性工作: May 2011的归档

FEMINISM, POWER, AND SEX WORK IN THE ONTEXT OF HIV/AIDS: CONSEQUENCES

FOR WOMEN'S HEALTH

 

AZIZA AHMED*

 

  Globally, women constitute approximately fifty percent of all HIV infections. Women may eventually comprise the majority of people living with HIV/AIDS in the world; this is already true in Sub-Saharan Africa where women constitute sixty percent of the individuals living with HIV. The recognition that women's inequality may be a driver of women's vulner- ability to contracting HIV has led to a series of feminist legal responses in an effort to address HIV.

 

  This Article assesses feminists' conflicting legal, policy, and regulatory proposals to address sex workers' vulnerability to contracting HIV. This Article employs a Governance Feminism ("GF") analysis that allows us to assess feminists as powerful actors in the institutions that govern HIV. This Article focuses on two cases in which particular legal and policy proposals can be traced directly to feminist engagement and disagreement: the drafting of the United Nations Joint Programme on HIV/AIDS Guidance Note on Sex Work and the creation and implementation of the Anti-Prostitution Loyalty Oath.


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艾滋病背景下的女权主义,权利与性工作:对女性健康的影响

作者:Aziza Ahmed

哈佛大学法律与社会性别期刊

 

全球范围内妇女约占艾滋感染人口的一半。在未来,妇女有可能最终将成为主要艾滋感染人口,这种情况在撒哈拉以南的非地区已成为现实,艾滋感染者中60%为妇女。普遍认为妇女的不平等地位是使妇女面对艾滋感染时异常脆弱,这也导致在抗击艾滋的努力中很多出现了一系列女权主义的法律回应。

  本文分析了不同的女性主义者针对性工作者感染艾滋的脆弱性所提出的相互冲突的法律、政策和管理方面的提案。文章采用Governance Feminism分析法让读者了解女权主义者作为有影响力的行动者,积极参与对艾滋问题的管理。本文关注的两个案例可以清晰地表明女权主义者如何参与不同的法律和政策提案,以及如何表达不一致的意见。这两个案例分别是:《联合国联合项目:艾滋指南与性工作须知》和《打击卖淫效忠誓言》的制定和实施。


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组织:

Iwag Davao--达沃市之光(菲律宾)

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1994年5月,Iwag Davao起初是一个对25名男同性恋者开展艾滋朋辈教育培训的研讨会。该培训受到了男同参与者热烈地回应和积极地参与,之后Iwag Davao有继续为另外25名男同性恋者继续开展培训。在此基础上,1994年10月,Iwag Davao在男同性恋者委员会的组织下正式成立为一家非政府组织。Iwag在宿雾语中意为光,因此Iwag Davao代表了"达沃市之光 "的意思。

该名称也反映了机构的目标:为男同社区赋权,提高他们的社会与经济地位。它象征着引导和解放男同性恋的光芒,使该群体积极参与社区建设,向着自由和团结前进。

网站:http://www.angelfire.com/vamp/iwagdvo/pg2.html


    FHI是一所致力于健康与发展的全球性国际机构,机构通过开展以科学为基础的项目为全世界脆弱人口带来改变。机构拥有2500名来及健康、发展和管理领域的顶级的医生、科学家和技术专家。
从1971年开始,机构在125个国家与1400个机构合作开展工作,其中包括政府、各种组织机构、私营部门和社区。通过开展科学项目,FHI为成千上万的家庭带来福祉,并帮助合作过发展对抗疾病、贫穷和不公的有效方法。

我们的任务:
用可持续的方法提高全世界脆弱人口的生活质量。

我们所秉承的价值:
责任
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Reuters

By Tan Ee Lyn and Fitri Wulandari

JAKARTA | Tue Apr 12, 2011 10:28am EDT

Liana, who holds an economics degree, is one of 300,000 Indonesians in the world's most populous Muslim nation who have fallen victim to widespread ignorance about AIDS, and the government's inability to campaign effectively against it for fear of being accused by conservatives of promoting promiscuity.

