, released just over a week ago, reported that while Vietnam has reached or is on the way to fulfill almost all MDGs, a set of targets for education, poverty, health and other areas, the goal on HIV (MDG 6) is likely to be out of reach by 2015 if access to services is not improved remarkably, especially for groups at high risk.

"˜Some real warmth'

Campbell said that involving civil society in service provision and piloting new approaches are the best ways to increase services for sex workers.

"Local non-governmental organizations are well-placed to support high-risk populations, and their track record with sex workers in Vietnam is strong," he said.

An approach that has been successful in various countries is the "one-stop shop," Campbell said. This model provides many different services in one user-friendly clinic, he added.

Oanh of the Center for Supporting Community Development Initiatives said the best way to reduce stigma against sex workers should be to start with a more altruistic attitude towards them.

"Policymakers and the entire society should be more tolerant of sex workers. Such attitudes would deliver far-reaching results in reducing the HIV prevalence in Vietnam."

Poverty, trafficking and violence drive women into the sex trade. Many women and men enter sex work in an attempt to escape financial hardship, said Campbell.

"We know, from what they tell us, that when they want to leave sex work they don't always have an easy way out. Let's address the socio-economic conditions that are driving more people to enter sex work every day, and trapping them in the trade," Campbell said.

Several experts including sociologists have noted that legalization of prostitution and a shift in focus from women to men would be a more rational approach to dealing with the issue. They have argued that most often, women are victims and not perpetrators of the "crime."

Historian and author Ruth Mazo Karras has noted in her book, "Common Women," that: "Prostitution exists today because women are objectified sexually, and because it is considered more permissible for men than for women to have purely sexual experiences."

Nguyen Thi Thao, another peer educator in Hue Town, said sex workers have endured enough suffering and isolation from society.

"They need more human treatment because they are also human," Thao said.

Thao said all the local sex workers she got to know have their own partners, for a very reason simple.

"I just need some real warmth from a man when I go to bed. People will never know how lonely we are after each working shift," said a Hue sex worker who spoke on condition of anonymity.

Despite the fact that a majority of partners of the sex workers are injecting drug users or unemployed people who just need money, Thao said the women ignored the dangers.

"They are scared of being alone," she said.

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