Female Sex Workers Last updated: October 2015

CONTENT Data availability and population size estimates HIV prevalence and epidemiology Risk behaviors Violence Vulnerability and HIV knowledge National response

Data availability and population size estimates

229,856 (both direct and indirect) Female sex workers population size estimates, countries where data is available   Estimated FSW (a) Year of estimate Year of reporting HIV prevalence (b) 1 Afghanistan 6,000 2015 0.3 (2012) 2 Australia 20,500 … 0.03 (2012) 3 Bangladesh 74,300 2010 0.3 (2011) 4 Cambodia 34,400 2012 4.6* (2010) 5 China 2,470,000 2011 0.2 (2014) 6 Hong Kong SAR 20,000 - 100,000 2005 0 (2013) 7 Fiji (Suva, Nadi, Lautoka, Labasa,Savsavu) 538 2014 0 (2012) 8 India 868,000 2.8 (2010-11) 9 Indonesia 229,856 (both direct and indirect) 7 (2011) 10 Lao PDR 14,814 1.4 (2014) 11 Malaysia 45,000 7.3 (2014) 12 Maldives 900 - 4,000 2008 0 (2008) 13 Mongolia 1,500 - 19,000 2006 0 (2014) 14 Myanmar 70,000 6.3 (2014) 15 Nepal 26,504 (24,649 – 28,359) 1.7 (2011) 16 Pakistan 136,156 – 149,111 0.6 (2011) 17 Philippines 80,000 (70,167 - 89,175) 0.4 (2013) 18 Papua New Guinea 40,000 19 (Port Moresby, 2010) 19 Sri Lanka 14,132 2013 0.8 (2014) 20 Thailand 141,769 1.1 (2014) 21 Timor Leste 1,688 1.5 (2011) 22 Vanuatu (Port Vila) 1,398 23 Viet Nam 71,936 2.5 (2014) Prepared by www.aidsdatahub.org ; Note: a) Please see next slide for references; b) National HIV Sentinel Surveillance surveys and Integrated Biological and Behavioral surveys reported in GARPR 2013 to 2015 * Weighted and adjusted average

References , Female sex workers population size estimates Afghanistan Global AIDS Response Progress Reporting 2015 Australia Global AIDS Response Progress Reporting 2015 Bangladesh Global AIDS Response Progress Reporting 2015 Cambodia Global AIDS Response Progress Reporting 2015 Ministry of Health China, WHO, and UNAIDS. (2011). 2011 Estimates for the HIV/AIDS Epidemic in China (Unpublished). 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 2006. 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 National AIDS Control Organisation India, Department of AIDS Control, & Ministry of Health & Family Welfare. (2011). Annual Report 2010-11. Indonesia Global AIDS Response Progress Reporting 2015 based on Ministry of Health.(2013). Estimasi Populasi Rawan Tertular HIV di Indonesia Tahun 2012 (In Indonesian Language) Lao PDR Global AIDS Response Progress Reporting 2015 Malaysia Global AIDS Response Progress Reporting 2015 WHO. (2009). HIV/AIDS in the South-East Asia Region 2009. National Committee on HIV/AIDS, UN, & gtz. (2008). Comprehensive Review of the National Response to HIV and STIs in Mongolia. Myanmar Global AIDS Response Progress Reporting 2014 based on a mapping study conducted by Nataional AIDS Programme and PSI in 2010 Nepal Global AIDS Response Progress Reporting 2014 Pakistan Global AIDS Response Progress Reporting 2015 Philippine National AIDS Council. (2011). Estimates of the Most At-Risk Population and People Living with HIV. Asian Development Bank. (2005). Socioeconomic Implications of HIV/AIDS in the Pacific. Sri Lanka Global AIDS Response Progress Reporting 2015 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 Thailand Global AIDS Response Progress Reporting 2015 Timor Leste Global AIDS Response Progress Reporting 2015 Vanuatu Global AIDS Response Progress Reporting 2014 based on IBBS and Population Size Estimation in Port Vila in 2011 Viet Nam Global AIDS Response Progress Reporting 2014

Size estimates of FSW as proportion of adult female population (15-49) years Source: Prepared by www.aidsdatahub.org 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 Dataset

Data availability of FSW in HIV sentinel surveillance surveys conducted between 2009 and 2013 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 Source: Prepared by www.aidsdatahub.org based on National HIV Sentinel Surveys and www.aidsinfoonline.org

Data availability of FSW in behavioral surveys conducted between 2009 and 2013 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 Source: Prepared by www.aidsdatahub.org based on Behavioral Surveillance Surveys; Integrated Biological and Behavioral Surveys; and www.aidsinfoonline.org

HIV prevalence and epidemiology

HIV prevalence among female sex workers, 2008-2014 Source: Prepared by www.aidsdatahub.org based on Integrated Biological and Behavioural Surveys; HIV Sentinel Surveillance Surveys; and www.aidsinfoonline.org

Geographic locations where HIV prevalence among FSW is higher than national prevalence, 2010-2014 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys

HIV prevalence trends among FSW - ASEAN countries, where data is available, 2000-2014 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3) www.aidsinfoonline.org

HIV prevalence trends among FSW - SAARC countries, where data is available, 2000-2014 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3) UNAIDS Report on The Global AIDS Epidemic, 2010 ; and 4) www.aidsinfoonline.org