Social taboos and strict laws that ban prostitution also work against those most vulnerable to the incurable disease, because police often use condoms -- one of the best protection against AIDS -- as evidence against sex workers.

Although HIV prevalence in Indonesia's population is low at 0.2 percent, the government and health experts are worried because the number of newly confirmed cases has more than doubled to 4,158 in the five years to 2010.

"When I started the job, I did not know anything about HIV/AIDS or that condoms can prevent you from getting infected with the disease", said Liana, who quit her job and turned to prostitution after her husband died in 2007 because she needed to pay off a mortgage and support their daughter.

A few months after she started sex work, Liana heard about HIV and tried getting tested. But was turned away two times by healthcare workers, who often do not understand the disease and are afraid of getting infected themselves.

Liana tested positive last year after falling ill and is now on AIDS drugs, which cost her 30,000 Indonesian rupiah ($3.5) a month as they are subsidized. Until today, she doesn't know how she became infected. Her 4-year-old daughter is uninfected.

"Thinking it over, I'm not lacking in education. But how is it that I never heard of this disease nor how to prevent it? Why does the government not spread the information," said Liana, a graduate of an East Java university who now insists all her clients use condoms.

"How can we prevent HIV/AIDS if we can't use the only protection that we have?

MAJOR OBSTACLES

There is no cure for Acquired Immune Deficiency Syndrome (AIDS), which is caused by the Human Immunodeficiency Virus (HIV), but drugs can help to control the replication of the virus and prolong life.

While Liana uses condoms, she says many of her friends do not as they are tempted by offers of more cash from clients who don't want to practice safe sex. They are also afraid they may be thrown in jail if police find condoms on them.

Health Minister Endang Sedyaningsih told Reuters the government faced enormous opposition in the fight against AIDS in this country of 238 million people. "We cannot put ads for condoms openly on television or promote their use, or people will say the Ministry of Health promotes promiscuity," she said in a recent interview.

Islam is the dominant religion in Indonesia and society remains largely conservative. "We have a program for methadone substitution and clean needle exchange (for drug users) but it's very difficult to expand it as it is seen as legalizing narcotics use."

Indonesia's approach is in sharp contrast to the aggressive interventions taken in nearby Thailand, which implemented a high-profile "100 percent condom use campaign" in the early 1990s to rein in an explosive HIV epidemic.

That campaign was hugely successful and brought down drastically new HIV infection rates particularly in young men.

The disease, which has killed 4,539 people so far in Indonesia, used to be spread mainly by injecting drug users. Eight out of 10 addicts have HIV. But in 2010, 65 percent of newly confirmed HIV infections came through unsafe heterosexual sex between sex workers and clients, who went on to infect their wives or girlfriends. The government estimates there are 200,000 female sex workers in the country and a male clientele of up to 3 million. Only 10 to 15 percent of clients use condoms.

A sharp jump in mother-to-fetus HIV infections is one of the clearest signs that the AIDS epidemic may be moving from particularly vulnerable groups, such as injecting drug users and sex workers, into the general population. These perinatal infections made up 3 percent of all newly confirmed HIV cases in 2010, up from 0.2 percent in the 1990s. "This means that HIV transmission within the family is increasing ... If we have no new approach for HIV prevention within the family, it (the HIV epidemic) may become generalized. We should think out of the box to protect the family from AIDS," said Inang Winarso, assistant deputy secretary of the National AIDS Commission for program coordination.

When HIV/AIDS becomes generalized and widespread, as in many parts of Africa, it takes a huge toll on countries, draining them of resources and economic productivity.

