PAHO report on sex workers, homosexuals
Public health system lacking in confidentiality
December 18, 2006
Although female sex workers (FSW) and men who have sex with men (MSM) have access to STI/HIV/AIDS services such as information, condoms, treatment and testing, there are many complaints about the quality of these services in reference to the public health system.
This is according to a study conducted by Pan American Health Organisation (PAHO) Suriname Consultant, Julia Terborg.
Terborg was presenting the findings of a report on the “Perceptions and Behaviour regarding HIV/AIDS Prevention and Care among Female Sex Workers and Men who have Sex with Men”.
She found that there were glaring manifestations of stigma and discrimination as obstacles to accessing health services.
Terborg noted that public health workers would sometimes react and often displayed inappropriate attitude towards persons seeking attention.
The consultant also discovered that FSW and MSM were met with serious challenges that could further hamper the progress of controlling the dreaded HIV/AIDS pandemic.
The workers are exposed to unmet contraceptive need, persistent unprotected sex, violence, drugs, economic dependence on sex work and social exclusion.
In the study, Terborg said many male sex workers reported being frequently harassed by police.
According to her, physical and mental abuse by members of the public, job discrimination based on sexual preference, and lack of legal protection of sexual rights were also matters for concern.
Terborg noted that estimations of HIV risk seemed to be influenced by the type of sexual practice.
In conclusion, the Consultant stated that due to the persistent stigmatisation of public commercial sex, FSW prefer to remain a “hidden population”.
Because of this, Terborg said, they are therefore less likely to visit formal health facilities for job-related health problems.
FSW expressed the need for comprehensive health services for issues such as hypertension, diabetes, family planning, personal hygiene, drugs and alcohol abuse.
Terborg revealed that clients' behaviour appeared to be a major obstacle in efforts of FSW to have safe sex.
“FSW are hardly protected against criminal behaviour of clients. Physical violence, verbal abuse, robbery, reluctance to use condoms and sexual coercion are all client-related problems characterising the unsafe working environment of the FSW,” Terborg remarked.
She added that large groups of FSW are drug addicts and there is a huge call for care and support towards rehabilitation.
However, such facilities for FSW are unavailable locally and extremely limited for male drug users.
Due to continued stigma and discrimination, there is largely a reluctance of HIV-positive sex workers to be exposed.
In her recommendations, Terborg stressed that improvement of quality care within existing services is a key issue to be addressed urgently.
Terborg stated that the health sector must work to establish a comprehensive and integrated health service which will cover all areas relevant to FSW.
“Development of an outreach drug prevention, counselling, treatment programme for addicts, involvement of club owners and police to increase protection, security in the streets and the active involvement of HIV-positive workers in the development of policies aimed at educating and raising awareness of clients,” Terborg said.
According to the Consultant, the men complained of a lack of information on safe sex practices in sexual relations and existing MSM networks.
The MSM also disclosed the vulnerability of ‘straight givers' population which is very hidden and hard to reach as well as young, unemployed poor men.
They highlighted unsafe working conditions and high risk of violent attacks during sex at public locations.
“Reluctance among MSM and their clients to use condoms and unprotected sex with regular partners, the widespread pattern of multiple and changing partners, and reluctance to conduct HIV tests are also some of the challenges,” the consultant said.
She added that MSM also decried the lack of confidentiality at public health facilities and inappropriate attitude of caregivers against them.
The MSM also noted that there is hardly any systematic involvement of MSM in current HIV/AIDS programmes.
Terborg found that the MSM community is very diverse and was identified as ‘givers', ‘receivers', ‘cross-dressers', and ‘takers'.
She related that they can be differentiated by exclusive or non-exclusive involved in commercial sex, sex worker or client.
Much more than FSW, MSM are highly stigmatised and so perceive Guyana as a homophobic society.
“This hostile public climate is a main obstacle in reaching this target group. Due to their hidden character, most MSM are not likely to visit health facilities for job-related health problems and therefore an open outreach programme must be developed,” Terborg suggested.
Terborg said the participation of MSM in outreach activities, such as the distribution of condoms, lubricants, HIV counselling and testing, candlelight memorials and World AIDS Day events must be sought.
In her recommendations for this group, Terborg said health workers must be trained on issues of confidentiality, sexual diversity, communication skills and needs of the MSM population.