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Программы профилактики ВИЧ пропагандируют безопасность и благополучие секс работников

A recent study points out that in spite of high awareness levels about modes of HIV transmission and methods of prevention among mobile sex workers, brothel and non-brothel-based sex workers, these women continue to believe in myths and have misconceptions about the infection.

The study, conducted in 2006-07 by the Population Council in collaboration with two non-governmental organisations — CARE-India in Rajahmundry and CHANGES in Kakinada, found a majority of female sex workers (FSW) in these two towns were aware that their risk of being infected by HIV was high. While this perception of risk prompted many to get tested for HIV, they were unable to understand that by using substances like soda, turmeric and Dettol, they were preventing creation of fluids naturally produced by a woman's body to fight vaginal infections.

"This is primarily because their access to information and HIV treatment services is low. At the same time, while large-scale HIV prevention efforts with sex workers have been implemented countrywide, little attention has been paid to care related to their sexual and reproductive health (SRH). This is why the Population Council conducted a study to understand SRH needs of sex workers and assess areas and strategies for linkages with HIV," said Vaishali Sharma Mahendra, senior programme officer, Population Council.

Condom use

One important finding of the study among 348 female sex workers is that while they insisted on condom use with clients, they did not consider non-usage with intimate partners as unsafe. This was not just because they were afraid their lover/husband would leave them if they insisted on condom usage but also proof of their love and trust in their partners. "I used to use condoms with him earlier but not now. I love him and have faith that he doesn't have any other partner," said a 20-year-old HIV-negative pregnant sex worker.

"This is primarily because HIV prevention programmes have so far focused narrowly on promoting condom use with clients. Condoms have also been promoted as a way of preventing sexually transmitted diseases. So while condom use is high with clients, it is low with lovers and husbands. Clearly, they do not realise that they risk HIV and other sexual and reproductive health problems by such unsafe practices," said Vaishali.

Interestingly, almost all the HIV-positive sex workers used condoms with their clients and regular partners, as they did not want to transmit the infection to their partners. "I am already positive. So I do not want him to get it through me. Actually I take more care with my love. He is not even married and if he gets it then it will be difficult. He will spoil his life. So I take more care when it comes to him," said a 22-year-old HIV-positive sex worker.

Target of violence

However, this insistence on condom use is not always appreciated. A significant proportion of brothel-based and mobile sex workers experienced violence in the course of their work if they insisted on condom use against the wish of the customer. Besides being beaten and slapped, many were forced to have sex with more than one person.

The study also found that even though violence and alcohol use emerged as key risk factors in the lives of FSWs, the majority of women who entered sex work to support their family had no choice but to accept this sexual violence. Resistance could mean the loss of a monthly income of Rs 3,000-5,000.

This is also why nearly 85 per cent of FSWs continue with sex work even during pregnancy. Those who opt to end the pregnancy start sex work within a month of the abortion. Even HIV-positive FSWs preferred to stay away from antiretroviral treatment (ART) centres located in another town as it meant `wasting' precious time that could be spent in working and earning money.

Change in approach

Another reason why FSWs avoid services for the prevention of parent-to-child transmission and ART is the callous behaviour of the counsellors. "The counsellor said that you will die in a year. I said I am using medicines and spending Rs 3,000 per month. He said you are just wasting your money. Whatever you do you will die in one year," said a 25-year-old HIV-positive sex worker.

Clearly, there is a greater need to see FSWs as women in need of treatment and care instead of treating them as `target population'. While recognising sexual violence and alcohol use as having an impact on safe sex and condom use, programmes must address these risk factors along with stressing on the need for protected sexual practices irrespective of the type of partners.

Hindu Business Line, India