FEW TOOLS LEFT

In many parts of Asia, HIV has made a comeback in recent years among vulnerable groups. Governments and concerned groups in China, Hong Kong, Australia and Cambodia are battling hard to contain the epidemic. Through the use of high-profile campaigns, sometimes even involving state leaders as in China, they push hard for the use of condoms and clean needles to prevent the disease from spreading into the general community. But such high-profile interventions cannot be adopted in conservative Indonesia.

Winarso, who was involved in a successful campaign against HIV transmission among gay and bisexual men, hopes to stop the virus from spreading among sex workers through empowering the women, quietly. "In every story that was told to me, nobody said they liked or that they trained to be sex workers. They all started because of trafficking or because of poverty, but they have no awareness that they are victims," he said.

Winarso and his colleagues plan to reach out to sex workers in a pilot project in Semarang in East Java.

"We will visit brothels, we will avoid the pimps. We will spread awareness, get them to tell us their stories, so that they realize they are victims, and continue to be victims under their pimps," said Winarso. "How do they fight? They need to fight their customers (for condom use) and they must fight the government to provide them with jobs."

The World Health Organization estimates there are 300,000 people in Indonesia living with HIV/AIDS, with the worst affected places being Jakarta and Papua province, where 2.3 percent of the population is infected. Some 50,000 HIV patients require drugs but only 20,000 are getting them. "There are several reasons: no access and shortage of drugs even though there are 200 (HIV drug distribution) sites all over the country," said Khanchit Limpakarnjanarat, the WHO's representative in Indonesia. The WHO has a 10-member team in Indonesia and one of its missions is to train medical personnel in treating HIV patients. "We need to strengthen the healthcare system in terms of human resources ... To provide HIV services requires human resources, like counseling and testing. Drug treatment is complicated. These remain a challenge," he said. ($1 = 8,677.5 Rupiah)

(Editing by Alan Raybould and Miral Fahmy)

Weblink: http://www.reuters.com/article/2011/04/12/us-indonesia-aids-idUSTRE73B18H20110412?feedType=nl&feedName=ushealth1100
【路透社】
2011年4月12日

    财务危机迫使丽阿娜在四年前从事性工作,但这名30岁的前会计人员表示她从不知道无防护措施的性行为会让她感染上艾滋病毒。拥有经济学学位的丽阿娜是印尼30万艾滋感染者中的一名,这个拥有世界最多穆斯林人口的国家对艾滋病毒缺乏足够的重视,同时政府由于害怕被保守党派指责为推动社会混乱而无法开展有效的宣传倡导。

    社会禁忌和严格的法律禁止色情行业,同时,由于警察常常拿安全套作为指控性工作者的证据,使得这个本来就处于边缘的群体在面对艾滋病毒侵袭时束手无策。虽然该国艾滋感染率只占全国人口的0.2%,但过去五年新增确认患者数量翻了一倍,达4158名,这一增长让政府和卫生专家担忧。

    "当我刚开始从事这个行业时,我对艾滋病一无所知,也不知道安全套可以防止感染",丽阿娜表示。在2007年丈夫去世后,因为需要付清葬礼花费以及抚养女儿,丽阿娜辞去工作,转行从事性服务工作。在从事性工作几个月后,丽阿娜听说了艾滋病毒并尝试检测,却两次遭到医疗人员的拒绝。这些医护人员本身对该疾病缺乏了解,同时也害怕自己被感染。去年莉安娜检测出已感染病毒,现在通过政府救济她每月花费三万印尼币(约3.5美元)买药。直到现在她仍不清楚自己是如何感染上病毒。她四岁大的女儿并未感染。

    "我反复思考过,我并非没接收过教育。但是为何我却从来没听说过这种疾病,也不知道如何预防?为什么政府没有对这些信息做宣传。"毕业于东爪哇大学的丽安娜现在坚持要求她所有顾客使用安全套。

    "如果我们连这仅有的保护都没有,那又如何防止艾滋感染呢?"