Proportion of heterosexual transmission among reported HIV cases, 2009-2014 Sources: Prepared by www.aidsdatahub.org based on 1. UNGASS Country Progress Reports 2010; 2. Country Global AIDS Response Progress Reports 2012 to 2015; 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. (2015). Philippines HIV/AIDS Registry: July 2015; 5. National AIDS Control Organisation India, Department of AIDS Control, & Ministry of Health and Family Welfare. (2012). Annual Report 2011-12.; 6. Ministry of Health Malaysia (2014). HIV and AIDS Reporting System (1986-2013).; 7. Centre for Health Protection, Department of Health Hong Kong. (2014). Hong Kong STD/AIDS Update, Vol. 19, No.1, Quarter 1 2013; 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 prevalence among FSW in geographical locations where rising HIV prevalence trends are observed, 2003-2013 Source: Prepared by www.aidsdatahub.org based on 1. Directorate General of Disease Control and Environmental Health Ministry of Health Indonesia (2011). Progress Report HIV & AIDS Situation in Indonesia up to January 2011; 2. Ministry of Health Republic of Indonesia (2011). IBBS 2011 - Integrated Biological and Behavioral Survey; 3. Robert Magnani, Pandu Riono, Nurhayati, et al. Sexual Risk Behaviors, HIV and Other Sexually Transmitted Infections among Female Sex Workers in Indonesia, sti.bmj.com, published online June 3, 2010; 4. National AIDS Control Organization, India (2012) HIV Sentinel Surveillance 2010-11: A Technical Brief; and 5. National HIV and STI Surveillance and Strategic Information Unit, National Epidemiology Center, DOH. Integrated HIV Behavioral and Serologic Surveillance (IHBSS) Reports. Manila, Philippines.

Sexually transmitted infections (STI) prevalence among FSW, countries where data is available, 2009-2014 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys; 2) HIV Sentinel Surveillance Surveys; 3) Global AIDS Response Progress Reports

Risk behaviours

Average duration in the profession of selling sex among FSW, countries where data is available, 2006-2013 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys

Average number of clients among FSW, 2006-2014 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys

Proportion of FSW who reported condom use at last sex, 2006-2014 Lao PDR has condom use at last sex data for 2014 Corrected year for Lao PDR Source: Prepared by www.aidsdatahub.org based on Global AIDS Response Progress Reporting and www.aidsinfoonline.org

Proportion of consistent condom use among FSW with their clients Source: Prepared by www.aidsdatahub.org based on 1) Chhorvann, C. (2011). Behavioral Sentinel Surveillance 2010. 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), 2011-200511; 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), 100-112; 5) National Centre for HIV/AIDS Dermatology and STD Cambodia (2013). 2011 Cambodia STI Survey: Female Entertainment Workers

Proportion of FSW who reported consistent condom use with their clients, 2006-2014 Source: Prepared by www.aidsdatahub.org 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, 2010-2012. Chin Med J, 127(4), 707-711.

Proportion of FSW who inject drugs, 2008-2013 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys;

Violence

Proportion of female sex workers who were physically assaulted, 2006-2012 * Street-based FSW Source: Prepared by www.aidsdatahub.org based on Behavioural Surveys and Integrated Biological and Behavioural Surveys

Proportion of female sex workers who were physically assaulted or harassed by police or security personnel, 2010-2012 Source: Prepared by www.aidsdatahub.org 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 Moresby

Proportion of female sex workers who have been forced to have sex, 2008-2012 Source: Prepared by www.aidsdatahub.org based on Behavioural Surveys and Integrated Biological and Behavioural Surveys

Proportion of FSW who were forced by clients for unprotected sex in the last 3 months, 2005-2008 * Last week Source: Prepared by www.aidsdatahub.org based on IBBS 2008 (Lao PDR) and STI Sentinel Survey 2005 (Cambodia)

Vulnerability and HIV knowledge

Proportion of FSW with comprehensive HIV knowledge, 2006-2012 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveys; 2) Behavioral Surveillance Surveys 3) UNAIDS. (2010). Global Report: UNAIDS Report on the Global AIDS Epidemic.

HIV expenditure

HIV prevention spending in Asia and the Pacific – low on HIV prevention spending among sex workers and clients, latest available year reported by countries, 2009-2013 Prevention spending breakdown is not available for China and India Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

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%, 2006-2013 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Spending on HIV prevention programmes focused on sex workers and clients, 2009-2013 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Prevention spending on sex workers and clients is heavily dependent on international financing sources Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of AIDS spending by major spending category, Asia and the Pacific, 2009-2013 AIDS spending breakdown is not available for China and India Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of prevention spending by category, 2009-2013 Youth Prevention mother-to-child General prevention and others Sex workers and their clients People who inject drugs Men who have sex with men Note: Data from latest available year. China and India did not report prevention spending breakdown. Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

National response

Proportion of FSW reached with HIV prevention programmes in the last 12 months, 2006-2014 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of FSW who received an HIV test in the last 12 months and know their results, 2006-2014 * 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. Source: Prepared by www.aidsdatahub.org 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. www.aidsinfoonline.org

Trends in prevention coverage among FSW, 2009-2014 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Criminalize sex work in private Criminalize soliciting Punitive laws hindering the HIV response among sex workers in South Asia Criminalize sex work in private Criminalize soliciting Afghanistan YES Bangladesh NO Bhutan India Maldives Nepal Pakistan Sri Lanka Sources: Prepared by www.aidsdatahub.org based on UNAIDS, Data Hub, UNDP, UNFPA, and UNODC. (2014). Punitive Laws Hindering the HIV Response in Asia and the Pacific in October 2014

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

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

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

slides compiled by www.aidsdatahub.org THANK YOU slides compiled by www.aidsdatahub.org 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 www.aidsdatahub.org if slides are lifted directly from this site