1. Module 1: Understanding the Context
Effective HIV & SRH Responses Among Sex Workers and other Key Populations
Module 1: Understanding the Context

2. Understanding the Context REGIONAL DATA OVERVIEW
Session 1
Understanding the Context
REGIONAL DATA OVERVIEW

3. Philippines data
HIV prevalence is low among the general population: % in 2013
HIV prevalence is considerably higher Key Affected Population (KAPs), estimated national HIV prevalence (2013):
0.07% female sex workers registered establishments (RFSW)
1.03% freelance female sex workers (FFSW)
3.5% men who have sex with men
53.8% people who inject drugs (PWID) in Cebu
62% of FSW and 65% of MSM are under 25 years old (2009 IBBS age disaggregated data).
Sources
Indonesia Directorate General of Disease Control and Environmental Health . (2011). IBBS 2011
National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India (Sept 2012), HIV Sentinel Surveillance : A Technical Brief. (unpublished draft report)
Ministry of Health of the People’s Republic of China (2012) China AIDS Response Progress Report.

4. Myanmar: 2011 HIV prevalence among FSW was 9.4%
Regional Data
National trends often mask high prevalence in specific locations
Myanmar: 2011 HIV prevalence among FSW was 9.4%
Range of 4.7% in Lashio to 18% in Yangon [1]
Viet Nam: HIV Sentinel Surveillance
HIV prevalence among FSW 3 %
Range of 0% in 6 provinces to 22.5% in Ha Noi [2]
India: Declines in prevalence among FSW in southern states, but remains as high as 7% in Maharashtra and Andhra Pradesh [3]
Sources
National AIDS Programme, Ministry of Health, Myanmar (2011). HIV Sentinel Sero-surveillance 2011.
National Committee for AIDS, Drug and Prostitution Prevention and Control, Viet Nam. (2012). Global AIDS Response Progress reports 2012, Viet Nam.
National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India (Sept 2012), HIV Sentinel Surveillance : A Technical Brief. (unpublished draft report)
Ministry of Health of the People’s Republic of China (2012) China AIDS Response Progress Report.

5. HIV Prevalence among Male and Female Sex Workers 2010 - 2011
Regional Data
HIV Prevalence among Male and Female Sex Workers
Show where data exists on MSW – high HIV prevalence.
* Port Moresby ** Venue-based FSWs (median prevalence)
Source: Prepared by based on Global AIDS Response Progress reports 2012

6. Regional Data
Data on male and transgender sex workers is scarce but shows high HIV prevalence
18% of surveyed male sex workers in Indonesia and Thailand tested HIV positive [1], as did 31% of transgender (Waria) sex workers in Jakarta [2] and 19% in Maharashtra, India [3]
In Phnom Penh, Cambodia, HIV prevalence among transgender people was higher than among MSM (3.6% vs 3.1%) [4]
In Pakistan, 5.2% prevalence among transgender (Hijra) sex workers was much higher than male sex workers and female sex workers, 1.6% and 0.6% respectively [5]
Sources:
Indonesia and Thailand Global AIDS Response Progress reports
Indonesia Directorate General of Disease Control and Environmental Health . (2011). IBBS 2011.
National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India (Sept 2012), HIV Sentinel Surveillance : A Technical Brief.
National Center for HIV/AIDS, Dermatology and STDs (NCHADS), Ministry of Health, Cambodia and FHI 360.(2010). Bros Khmer: Behavioral Risks On-site Sero-survey among At-risk Urban Men in Cambodia.
National AIDS Control Program, Pakistan. (2011). HIV Second Generation Surveillance in Pakistan - National Report Round IV 2011.

7. Regional Data
Overlap between sex work & injecting drug use: % of FSW who injected drugs in last 12 months
Source: Prepared by based on Integrated Bio-Behavioural Surveys and Behavioural Surveillance Surveys

8. Regional Data
Proportion of KAPs <25yrs in countries with available age-disaggregated data
Source: Prepared by based on Behavior Surveillance Surveys

9. Regional Data Young Key Populations:
2011 IBBS Young Key Affected Populations in Indonesia:
HIV Prevalence among 20-24yrs waria at 19%, PWID at 14%.
Prevalence of gonorrhoea and/or chlamydia high across all young key populations, and reported at 71% in direct FSW aged years
Higher number of clients for younger sex workers years (average of 15.3, median of 6 in one week)
8 in 10 young waria had sold sex to a male in last year compared to around 50% of young MSM.
Philippines research: 62% of 9,316 FSW under 25 years old
Need more age disaggregated data across region to develop clear picture of risk and protective factors related to age in young key populations

10. HIV & Sex Work Collection, p16
Regional Data
Young female sex workers & technology:
Recent study of 5,498 FSW in India:
25% used mobile phone to solicit clients
Sex workers were younger and better educated, yet more likely to report inconsistent condom use and experience STI related symptoms
Exposure to HIV prevention programmes likely limited
New and innovative strategies required to reach these groups of young women
“Using ICT as channels for health promotion is a promising and likely cost-effective HIV prevention tool, relevant to highly mobile and hidden populations of sex workers, particularly those who are young”
HIV & Sex Work Collection, p16

11. Integrated HIV & SRH Services
Why integrate HIV & SRH for sex workers?
To realise High Level Meeting targets, greater attention is needed to integrating SRH and HIV services for KAPs to:
Reduce unintended pregnancies
Improve access to antenatal, delivery and post natal care, including access to the antiretroviral drugs both for the mothers’ own health and to prevent infection to their child during pregnancy, delivery and breastfeeding
Programmes for sex workers often narrowly focused on condom programmes and STI diagnosis and treatment for STI/HIV prevention

12. Integrated HIV & SRH Services
HIV prevention efforts among female sex workers are often narrowly focused on access to condoms & diagnosis and treatment of STIs, missing a critical opportunity to improve access to:
Screening for unmet contraceptive need
Counselling on choice of contraceptive methods and understanding of the implications of different methods for preventing HIV/STI and unwanted pregnancy
The full range of contraceptive methods to enable key affected women to choose dual contraceptive methods that will work best for them

13. Integrated HIV & SRH Services
Key drivers and consequences of unintended pregnancies among female sex workers include:
Low condom use among non‐commercial partners
High rates of unintended pregnancies and abortion demonstrating unmet contraceptive need;
High levels of sexual violence
Greater efficacy of other contraceptive methods, when compared with condoms, for preventing pregnancy

14. Integrated HIV & SRH Services
Low levels of condom use with regular partners:
Cambodia 2010 rate of condom use in last 3 months with ‘sweethearts’ remains low 39.4 – 48.3% [1]
High rates of abortion evidence of unmet contraceptive need:
Cambodia - 28% of FSW reported having an abortion within the last year
Laos - 28% of FSW had ever had abortion [2]
Sources:
BSS 2010 Cambodia
Morineau, G. et al (2011). Falling through the cracks: Conceptive needs of female sex workers in Cambodia and Laos. In press: Elservier Inc.

15. Integrated HIV & SRH Services
Missed opportunities: sex workers regularly attending STI services, when feasible to provide wider range of SRH
Integrating SRH & HIV focuses on meeting the needs of sex workers as people, not only as sex workers
Experience demonstrates improvements in service uptake, precisely because services met felt needs
Sources:
Integrating HIV prevention and Family Planning Services: the Aastha Project Mumbai, India, FHI Program experience SMARTGirl Program Cambodia, FHI 2010