Partnering with Sex Workers in Viet Nam to Contain the HIV Epidemic and Protect Human Rights

  • 18 January 2011

An estimated 9.3 per cent of all female sex workers in Viet Nam will be living with HIV in 2012. Although sex work is illegal in the country and labelled as a ‘social evil’, there are about 31,000 sex workers operating throughout the country. Research by the UN in 2009 shows that the HIV epidemic in Viet Nam is still in a concentrated phase, with a high prevalence among most-at-risk populations. In the country, female sex workers have the third highest HIV prevalence as a group, after injecting drug users, and men who have sex with men. Supporting their right to information and protection can also help keep the epidemic from becoming more generalized.

HUE CITY, Viet Nam — When she married an overseas Vietnamese (or ‘Viet Kieu’) at the age of 22, Diu Trang had high hopes. She dreamed about starting a wonderful new life in America where her husband had grown up. However, very soon after her marriage in Viet Nam, her husband abandoned her, leaving her alone with a small baby and no income. Desperate to find a way to make ends meet for her and her child, Trang got involved in sex work.

In 2003, after 10 years as a sex worker, she had saved enough money to open a small karaoke bar in Hue. Because the competition with other pubs was so high, she recruited young girls to work in her business and introduced them to clients who would pay money for sex.

“Most of women enter the sex work for economic reasons. At the beginning, they are ashamed and frightened, but they hardly have any alternatives,” said Trang, who shared her experiences at the National Sex Work Prevention Workshop organised by Ministry of Labour, Invalids and Social Affairs (MOLISA) in Hue City last fall. The workshop brought together 250 participants from MOLISA (from both national and provincial levels), Ministry of Public Security, Ministry of Police, and Ministry of Culture, United Nations agencies, international and local organizations and the media.

Stigma and discrimination increase sex workers’ vulnerability to HIV

The Viet Nam Millennium Development Goal Report, launched last September, reported that while the country has reached or is on track to fulfilling almost all of the MDGs, the goal on HIV (MDG 6) is likely to be out of reach if access to services does not improve, especially for the three groups at greatest risk mentioned above.

According to Mr Bruce Campbell, UNFPA Representative in Viet Nam, sex workers still face many barriers in accessing the essential social and health services they need. Some of these barriers are due to cost, unavailability of services and lack of information. But the most significant barriers are often the least tangible: stigma, discrimination and fear.

Trang agrees: “Sex workers are often blamed, labeled and discriminated against. Many health workers often have a hostile attitude towards sex workers, not respecting the confidentiality of their HIV status and sometimes even threatening them by saying they will report their activity to the authorities. This makes many sex workers reluctant to seek health care services,” said Trang.

In addition, the concept of ‘social evils’ and the campaigns to ‘clean the streets of sex workers’ have created an atmosphere in which HIV and AIDS prevention activities have become difficult and sex work has been driven further underground.

At the workshop, Mr. Campbell emphasized that preventing HIV among sex workers goes beyond epidemiologic considerations. “It is a much broader human rights issue,” he said. “Sex workers have the right to access social and health services without discrimination or threat of arrest. They have the right to due process of law. And they have the right to voice their opinions and ideas about the laws and policies that affect them.”

Strengthening peer educators’ networks: a key to protecting sex workers from HIV

Trang closed her karaoke bar once she realised that it violated the law. She also became a peer educator after joining a training course on HIV supported by Hue Department for Labour, Invalids and Social Affairs (DOLISA).

Networks of peer educators have been established with technical support from international organizations in order to reach out to sex workers with HIV prevention information and support. “As a peer educator, I can communicate effectively with sex workers and establish a good rapport because I have a first-hand experience, and therefore can understand perfectly the overwhelming challenges these women are facing,” said Trang.

Gifted with strong communication skills, Trang is successful in increasing understanding among sex workers on how to protect themselves from sexually transmitted infections including HIV. Like other peer educators, Trang attends weekly meetings with sex workers in her community to provide them with the information on HIV and AIDS. She also counsels them on how to negotiate condom use with their partners or clients and other health related issues.

Nguyen Thi Thao, a middle-age mother with two teenage children who spent four years in jail as a drug trafficker, is another peer educator. At the workshop, she discussed how her life is now dedicated to helping other sex workers to protect themselves from HIV and stay away from drugs. “This job has changed my life and now I am trying to change other’s lives by providing sex workers with information on safe sex and encouraging them to have health check-ups regularly,” she said.

Piloting new approaches and involving civil society to increase services

Sex workers as well as their partners and clients have the right to access comprehensive social and health services without discrimination. These services include affordable access to male and female condoms, regular health checks, screening for HIV and other sexually-transmitted infections, and follow-up counselling and social support.

Involving civil society in service provision and piloting new approaches are the best ways to increase services. “An approach that has been successful in various countries is the ‘one-stop shop’,” said Mr. Campbell. “This model provides many different services in one, user-friendly setting. Based in the community, this model can be a fixed location or can be a mobile clinic, and could also serve as an alternative to the 05 centres [residential detention centrds where sex workers may be sent for rehabilitation]. Viet Nam certainly needs alternatives that can respond to the rapidly changing social and cultural norms,” he said.

At the workshop, most representatives agreed that sex work has become more fluid and difficult to control. Participants from different provinces actively contributed their recommendations for addressing the issue, such as strengthening vocational training for out-of-school children; enhancing peer education networks in communities; expanding care and support programmes, including community-based care and clinical services; and involving sex workers in harm reduction programmes.

Since 2008, the UN Joint Team on HIV in Viet Nam, led by UNFPA and UNAIDS, has supported the Department of Social Evils Prevention of MOLISA to address HIV and sex work, particularly by expanding sex workers’ access HIV prevention, care, treatment and other social services. A series of advocacy activities have been organized using a gender and human rights-based approach.

The contributions from female sex workers to the national workshop in Hue demonstrated the strong

Commitment from MOLISA to address the issue in an inclusive and participatory way. However, continuing efforts are needed to ensure that sex workers’ voices are consistently heard and their needs are taken into account during development and review of policies affecting them.

— Nguyen thi Hong Thanh

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