Vulnerability and Risk to HIV/AIDS

-Mohammad Khairul Alam-
-Executive Director-
-Rainbow Nari O Shishu Kallyan Foundation-

rainbowngo@gmail.com


Asia has one of the fastest rates of spread of HIV/AIDS infection in the world. At present, HIV/AIDS infection is still virtually nonexistent amongst most of these populations in Bangladesh. But it is extremely likely that once it is initiated, it will spread rapidly through these extended networks of risk. Prostitutes exist at significant levels in Bangladesh, India and Philippines, and condom use is minimal in these areas. In Bangladesh, sex workers in brothels as well as on the streets report rather high client turnover, by Asian standards. Sex workers contact around 19 clients per week on average and the ratio for the street workers is reported to be between 12 and 16 in different cities. Consistent use of condom is one of the lowest in the South Asia region.


The social exclusion of sex workers exacerbates the situation of the more vulnerable groups among them, such as minors, drug users, ethnic minorities or migrants, and finally the people who are under the total control of pimps and/or traffickers. All these groups face the pressure of repressive legislation, which often excludes them from the legal, social and health care facilities available to the general population. A prerequisite for the social inclusion of sex workers, including the above-mentioned groups, is the recognition and protection of their human and civil rights, irrespective of issues if they are migrant, local, drug-using or homosexual people.

 

Many women and girls from rural areas in developing countries feel it is their duty to migrate to urban areas to lessen the impoverished condition of their family. Some of them leave their familiar environment and live in the cities without much support. Theses women and girls who migrate are highly vulnerable to sexual exploitation, abuse or violence. This is where they are often exposed to high-risk situations for which they are not prepared to save themselves. These circumstances of instability and vulnerability often leave these female migrants easy prey to sexual exploitation and also very much vulnerable to HIV as a result.


Street sex workers in Bangladesh are very mobile. They typically work in one place for around a year before moving on to another location. In a survey conducted in Dhaka city by Rainbow Nari O Shishu Kallyan Foundation (2007), Floating/street sex workers interviewed were predominantly adolescent, illiterate, poor who come from rural areas. Street sex workers are at a heightened risk for acquiring HIV due to the fact that they go through multiple sexual contacts per night and rarely care about consistent use of condoms. Street sex workers, especially those new to the sex worker chain, are also very much vulnerable to HIV infection during their first six months of sex work, when they have minimal bargaining authority.


Due to the nature of their business - often as street gangs, overlooked by pimps - they are also a difficult group to educate and to be reached. Some NGOs, like the Rainbow Nari O Shishu Kallyan Foundation, have initiated livelihood training, through which they hope to provide these street girls with an alternative to prostitution. Consisting of education and awareness building programs in schools at the target areas, reaching out to students aged 15 and above, these programs are designed to give an overview of Reproductive Health, safe sexuality, STDs and HIV/AIDS awareness. But many of the street girls who end up on the training center at a very early age – 12 to14 years, would probably not benefit from the training program because there is a good chance that they might dropout from such program due to their frequent ratio of migration.


Behavioral change of men is essential to prevent unprotected sex as well as protecting commercial sex workers from physical violence. Because of their multiple sex partners and potential for HIV transmission through unprotected sex, sex workers are considered one of the highest risk groups for HIV. The Rainbow Nari O Shishu Kallyan Foundation found that floating sex workers with an average one year’s experience attend five clients per week. They work in diverse locations at night, most commonly in gardens, parks and terminal place, and also in the streets and markets. Many sex workers are faced with more immediate problems such as instability, loss of family environment, forced sex, violence, and social exclusion. Judging by all these aspects, this group does not emerge on a high position in our list of priorities to work with, because they are less likely to be found as a group.

Source: Rainbow Nari O Shishu Kallyan Foundation, UNAIDS, CARE, UNICEF