马来西亚: December 2010的归档

亚洲调查编者按

据统计,全球目前约3860万艾滋病毒携带者(PLWH),其中妇女数量接近一半。过去相关的艾滋病与生育的研究认为,由于有限的设施和资源,携带艾滋病毒的妇女并不寄望生产。然而,近年来抗逆转录病毒治疗(ART)的普及,使得更多艾滋病女性患者能够生活得更健康和长久。同时,ART的普及大大降低母婴传播的几率。

大量研究显示,越来越多的艾滋病女性患者渴望进行生育活动,对于该领域的研究需求也日益迫切。如何让妇女在决策过程中掌握主动权、追求生殖健康与权力成为学界探讨的焦点。

哈佛大学公共卫生院于20103月举行题为"女性艾滋病毒携带者的怀孕意愿:研究议程跟进"的学术论坛,会议集合了来自六个大洲、致力于性健康和生育权的不同学科的学者,共同探讨目前的研究成果以及未来研究方向。

大会报告针对艾滋病女性患者聚合现有研究成果,围绕以下六个主题进行探讨:艾滋对怀孕的渴望;防止怀孕的尝试;更安全的怀孕;怀孕的终止。并认为和所有妇女一样,艾滋病女性患者也拥有受孕和生产权利。报告因此呼吁多学科的跨界合作,弥补现阶段各学科之间的知识鸿沟,为艾滋病女性患者及其家庭提供更为全面和有效的信息,帮助其在生育决策过程中做出正确的决定。同时也能够促进改善相关领域政策和公共服务质量,为艾滋病女性患者及其家庭创造良好的社会空间。

PFD全文下载http://www.hsph.harvard.edu/pihhr/files/homepage/news_and_events/pregnancy_intentions_full_report.pdf
会议通讯:http://www.hsph.harvard.edu/pihhr/files/homepage/news_and_events/pregnancy_intentions_short.pdf

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Manila, 14 May 2010 - A major new WHO publication "Priority HIV and Sexual Health Interventions in the Health Sector for Men Who Have Sex with Men and Transgender People in the Asia Pacific Region" is designed for public health decision-makers, national AIDS programme managers, health-care providers, managers of community-based organizations, civil society, people living with and affected by HIV and international development partners.

The document indentifies the priority interventions required by the health sector to meet the HIV and sexual health needs of men who have sex with men and transgender persons. Key recommendations from WHO standards of practice and key resources are emphasized to highlight how national health sector partners can strengthen their response to HIV among men who have sex with men and transgender persons.

The document is a joint effort of the WHO Western Pacific and South-East Asia regional offices, the UNDP Asia Pacific Regional Center, UNAIDS, Asia Pacific Coalition on Male Sexual Health (APCOM) and the Department of Health, Hong Kong SAR (China).

After a global release of the document at the XVIII International AIDS Conference in July in Vienna, Austria, the partners will advocate and promote the development of case studies to document evidence-based, innovative and effective best practices; and support research to develop strategic information needed to better link community based responses with public health-led prevention interventions to care, support and treatment initiatives among men who have sex with men and transgender across the region.


PDF download: http://www.info.gov.hk/aids/pdf/g218.pdf

Stigma and Violence Against Transgender Sex Workers


Khartini Slamah and Sam Winter and Kemal Ordek


This article is part of a series published by RH Reality Check in partnership with the Global Network of Sex Work Projects (NSWP) to commemorate the International Day to End Violence Against Sex Workers, December 17th, 2010. It is excerpted from Research for Sex Work 12, published 17 December 2010 by the NSWP, an organization that upholds the voice of sex workers globally and connects regional networks advocating for the rights of female, male, and transgender sex workers. Download the full journal, with eight more articles about sex work and violence, for free at http://nswp.org/research-sex-work


Andrea is in her early twenties. She comes from a poor family in the provinces of a Southeast Asian country. Unlike most women, she has a male birth certificate. She is a transgender woman.

