Hostile public main obstacle to reaching groups at high risk for HIV - study finds
Stabroek News
December 15, 2006

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A recent study done among Female Sex Workers (FSW) and Men who have Sex with Men (MSM) has found higher levels of HIV-related stigma and discrimination against MSM than FSW and the hostile public climate is the main obstacle to reaching both groups.

The study also discerned that FSW found it more difficult 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 FSW," the study concluded. All of the persons interviewed were from Georgetown.

The study which was initiated to determine the 'Perceptions and Behaviour Regarding HIV and AIDS Prevention and Care' among the group, was done by Julia Terborg, a consultant from Suriname for PAHO and the Canadian Society for International Health (CSIH) in collaboration with the Ministry of Health. The findings were presented yesterday at the Hotel Tower.

Minister of Health Dr Leslie Ramsammy said while the country has made progress in the HIV and AIDS fight there is need for consistency in targeting the vulnerable groups such as FSW and MSM. He noted that too often in the past countries in the Caribbean implemented interventions that were not informed by data and specifics given what was happening on the ground. PAHO/WHO Representative Dr Kathleen Israel concurred.

Some 107 FSW and 67 MSM were interviewed during the research and they varied in terms of types of sexual behaviour, health status, age, gender, working conditions and socio-economic status.

It was stated that approximately 78% of the MSM were younger than 30 years with 16% of that group being between the ages of 15 and 19. The youngest interviewee was 16 and the oldest 50. In comparison 82% of FSW were in the 25-49 age group and their ages varied between 17 and 51. Young people between the ages of 15 and 24 accounted for 15% of the FSW and 37% of the MSM.

According to the research, 88% of MSM interviewed were involved in commercial sex and recruited mainly in the streets, night clubs and bars while the remaining 12% mainly recruited through MSM networks and are not commercial sex workers.

It was found that the educational level among FSW was much lower than MSM and that the women were financially much more dependent on sex work than the men.

"While 82% of the FSW declared sex work as the principle income source, among MSM this proportion was limited to 12%," the research found. Interestingly, the study found that more of the men had regular partners than the women and some 72% of the women had children aged one to ten years old. For the men, one in every four said they had between one and three children.

FSW

According to the study, 39% of the FSW do not use contraceptives, while 43% had at least one abortion. "An alarming 42% reported (having) complications after the abortion," the study said, while adding that regular use of alcohol, marijuana and hard drugs was reported by 69% of the women. Sixteen percent of the women had a sexually transmitted infection (STI) and 37% experienced violence in the last year. "These findings show high exposure of FSW to unwanted pregnancies, abortions and related complications, untreated STIs, substance abuse and (sexual) violence of clients," the study said. And although 78% of the women believed they could become infected with HIV and 94% reported consistent condom use with clients, prevention was not always adequate. It was concluded that condom use was still inconsistent, particularly during sex with regular partners.

MSM

The study pointed out that contrary to the women the FSM community was much more diverse. "Different types of MSM were identified: 'givers' or 'takers' and cross dressers."

MSM self image was mainly defined in terms of behaviour and less in terms of a fixed sexual identity. "Sexual lifestyle of most MSM is characterised by a relatively high number of changing partners and short-time sexual relationships. Many MSM still experience great difficulties in having and maintaining protected sex, even HIV + MSM," the study said. It was noted that unprotected sex was most likely to occur in sexual contact with a regular partner, while estimations of sexual risk for HIV also seemed to be influenced by the type of sexual practices, and sexual context/relation.

While both groups have access to STI/HIV/AIDS related services such as knowledge, condoms, early treatment of STI, and HIV testing, there were many who complained about the quality of the services, in particular public health services.

Long and inconvenient waiting hours, lack of confidentiality, limited pre-test counselling and inadequate post-test counselling, lack of informed consent, the prejudiced attitude of health workers and their lack of adequate communication skills, were some of the issues listed. And HIV positive respondents expressed specific problems related to post-test counselling, confidentiality, procedures of antiretroviral (ARV) provision, adherence to the treatment, psychosocial support to people living with HIV/AIDS (PLWHA) and involvement of PLWHA in HIV and AIDS programmes and development policies.

"HIV infected FSW and MSM stressed the double burden of stigma and discrimination. First they suffer stigma and discrimination based on their sexual lifestyles and second because they are HIV positive." Most of the respondents expressed a strong need for psychosocial support since in times of problems they mainly rely on close family and to a less extent on peers. Structured systematic psychosocial support from community resources, such as specialised government institutions or non governmental organisations, "€¦is obviously absent."

In relation to the FSW the study recommended that there be an improvement in quality care of the existing services, improvement in confidentiality and attitude of health workers. Further there should be a strengthening of outreach work and establishment of outreach (mobile) comprehensive and integrated health services, covering all health needs for FSW. The development of an outreach drugs prevention, counselling and treatment programme for drug addicts was also recommended along with the involvement of club owners and police to increase protection and security in the streets and in clubs.

With regard to the MSM the recommendations included raising the profile of MSM through their participation in public activities such as World AIDS Day events and candlelight memorials. There should also be outreach education, including the distribution of condoms, lubricants, information leaflets and advice on HIV counselling and testing and empowerment.

Also it was posited that forums be created where different groups of MSM could communicate openly on issues affecting them, and obtain support for the difficulties they face. There should also be training of peer counsellors to provide education to MSM and to their families to promote self-esteem, a positive attitude towards sexual health and lasting behavioural change. The objective of the study was to assess the priority health needs of FSW and MSM and provide information for improvement/expansion of the existing health services. It also sought to develop an understanding of specific social, economic and cultural factors that could strengthen the target groups in their efforts to negotiate for safe sex and protect themselves from infection with STI/HIV.

The findings of the research will be used for the development of targeted and tailored STI/HIV/AIDS care, treatment and support programmes for FSW and MSM in Georgetown. (Oluatoyin Alleyne)