The Left-Behind of the “Left Behind”
I attended a session today on vulnerable populations who are (still) being left behind in our programming and funding within the epidemic. The session focused on sex workers, injection drug users, Indigenous Populations and the TB/HIV Co-infected.
It was an interesting session and each presenter made a clear, evidence based case for more support for their key population. There was – and has been throughout the conference – still another group that was missing: incarcerated populations (prisoners). Since Monday, I’ve seen only a total of two slides presented on HIV risk and treatment for those who are incarcerated, although there is one session coming up on Thursday. Obviously, these are sensitivities, legalities and challenges in working with prison populations, but one would still expect that in an international forum specifically talking about those ‘left behind’, that no one would actually get ‘left behind’. In Botswana, condoms are not provided in prisons, and it has been anecdotally reported that a lot of infections occur in prisons. It got me thinking about the people who are not visible here at these types of conferences – and if the research isn’t happening, how much intervention could be occurring? If there is intervention, is it appropriate?
For example, for the last decade or so, many interventions for sex workers have been focused on prevention, but also on income generation – in an attempt to discourage sex workers from engaging in sex work. Times change, and I think as we have involved sex workers in their own interventions, we’re designing much more effective campaigns. This was exemplified during this morning’s plenary, when a sex worker from Uganda (who was a speaker) said. “Please. Don’t send us any more sewing machines”.
In 2013, Botswana did a study of Most At Risk Populations (MARPS) and that study showed that 61.9% of the country’s sex workers are HIV positive. The act of sex work is illegal in Botswana, legal in Canada (although brothels, solicitation and procurement is illegal), so coming from these varied contexts, I wanted to get a feel for what the epidemic looks like in a place where sex work is not criminalized and is regulated. So, I signed up for a brothel tour offered through the conference.
A small group of 20 conference participants took a bus to two brothels this morning, where we walked through the brothels, spoke with workers and staff and toured some of the rooms. The tour was sponsored by an NGO that provides support and services to both brothels and workers in the Victoria province. Regulations for sex workers and brothels are different from province to province in Australia, but here were some of the regulations for the Victoria province:
- No alcohol is allowed in brothels
- Sex workers must go for STI and HIV tests quarterly
- Sex workers must do visual examinations of the client’s genitals and anus prior to the act
- It is illegal not to use condoms or to remove the condom during the act
- Condoms must be provided by the brothel
- If a sex worker tests positive for HIV, she or he is no longer allowed to be licensed for sex work
- Street sex work is criminalized
- Clients must shower before the act – showers are actually built into each brothel room
Interesting visit – they gave us some really good insight. What are your thoughts?