HIV and AIDS Data Hub for Asia-Pacific Review in slides Female Sex Workers Last updated: December 2014

HIV and AIDS Data Hub for Asia-Pacific 2 Data availability and population size estimates HIV prevalence and epidemiology Risk behaviors Violence Vulnerability and HIV knowledge National response CONTENT

Data availability and population size estimates

Female sex workers population size estimates, countries where data is available Estimated FSW (a)Year of estimate Year of reportingHIV prevalence (b) 1Afghanistan (2 cities) 4, (2012) 2Australia20,500… (2012) 3Bangladesh 74, (2011) 4Cambodia 37,000 (female entertainment workers) * (2010) 5China 2,470, …0.2 (2013) 6Hong Kong SAR 20, , …0 (2013) 7Fiji (Suva, Nadi, Lautoka, Labasa,Savsavu) (2012) 8India 868, ( ) 9Indonesia 229,856 (both direct and indirect) (2011) 10Lao PDR 13, (2011) 11Malaysia 40, (2012) 12Maldives , …0 (2008) 13Mongolia 1, , …0 (2012) 14Myanmar 70, (2013) 15Nepal 26,504 (24,649 – 28,359) (2011) 16Pakistan 136, (2011) 17Philippines 80,000 (70, ,175) (2011) 18Papua New Guinea 40, …19 (Port Moresby, 2010) 19Sri Lanka 14, (2011) 20Thailand 123, (2012) 21Timor Leste …1.5 (2011) 22Vanuatu (Port Vila)1, … 23Viet Nam71, (2013) Prepared by ; Note: a) Please see next slide for references; b) National HIV Sentinel Surveillance surveys and Integrated Biological and Behavioral surveys reported in GARPR 2013 and 2014www.aidsdatahub.org * Weighted and adjusted average

HIV and AIDS Data Hub for Asia-Pacific References, Female sex workers population size estimates 5 1. Afghanistan Global AIDS Response Progress Reporting Australia Global AIDS Response Progress Reporting Bangladesh Global AIDS Response Progress Reporting Cambodia Global AIDS Response Progress Reporting 2014 based on female entertainment workers size estimation conducted by NCHADS in Ministry of Health China, WHO, and UNAIDS. (2011) Estimates for the HIV/AIDS Epidemic in China (Unpublished). 6.Hong Kong Advisory Council on AIDS. (2006). Report of Community Assessment and Evaluation of HIV Prevention for Commercial Sex Workers and their Clients in Hong Kong Fiji Global AIDS Response Progress Reporting 2014 based on Mossman, E., Roguski, M., Ravuidi, R., & Devi, R. (2013). Integrated Biological Behavioural Surveillance Survey and Size Estimation of Sex Workers in Fiji 8.National AIDS Control Organisation India, Department of AIDS Control, & Ministry of Health & Family Welfare. (2011). Annual Report Indonesia Global AIDS Response Progress Reporting 2014 based on Ministry of Health.(2013). Estimasi Populasi Rawan Tertular HIV di Indonesia Tahun 2012 (In Indonesian Language) 10. Lao PDR Global AIDS Response Progress Reporting 2014 National Committee for the Control of AIDS Lao PDR. (2010). National Strategy and Action Plan on HIV/AIDS/STI Malaysia Global AIDS Response Progress Reporting 2014 based on Lim HE, Ang CL and Teh YK., Size estimation for Local Responses in Malaysia for HIV Prevention in Sex Work, 2010 (unpublished) 12.WHO. (2009). HIV/AIDS in the South-East Asia Region National Committee on HIV/AIDS, UN, & gtz. (2008). Comprehensive Review of the National Response to HIV and STIs in Mongolia. 14. Myanmar Global AIDS Response Progress Reporting 2014 based on a mapping study conducted by Nataional AIDS Programme and PSI in Nepal Global AIDS Response Progress Reporting Pakistan Global AIDS Response Progress Reporting 2014 based on extrapolation and triangulation from mapping conducted as part of IBBS Round II, Philippine National AIDS Council. (2011). Estimates of the Most At-Risk Population and People Living with HIV. 18.Asian Development Bank. (2005). Socioeconomic Implications of HIV/AIDS in the Pacific. 19. Sri Lanka Global AIDS Response Progress Reporting 2014 based on National STD/AIDS Control Programme and the Family Planning Association of Sri Lanka. (2013). National Size Estimation of Most at Risk Populations (MARPs) for HIV in Sri Lanka 20. Thailand Global AIDS Response Progress Reporting 2014 based on Sub-Technical Working Group on Projection and Estimation. (2012). Size Estimation for Sex Workers. Unpublished Power Point Presentation at Size Estimation Stakeholder Seminar January 10th, 2012, Richmond Hotel, Nonthaburi. 21.National AIDS Programme, Ministry of Health as cited in WHO SEARO (2010).Timor Leste: Epidemiological Situation and Health Sector Response 22. Vanuatu Global AIDS Response Progress Reporting 2014 based on IBBS and Population Size Estimation in Port Vila in Viet Nam Global AIDS Response Progress Reporting 2014