Andrea has felt female as long as she can remember, and began living a female life as soon as she could. For this she was insulted by neighbours, teased by teachers and classmates at school, beaten up and raped by a bunch of young boys one night, and eventually beaten and disowned by her father. She dropped out of school, left home and migrated to the city, to stay with an older transwoman from her home town who, it turned out, was a transgender sex worker working the streets. Andrea didn't much like the idea of sex work, but without education or connections was unable to get a job. Being 'trans' worked against her. No one wanted to employ her, even as a waitress or shop assistant. She turned to the 'entertainment' sector. Unable to get a job as a bar dancer or hostess, and barred from nightclubs and discos (all because she is trans), she too began to work on the streets. She has done it for five years, earning money for food and lodging, and a little extra for hormones and new silicon injections for her hips and breasts.

Andrea's story is one of many thousands of transwomen worldwide (especially those like Andrea who are rural, less educated and socially isolated) who turn to sex work, not as the most attractive of a range of job options, but as the sole viable option for survival. Doubly stigmatised as transsexuals and as sex workers, pushed into street work, they become victims of abuse and violence perpetrated by bystanders, customers, their own 'sisters,' and (sadly) even by those who should be protecting them - the police.

As Andrea soon found out, competition on the streets is tough. There are too many trans sex workers and too few customers. Increasingly, her competitors are younger and more attractive. There have been fights over customers. Bystanders often abuse her verbally. Customers sometimes refuse to pay, angrily claiming they did not know she is trans. She has been beaten a few times. She knows others have been murdered. Nowadays, in order to avoid violence, she makes clear to every man who approaches her that she is transgender, even if that loses her customers. 

Discrimination, Abuse and Violence

Latin America perhaps presents the most shocking examples of violence against transwomen, especially sex workers. Possibly hundreds of travesties have been murdered in recent years. But the situation in Asia, with which we are more familiar, is pretty bad too. Continent-wide conservative attitudes and religious beliefs fuel intolerance and stimulate discrimination, abuse and violence against transgender people; particularly against transwomen. All three thrive because concepts of individual rights and equal opportunity are often undervalued or unenforced.

A few recent cases from the first half of 2010 illustrate the situation well. An ultra-nationalist group in Mongolia has beaten, abducted and raped transwomen, and has issued death threats, all because they consider these persons un-Mongolian. A Vietnamese woman was gang-raped, her case making news because her legal status (male) invalidated any rape charges against the perpetrators. In Bali, transwomen have been pursued, assaulted and humiliated by young men who have shaved the hair from their victims' heads. In Turkey there has been a long series of incidents involving thugs beating transwomen on the streets, and police arbitrarily arresting, beating and humiliating transgender activists. In a most recent incident, just a few days before completion of this article, a Turkish transwoman was found murdered; stabbed twelve times and with wounds from her throat to her stomach. Finally, across Indonesia, thugs have broken into meetings of transwomen and driven away the participants, chasing them into the streets, all on the grounds that they are un-Islamic.

Partner violence against transwomen seldom makes it into the newspapers or web blogs. And yet it is a major problem. Many transwomen drift into abusive and violent relationships through low self-esteem. Once there, many feel unable to leave their partners. Beliefs about gender roles foster an even higher tolerance for violence. One South Asian transwoman admitted, "I don't mind if my girya (man) beats me up. It only shows how manly and powerful he is." Another claimed, "When my parik ("husband") beats me, I feel as helpless as a woman. Since I want to be a woman, it actually makes me feel good."1

As is already apparent from the Turkish example above, abuse and violence are often perpetrated by state organs supposedly there to protect the weak. In Kuwait, Nepal and India there have been clear cases of organised police violence against trans communities; so organised as to take on the appearance of 'sexual cleansing' programmes (apparently aimed at instilling fear into transwomen intending to come out of their homes). In some countries anti-homosexuality laws have been used to oppress transwomen, and anti-sex work laws have been used to oppress transgender sex workers (along with others). In Cambodia, programmes of forced occupational rehabilitation for sex workers have resulted in transwomen (and other women) being placed into training programmes aimed at providing workers for the garment industry. Not for nothing does APNSW (the Asia-Pacific Network of Sex Workers) feature a 'no sewing machines' image as its logo.

Andrea has had her share of police encounters. The police often harass her and have arbitrarily arrested her. Police extortion is a problem too (either after arrest or as a condition for not arresting her). A few times they charged her with being a nuisance to tourists (though in each case it was the tourist who approached her). At other times they found her in possession of a condom and charged her with prostitution, which is illegal in her country. She now does not carry condoms anymore, and often has unprotected sex. She had twice been sexually assaulted in a police station, once by two police officers, and another time by a male inmate with whom she had been locked up. In each case there was no condom used. She recently found out that she is HIV positive.

