by Alex Delamare, 23 May 2011.
When Thida Win contracted HIV after selling her body on the Yangon streets, it was her fellow sex workers that she turned to, not Myanmar’s crumbling health service.
The Top project, run almost entirely by those in the sex trade, gave her treatment, a place to be herself away from the dual stigma of HIV and prostitution — and eventually a job.
“I am now a health worker for my community and I can forget I am positive. I am so proud to work for the programmes, I will work for them for my whole life,” the 33-year-old told AFP.
Top and similar projects are a vital resource in army-dominated Myanmar, where a chronically underfunded health service, large itinerant populations and poor education fuel one of Asia’s worst HIV epidemics.
“When I was diagnosed I was pregnant and they told me how to find a safe way for the baby. So the child is negative and I am so happy,” Thida Win said.
Nearly one in five of Myanmar’s estimated 60,000 sex workers were infected with HIV in 2008.
A United Nations report from August last year said legal constraints and discrimination made it hard to reach those in the trade, which is illegal. Surveys suggested police even used condoms as evidence for arrest.
Top founder and director Habib Rahman said providing a place free from taboos and letting people share their problems with contemporaries was a key aim for the project.
“Even the cleaner comes from the sex worker community, the counsellors are also sex workers. That’s one of the reasons I decided to recruit from the community — because there should not be any stigma and discrimination,” he said.
Rahman said many women enter sex work without knowing about the risks.
“In general in Myanmar I do not think there is any sex education in school,” he said.
The project recruits former and current sex workers to help educate others about HIV, spreading the message from a position of trust within the community.
“We cannot tell anyone to stop selling sex even though they are positive but what we do is tell them how they can keep healthy and protect the client by using condoms,” said Rahman.
He said Top’s part-time “peer educators” who chose to continue in the sex trade were encouraged to always use protection, while full-time employees were instructed to stop selling sex altogether.
Myint Myint contracted HIV soon after being recruited to work in a brothel following the break-up of her marriage. She said her clients, mainly local bean and fish traders, had often been reluctant to use protection.
“I have faced violence with customers who don’t want to use condoms. This is a big problem. I think customers don’t know about condoms. They think they are plastic rubbish,” said the Top peer educator who continues to sell sex to a few of her old clients.
HIV transmission in Myanmar occurs “primarily through high-risk sexual contact between sex workers and their clients”, as well as men who have sex with men and their partners, according to the UN report.
It said while injecting drug users have the highest HIV prevalence, at 36 percent, they are also likely to pay for sex and “this interaction may refuel the sex-work-driven epidemic”.
Years of neglect by the ruling generals — Myanmar spent just 0.9 percent of its budget on health in 2007 — have left foreign donors facilitating most of the country’s HIV treatment.
A new government, which came into power after controversial November 2010 elections, has raised hopes of more investment from overseas donors — but not the state, which is expected to spend around 20 percent of outlay on the army this year.
In 2009 the UN estimated 240,000 people in Myanmar were living with the virus and while there have been improvements, the situation remains worrying with prevalence rates the third highest in Asia after Thailand and Papua New Guinea.
“The HIV epidemic in Myanmar is on a decreasing trend and among the key population groups it is also reducing — but it is still really quite high,” said Soe Naing of UNAIDS in Myanmar.
He said some state provision for HIV treatment does exist in big cities, “but of course the standards and situations are not ideal. People are reluctant to go to them because of privacy issues and quality”.
Top clinics provide everything from testing and counselling to routine medical care.
Last year it gave treatment and consultation to 11,770 female sex workers and 10,727 men. It also accounted for 40 percent and 82 percent of all HIV tests for those groups respectively in the country.
The programme, which was formed by Population Services International (PSI) seven years ago, now employs 350 people — 95 percent of whom are from the sex worker community and men who have sex with men — in 19 towns and cities.
In Myanmar, where the US estimates around a third of people were below the poverty line in 2007, money worries are likely to continue to drive people into sex work.
Thida Win, who was still a university student when she first sold sex, said the financial burden of marriage and children only pushed her further into the trade.
“I got my degree with sex work, I supported my family very well with sex work,” said the chemistry graduate, who said her earnings still help support seven family members.