HIV and AIDS Data Hub for Asia-Pacific Size estimates of FSW as proportion of adult female population (15-49) years Source: Prepared by based on size estimates of FSW ( please see the information provided in the previous 2 slides) and adult female population (15- 49) years is based on 2012 population based on UN Population Division. (2013). World Population Prospects: The 2012 Revision - Extended Datasetwww.aidsdatahub.org Regional median 0.4%; Range 0.2% - 4.1%

HIV and AIDS Data Hub for Asia-Pacific 7 Bangladesh, China, India, Myanmar, Sri Lanka Cambodia, Myanmar, Viet Nam Bangladesh, Cambodia, India, Myanmar, Sri Lanka, Thailand, Viet Nam Bangladesh, Cambodia, China, India, Indonesia, Myanmar, Sri Lanka, Thailand, Viet Nam Data availability of FSW in HIV sentinel surveillance surveys conducted between 2009 and 2013 Source: Prepared by based on National HIV Sentinel Surveys and

HIV and AIDS Data Hub for Asia-Pacific 8 Data availability of FSW in behavioral surveys conducted between 2009 and 2013 Source: Prepared by based on Behavioral Surveillance Surveys; Integrated Biological and Behavioral Surveys; and Afghanistan, China, Fiji, Indonesia, Japan, Lao PDR, Malaysia, Mongolia, Pakistan, PNG, Philippines, Viet Nam Cambodia, Fiji, Mongolia, Nepal, Pakistan, Afghanistan, Cambodia, Fiji, India, Indonesia, Lao PDR, Mongolia, Nepal, Pakistan, PNG, Philippines, Timor Leste, Viet Nam Afghanistan, Cambodia, China, Fiji, India, Indonesia, Japan, Lao PDR, Malaysia, Mongolia, Nepal, Pakistan, PNG, Philippines, RO Korea, Singapore, Timor Leste, Thailand, Viet Nam

HIV prevalence and epidemiology

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! 10 HIV prevalence among female sex workers, Source: Prepared by based on Integrated Biological and Behavioural Surveys; and HIV Sentinel Surveillance Surveyswww.aidsdatahub.orgwww.aidsinfoonline.org

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! HIV prevalence among FSW in geographical locations that are higher than national prevalence, Source: Prepared by based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveyswww.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! HIV prevalence trends among FSW - ASEAN countries, where data is available, Source: Prepared by based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3)

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! HIV prevalence trends among FSW - SAARC countries, where data is available, Source: Prepared by based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3) UNAIDS Report on The Global AIDS Epidemic, 2010 ; and 4)

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Proportion of heterosexual transmission among reported HIV cases, Sources: Prepared by based on 1. UNGASS Country Progress Reports 2010; 2. Country Global AIDS Response Progress Reports 2012 and 2014; 3. Directorate General of Disease Control and Environmental Health, Ministry of Health, Indonesia (Feb 2014). Situation Progress Report of HIV and AIDS in Indonesia in 2013 (Laporan Situasi Perkembangan HIV & AIDS di Indonesia tahun 2013, Kementerian Kesehatan RI 2013); 4. National Epidemiology Center Philippines. (2014). Philippines HIV/AIDS Registry: August 2014; 5. National AIDS Control Organisation India, Department of AIDS Control, & Ministry of Health and Family Welfare. (2012). Annual Report ; 6. Ministry of Health Malaysia (2014). HIV and AIDS Reporting System ( ).; 7. Centre for Health Protection, Department of Health Hong Kong. (2014). Hong Kong STD/AIDS Update, Vol. 19, No.1, Quarter ; 8. Ministry of Health and Population Nepal, National Center for AIDS and STD control. Factsheet Number 2: Cumulative cases in Nepal, As of Mangsir 2070 (Nov 2013)