High-risk Sex

Worldwide, HIV prevalence rates for transwomen are commonly found to reach double figures. One suspects that the precise figure often depends in part on the proportion of the sample involved in sex work. High HIV infection rates, often coupled with lack of access to HIV/ AIDS care, arguably represent the most glaring example of violence perpetrated against transwomen. This is not just about commercial sex or receptive anal intercourse; transwomen's HIV rates are sometimes higher than those for female sex workers or men who have sex with men. Rather they are the inevitable consequence of widespread prejudice that frames transgenderism as unnatural, immoral or mentally disordered; of legal frameworks that view transwomen as men, denying them respect, equality and dignity as women; and of laws that criminalise sex between transwomen and men as same-sex activities.

In these circumstances many trans sex workers drift or get pushed into high-risk sex. Water-based lubricants may be too expensive. Some substitute them with oil-based lubricants (including engine oil), which are known to corrode condoms. Sex work on the street may be hurried (leaving less time for a condom anyway). In any case, trans sex workers like Andrea often avoid carrying condoms and lubricants as a way of depriving police of evidence of sex work. Rural migrants, often cut off from family, and less educated and informed than their urban counterparts, are particularly at risk for unsafe sex. Drug and alcohol use, which are quite common among those involved in transgender sex work, exacerbate the problem. Viagra and its analogues, making for longer and repeated sexual intercourse and raising the risk of anal wounds, also increase risk.

Many trans sex workers, despite being poor, need money for hormones, silicone injections or surgery. The associated costs increase their poverty, making it harder to refuse a customer who does not want to use a condom. And then there is the pervasive problem faced by many (trans)women worldwide: low in self-esteem and desperate for a life partner, glimpsing an opportunity for a long-term relationship, wanting to put trust in someone, they cease to use condoms all too quickly.

Human Rights

The organisers of a recent Barcelona conference on transgender rights (the first truly global conference organised by and for transpeople) were keenly aware of violence in the lives of transpeople, especially of trans sex workers.2 Several sessions touched on sex work and violence issues. A document on violence and criminalisation, widely endorsed in a plenary final session, declared a set of basic rights relevant to all transpeople, but often denied to them - especially to those in sex work.3 With regards to violence, the document calls upon Governments:

  • to recognise and condemn as human rights violations all cases of transrelated violence;
  • to investigate such cases of violence (including when perpetrated by organs of the state);
  • to provide fully funded trauma counselling and care for survivors of trans-related violence;
  • to enact laws providing protection against such violence;
  • to provide free and equal access to the justice system for transpeople; and
  • to provide administrative, security and legal personnel with sensitivity training on trans issues, as well as on human rights standards on transrelated issues.

In Asia we are a long way from implementation of the list of principles and recommendations produced in Barcelona. Hopefully, some day in the future, properly observed and implemented, they will contribute towards a much needed improvement in the quality of life of Andrea, other trans sex workers, and of transgender people in general.


About the Authors

Khartini Slamah is coordinator of the Asia- Pacific Network of Sex Workers (APNSW) and a founding member of the Asia-Pacific Transgender Network. Sam Winter is associate professor at the University of Hong Kong, director of the Transgender ASIA Research Centre and a board member of WPATH (the World Professional Association for Transgender Health). Kemal Ordek is the general secretary of Pink Life LGBTT Solidarity Association ( Pembe Hayat, the only trans rights association in Turkey); and sexual orientation and gender identity taskforce member of the Youth Coalition for Sexual and Reproductive Rights.

Notes

1 Cited by Shivananda Khan in a paper presented at the 2nd International Expert Meeting on HIV Prevention on MSM, WSW and Transgenders, Amsterdam, November 2009.

2 The International Congress on Gender Identity and Human Rights, Barcelona, June 2010. A key feature of this conference, drawing participants from six continents, was that almost all attending were transpeople, and many were sex workers.

3 Violence, Criminalization, and Gender Identity (2010), available from: http://web.hku.hk/


weblink http://www.rhrealitycheck.org/blog/2010/12/16/stigma-exclusion-violence-against-trans-workers



 

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