Program Experience:
HIV Risk Reduction among Young FSW in Vietnam
Le Quang Nguyen,
Protection Specialist Vietnam Country Office
Lisa Sherburne, HIV and Adolescent Health manager
Presented by: Bradley Kerner,
ARSH Senor Specialist
HIV in Vietnam
• Relatively new epidemic
• Remains concentrated
among people who
engage in sex work, IDU,
MSM (& sexual partners)
– Highest in men, young
people, in urban areas and
some borders
Vietnam
Cambodia
Female Street Youth who Sell Sex
Location of Work
On the streets:
In cafes/ bars or on call:
Usually controlled by a pimp who:
Works alone:
9 Pays for room, food, health costs
9 Bails her out if arrested
ÖKeeps her in debt (she must pay
the debt to leave)
9 Often ‘manages’ several women
9 Many are powerful ‘generals’ of
the street – spent years in jail
9 Usually with support of a gang
9 Earnings go to gang & room rent
Or, has a boyfriend who:
9 Bails her out if arrested
9 Protects her from violence
9 May have paid a pimp’s debt
Female Street Youth who Sell Sex
Ho Chi
Minh City
• Interviews with FSW:
– All asserted that they do it for
survival or debt to pimp
– Some start between 13 – 15
years of age; more start >17
– Younger sell occasionally (ie
after boyfriend is arrested)
– Vast majority of clients are
Vietnamese men
– Most self-harm (cutting, alcohol
abuse)
Female Street Youth who Sell Sex
“I don’t want to earn my living
this way, but what else could I
do? Where could I go? At least
this work doesn’t cause other
people harm people like
stealing does.”
Philosophy: Continuum of Volition
Voluntary sex
Education & Services:
decision-making;
condom promotion; YFS
Economically driven /
Economically rational
Education & Services +
Economic Opportunities
Weissman, et al. Gender & Development Vol. 14, No. 1, March 2006
Coerced sex
Protection
Approach
for Most-at-Risk Youth
Tailored IPC to
assess and
negotiate risk
reduction
15 PEs meet
young FSW
through
peers or
searching
PEs spend
time to get
to know
FSW
(& if possible
also gang
leaders,
pimps)
Invite to group
discussions
Referral to VCT,
health services
Condom
distribution
Referral to social
worker for case
management &
job/training linkages,
as needed
PE-facilitated
group
discussions
using Program
H / M adaptation
Accompany to
VCT clinic or
hospital as
requested
Case
Management for
selected youth
Interpersonal Communication (IPC):
Experience
After 1 or 2 meetings, PEs:
•
Ask about & listen to concerns
and interests: work, seeking
services, finding relationships
•
Negotiate risk reduction
tailored to situation
•
Give free condoms
•
Make referrals, as needed
•
Set up time to talk again
Group Discussions: Experience
•
PEs facilitate weekly
discussions with 10–25
youth
–
They prefer not to segment
by sex, type of work, etc
–
Meet in late afternoons in
parks or street restaurants
•
FSW participants
–
Participate when they do
not work for a pimp or
when the pimp knows a PE
–
More active over time
Group Discussions: Experience
•
PEs use a curriculum with a
series of 20 one-hour sessions,
adapted from Program H
k
•
Street life and friendships* ce ris
n
e
es
u
c
l
i
•
Condom negotiationinand
f use
t
ac
t
r
a
p
h
t
e
•
STIs
v
s
i
t
m
or even
n
r
•
VCT de
pr
t
n
p
ge ado
• onCommunication
n
t to
r
o
i
o
t
c • uppExpressing emotions
e
l
f
s
e
9R roup• Violence
9G
•
Substance use
•
Seeking services / identity papers
Case Management
• PEs refer selected youth to SC staff & Social Worker
– The social worker provides case management for:
• Pregnancy
• Desire for another job
• Support to re-connect with family
“I am very happy that my wish for a healthy baby
came true. I promised my child that I will not start
again so that he can have a mother like other
mothers. I will leave my past behind.”
Monitoring Data:
Interpersonal Communication (IPC)
160
140
120
100
80
IPC FSW
60
40
20
0
1400
FY 08
Q2
FY 08
Q3
FY08 Q4 FY09 Q1 FY09 Q2
1200
1000
Condom s
FSW
VCT FSW
800
600
400
200
0
FY 08
Q2
FY 08
Q3
FY08
Q4
FY09
Q1
FY09
Q2
Lessons Learned
• Peer Education programming for
at-risk youth is an effective way to
reach young FSW
• Call it “youth programming”
• In addition to peers, young FSW
also want adults who care –to
listen &understand
• Most are willing and able to
reduce risks…. & many want to
make a life change – timing is
important
Lessons Learned
• Lack of data limits ability to advocate for services
• Policy environment that criminalizes & labels FSW a
“social evil” makes them hide / blend in
– As a result, despite active & increasing participation in IPC and
group discussions, use of VCT remains low
• FSW is highly linked to HIV so they fear test results
• Try to avoid discrimination by VCT counselors and health workers :
self-treat STIs
• Need more services-- they appreciate and now trust PEs.
They would want to use services that accept and support
them (without risk of arrest)
Lessons Learned: USG Regs
• The U.S. Government is opposed to prostitution and
related activities, which are inherently harmful and
dehumanizing, and contribute to the phenomenon of
trafficking in persons. None of the funds made
available under this agreement may be used to
promote or advocate the legalization or practice of
prostitution or sex trafficking. Nothing in the
preceding sentence shall be construed to preclude
the provision to individuals of palliative care,
treatment, or post-exposure pharmaceutical
prophylaxis, and necessary pharmaceuticals and
commodities, including test kits, condoms, and, when
proven effective, microbicides.