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! HIV prevalence among FSW in geographical locations where rising HIV prevalence trends are observed, Source: Prepared by based on Directorate General of Disease Control and Environmental Health Ministry of Health Indonesia (2011). Progress Report HIV & AIDS Situation in Indonesia up to January 2011, Ministry of Health Republic of Indonesia (2011). IBBS Integrated Biological and Behavioral Survey; National AIDS Control Organization, India (2012) HIV Sentinel Surveillance : A Technical Brief; and National AIDS Programme, Myanmar (2014). HIV Sentinel Sero-surveillance Survey Report,

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Sexually transmitted infections (STI) prevalence among FSW, countries where data is available, Source: Prepared by based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3) 4) Global AIDS Response Progress Reporting 2014www.aidsinfoonline.org

Risk behaviours

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Average duration in the profession of selling sex among FSW, countries where data is available, Source: Prepared by based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveyswww.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Average number of clients among FSW, Source: Prepared by based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveyswww.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Proportion of FSW who reported condom use at last sex, Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Proportion of consistent condom use among FSW with their clients Source: Prepared by based on 1) Chhorvann, C. (2011). Behavioral Sentinel Surveillance Power Point Presentation. National Center for HIV/AIDS Dermatology and STD; 2) Thailand UNGASS Report 2010; 3) Erausquin, J. T., Biradavolu, M., et al. (2012). Trends in Condom Use among Female Sex workers in Andhra Pradesh, India: The Impact of a Community Mobilisation Intervention. J Epidemiol Community Health, 66(2), ; 4) Mishra, R. M., Dube, M., et al. (2012). Changing Epidemiology of HIV in Mumbai: An Application of the Asian Epidemic Model. Glob J Health Sci, 4(5), ; 5) National Centre for HIV/AIDS Dermatology and STD Cambodia (2013) Cambodia STI Survey: Female Entertainment Workerswww.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Proportion of FSW who reported consistent condom use with their clients, Source: Prepared by based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys; 3) Li, D., Wang, L., Lin, W., Li, P., Guo, W., et al. (2014). HIV and syphilis infections among street-based female sex workers in China, Chin Med J, 127(4),

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Proportion of FSW who inject drugs, Source: Prepared by based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys; 3) Wang, H., Chen, R. Y., et al. (2009). Prevalence and Predictors of HIV Infection among Female Sex Workers in Kaiyuan City, Yunnan Province, China. International Journal of Infectious Diseases, 13, 162—169. *Street-based FSW ** Female entertainment worker ***Injected drugs in last 6 months

Violence

HIV and AIDS Data Hub for Asia-Pacific Proportion of female sex workers who were physically assaulted, Source: Prepared by based on Behavioural Surveys and Integrated Biological and Behavioural Surveyswww.aidsdatahub.org * Street-based FSW

HIV and AIDS Data Hub for Asia-Pacific Proportion of female sex workers who were physically assaulted or harassed by police or security personnel, Source: Prepared by based on Ministry of Health and Population, National Centre for AIDS and STD Control (NCASC). (2012). Integrated Biological and Behavioral Surveillance Survey among Female Sex Workers in 22 Terai Highway Districts of Nepal 2012 and Kelly, A., Kupul, M., Man, W. Y. N., Nosi, S., et al. (2011). Askim Na Save (Ask and Understand): People Who Sell and Exchange Sex in Port Moresbywww.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Proportion of female sex workers who have been forced to have sex, Source: Prepared by based on Behavioural Surveys and Integrated Biological and Behavioural Surveyswww.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Source: Prepared by based on IBBS 2008 (Lao PDR) and STI Sentinel Survey 2005 (Cambodia) * Last week Proportion of FSW who were forced by clients for unprotected sex in the last 3 months,

Vulnerability and HIV knowledge

HIV and AIDS Data Hub for Asia-Pacific Proportion of FSW with comprehensive HIV knowledge, Source: Prepared by based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveyswww.aidsdatahub.org 3) UNAIDS. (2010). Global Report: UNAIDS Report on the Global AIDS Epidemic.