主要障碍
    由人类免疫缺陷病毒(HIV)引起的获得性免疫缺陷综合症(AIDS) 无法治愈,但药物可以帮助控制病毒细胞的复制,并延长生命。
虽然丽安娜使用安全套,但她表示许多客人为了避免使用,愿意向性工作者提供更多现金,因此丽安娜的许多朋友并不使用安全套。她们也担心如果安全套一旦被发现,她们将面临牢狱之灾。

    卫生部部长Endang Sedyaningsih向记者表示,在这个拥有2.38亿人口的国家,政府对抗艾滋的努力面临巨大的挑战。"我们无法公开在电视上播放安全套的广告,也不能倡导使用安全套,不然大家会说卫生部在宣传混乱的性关系。"她在一个最近的采访中表示。
 
    伊斯兰教是印尼的主要宗教,因此印尼社会也更为保守。而邻国泰国在对待该问题上却采用了更为激烈的方法,与印尼形成巨大反差。从上世纪90年代初,泰国展开"百分百安全套使用运动",对抗艾滋病毒传播。这场运动成效显著,新增艾滋病毒感染率明显降低,特别是在青年男性群体中。

    在印尼目前已有4539人死于爱滋病,大多数感染者为注射吸毒人员,其中80%为病毒携带者。但2010年65%的新增感染者通过与异性发生不安全的性行为而感染病毒,多存在于性工作者和顾客之间,在此之后其女友或妻子也被传染。根据政府统计,全国大约有20万女性性工作者,男性顾客高达300万人,而其中只有10%-15%使用安全套。

    目前,印尼艾滋感染已从注射吸毒人员和性工作者等高危人群向普通大众过度,母婴传播的增长成为这一现象的显著标志。该传染率从上世纪90年代初的0.2%增长至2010新增感染者中3%。国家艾滋委员会项目协调中心助理副秘书长Inang Winarso 表示:"这说明家庭内部的艾滋感染在不断增长。如果我们不采用任何新方法应对这种传播途径,艾滋感染将会进一步扩大化。我们需要跳出过去的条条框框,用新方法防止家庭内部成员间的传染。"

     当艾滋病毒在社会中广泛传播时,将会给国家财政带来巨大的负担,榨干所有资源并阻碍经济增长。很多非洲国家对此深有体会。

缺乏工具
    最近几年来很多亚洲国家边缘人群的艾滋感染率出现增长趋势。中国、香港、澳大利亚政府和关怀组织正尽全力抗击该流行疾病。例如在中国,政府开展大量公共倡导活动,许多政府领导人也参与其中,呼吁公众使用安全套和干净的针头以防止艾滋病毒在社区内传播。可是这种高调的呼吁在保守的印尼社会却行不通。

    Winarso曾参与过一个针对男同性恋和双性恋群体艾滋预防的项目,该项目成效显著。现在,他希望通过对妇女的赋权来降低艾滋病毒在性工作者中的传播,当然,所有这一切都必须低调地进行。Winsor和他的同事计划在东爪哇岛三堡垄港市开展的示范项目中与性工作者合作。

    世界卫生组织预计印尼约有30万艾滋病感染者,雅加达和巴布亚省为重灾区,2.3%人口感染艾滋。5万名患者需要药物治疗,但只有其中2万人能获得所需的药品。世界卫生组织印尼代表Khanchit Limpakarnjanarat 表示:"即使印尼全国有超过200处艾滋药物发送站,但还是缺乏足够的药品和获得药品的途径"。世界卫生组织在印尼有10名工作人员,主要的任务之一是培训更多艾滋医护人员。他继续表示:"我们需要根据现有的人力资源增强卫生系统的能力。相关的艾滋服务要求足够的人力资源,例如开展咨询和检测的医护人员。药物治疗就更加复杂了,这些都是挑战。"


Asia Report 翻译

原文链接: http://www.reuters.com/article/2011/04/12/us-indonesia-aids-idUSTRE73B18H20110412?feedType=nl&feedName=ushealth1100



 

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