HIV expenditure

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Source: Prepared by based on HIV prevention spending in Asia and the Pacific – low on HIV prevention spending among sex workers and clients, latest available year reported by countries, Prevention spending breakdown is not available for China and India

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Trends in HIV prevention spending on sex workers and clients out of total prevention spending, countries where HIV prevalence among FSW is more than 5%, Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Spending on HIV prevention programmes focused on sex workers and clients, Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Prevention spending on sex workers and clients is heavily dependent on international financing sources 35 Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Proportion of AIDS spending by major spending category, Asia and the Pacific, Source: Prepared by based on AIDS spending breakdown is not available for China and India

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Youth Prevention mother-to-child General prevention and others Sex workers and their clients People who inject drugs Men who have sex with men Source: Prepared by based on Proportion of prevention spending by category, Note: Data from latest available year. China and India do not report prevention spending breakdown.

National response

HIV and AIDS Data Hub for Asia-Pacific Proportion of FSW reached with HIV prevention programmes in the last 12 months, Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Proportion of FSW who received an HIV test in the last 12 months and know their results, Source: Prepared by based on 1. Ministry of Health Indonesia.(2014). Recalculated HIV Testing Coverage presented at the Regional Management Meeting (RMM) 2014 using IBBS 2011 Data; and 2. * Programme data Data is not strictly comparable across countries since methods and sampling varied. In addition, many surveys were conducted in a few urban areas and it might not necessarily reflect prevailing conditions at the national level.

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Trends in prevention coverage among FSW, Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Punitive laws hindering the HIV response among sex workers in South Asia 42 Criminalize sex work in private Criminalize soliciting Afghanistan YES Bangladesh NOYES Bhutan YES India NOYES Maldives YES Nepal NOYES Pakistan YES Sri Lanka NOYES Sources: Prepared by based on UNAIDS, Data Hub, UNDP, UNFPA, and UNODC. (2014). Punitive Laws Hindering the HIV Response in Asia and the Pacific in October 2014

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Punitive laws hindering the HIV response among sex workers in South-East Asia 43 Criminalize sex work in private Criminalize soliciting Brunei NOT ILLEGAL YES Cambodia NO YES Indonesia NOT ILLEGAL Lao PDR YES Malaysia NOT ILLEGAL YES Myanmar YES Philippines YES Singapore NO YES Thailand YES Timor-Leste NO Viet Nam YES Sources: Prepared by based on UNAIDS, Data Hub, UNDP, UNFPA, and UNODC. (2014). Punitive Laws Hindering the HIV Response in Asia and the Pacific in October 2014 Not illegal- Generally not prohibited but exceptions apply

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Punitive laws hindering the HIV response among sex workers in East Asia 44 Criminalize sex work in private Criminalize soliciting China YES Japan YES Mongolia YES DRP Korea YES Republic of Korea YES Sources: Prepared by based on UNAIDS, Data Hub, UNDP, UNFPA, and UNODC. (2014). Punitive Laws Hindering the HIV Response in Asia and the Pacific in October 2014

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Punitive laws hindering the HIV response among sex workers in Pacific 45 Criminalize sex work in private Criminalize soliciting Fiji NO YES Kiribati NO YES Marshall Islands YES FSM* YES Nauru NO NO INFO Palau YES Papua New Guinea YES NOT ILLEGAL Samoa NO YES Solomon Islands NO YES Tonga NO YES Tuvalu NO YES Vanuatu NO YES *Federated States of Micronesia Sources: Prepared by based on UNAIDS, Data Hub, UNDP, UNFPA, and UNODC. (2014). Punitive Laws Hindering the HIV Response in Asia and the Pacific in October 2014 Not illegal- Generally not prohibited but exceptions apply

HIV and AIDS Data Hub for Asia-Pacific 46 THANK YOU slides compiled by Data shown in this slide set are comprehensive to the extent they are available from country reports. Please inform us if you know of sources where more recent data can be used. Please acknowledge if slides are lifted directly from this sitewww.aidsdatahub.org