妇女权益: June 2011的归档

NAIROBI, 7 June 2011 (PlusNews) - Epidemiologist Elizabeth Pisani raised eyebrows in 2008 with her book, The Wisdom of Whores, a frank account of her experiences working in the field of HIV/AIDS, from the politics of raising money to conversations in the backstreet brothels of Bangkok. She spoke to IRIN/PlusNews:

Question: Why have HIV prevention efforts failed to curb the spread of the pandemic?

Answer: Prevention has failed for many reasons. One is that we didn't actually start prevention until we had reached such a critical mass of HIV infection that prevention was always going to be difficult. The higher the prevalence in the population, the more effective prevention needs to be just to keep levels constant, let alone lower prevalence.

Globally, we missed some really easy wins when it comes to HIV prevention. One was needle exchange programmes for injecting drug users. Countries which have adopted these policies and adjusted their laws to accommodate them have virtually wiped out HIV among these populations. Unfortunately, a lot of countries have chosen not to do that, including the US and Russia.

Another easy win is providing commercial sex workers with condoms, lubricant and sexually transmitted infections screening; this isn't promoted nearly enough, particularly in sub-Saharan Africa, even though the evidence shows that it is fairly easy to achieve very high levels of condom use in commercial sex.

We've been very selective about our use of different HIV prevention methods. Prevention tools must work in four major ways in order for them to succeed - they must work behaviourally, technically, politically and financially - if any one of these things is missing, prevention won't work. Abstinence, for instance, works technically - you are definitely not going to get HIV through sex if you abstain - but behaviourally, studies tell us that abstinence doesn't actually work very well, so telling people to cross their legs for the rest of their lives isn't really going to prevent HIV.

Q: What is the truth within the HIV response that we're ignoring and why?

A: One of the great distortions is the gender thing; we've spent a lot of time acting like it's all about innocent women versus wicked men, when in fact it is impossible for heterosexual transmission to occur in the millions without both sexes being involved. The fact is, women like to get laid too. In sub-Saharan Africa, young women entering marriage are more likely to be the infected partner; more men will infect HIV-negative wives while married, but still, about one-third of new infections in marriage are a result of women infecting their husbands.

This fantasy of the innocent woman has led to some misdirected programming such as women's empowerment programmes and microfinance - both of which are useful, just not in the case of HIV. What should have been done is extremely aggressive promotion of condoms and sexual health services, especially in the context of sex work, much earlier on. We're still not focusing enough on commercial sex.

We've dichotomized HIV epidemics as generalized and concentrated, but even in generalized epidemics, commercial sex work contributes a much higher proportion of new HIV infections [than the general population].

Q: Treatment as prevention - is it the answer to ending the AIDS pandemic?

A: I think treatment is the answer to ending AIDS, but I don't think it is the answer to ending HIV, which is an important distinction. I don't think that it is financially feasible to scale up treatment to the levels it needs to reach in the population in order to end HIV transmission.

For those of us who worship at the altar of the randomized control trial, the recent HPTN 052 study gave us very good evidence that HIV treatment reduces infectiousness, something we've known for a while. But it has only proven this at an individual level; it doesn't tell us about the population level, whether the low viral load can be maintained in the entire population on treatment for the entire lifespan of this population while still ensuring newly infected people - who are highly infectious - are not infecting other people.

In addition, the study excluded people who were not able to adhere to treatment - that meant drunks, people who travelled for work and so on, did not participate in the study. People in the study were in a well-supported trial situation, and we don't know if we can feasibly recreate such a situation in the real world.
This is not to suggest that we shouldn't treat more people, and treat them earlier than we do at the moment. It is bound to reduce the infectiousness of people infected with HIV so it will certainly have an impact, but because treatment allows people to stay alive and sexually active for much longer it won't, in itself, be enough to wipe out new infections.

Q: In your book, Wisdom of Whores, you make the case that in Asia, HIV prevention should focus on high risk groups such as sex workers and IDUs. In East and Southern Africa, where HIV is much more generalized, what is the best way to approach HIV prevention?

A: I genuinely don't know what to do for HIV prevention in sub-Saharan Africa, and if anyone else has got ideas that really work I don't see them being put into practice. I would predict that incidence is unlikely to fall, and there's a fair chance that it will rise.

On the other hand, if it is possible to provide and keep expanding treatment at a higher CD4 count and sustain it without it undermining the progress of other health and development issues, then HIV may not - eventually - be such a big deal. Members of the 'AIDS mafia' - such as myself - won't say that HIV is not a big deal because we come from the generation of AIDS, when people died, which was a very big deal. But today, if HIV treatment is affordable and available and an HIV-positive person is in a well-managed situation, truthfully, HIV is really not that big a deal.

What I mean is it is not a big deal for an infected individual; it is a huge deal for health systems and tax-payers who have to manage the epidemic, and there is a real threat of drug-resistant strains emerging and taking us right back to the age of AIDS.

Q: In Wisdom of Whores, you say in the past the epidemiological data on HIV was presented in ways that aimed to cause alarm and spur increased AIDS funding. Has this changed - is the data we see today more reflective of the truth about the state of HIV?

A: I think it's getting harder to beat up the statistics the way we used to, and perhaps there has also been a realization that it can be counterproductive to the work you are doing - you might get the money but you can't do what you need to with it.

There is a greater realism compared to the earlier years, and I think there is less distortion even than five years ago. Perhaps lessons are being learned, or perhaps I've just been out of the UN system for too long to see what's going on.

Weblink: http://www.plusnews.org/report.aspx?reportID=92915

流行病学专家 Elizabeth Pisani2008年撰写的《妓女的智慧》(The Wisdom of Whores)一书引起了巨大反响,书中披露了其多年来在艾滋领域工作的经验,内容涵盖了从筹款的政治艺术到在曼谷与按摩院性工作者的交流等。IRIN/PLUS NEWS对她进行采访。






Q: 在对抗艾滋的过程中我们忽略了什么?为什么?





从另一个方面来说,在对其它健康和发展问题不造成影响的情况下,如果有可能在CD4细胞值更高的时候提供和扩大治疗,那么艾滋病毒最终将不会是什么大事。"AIDS Mafia"的成员,例如我自己,不会随便说"艾滋病毒并不是什么大问题"这样的话,因为我们是经历过艾滋感染爆发高峰期的一代人,病人的死亡可不是一件小事。但是现在如果每个人都有途径接受治疗并能够承担治疗费用,并且每个感染者的病情都能得到很好的控制,那么艾滋病将不再是一个大问题。

Asia Report 翻译





Asia Report 翻译

原文链接: http://www.thanhniennews.com/2010/Pages/20110601115436.aspx

  Hanoi authorities on Tuesday allocated VND5 billion (US$243,000) for a program to crack down on prostitution.

  Half of the funding will support a rehab center to treat sex workers, including those addicted to drugs, and HIV-infected children.

  Money will also be spent on propaganda such as leaflets, newspapers and documents aiming to raise awareness of sex workers.

  Hanoi police department will also be supported to strengthen crackdown on secret brothels and prostitutes in public places.

  On May 12, the government unveiled on its website a five-year plan to reduce prostitution by an initial 40 percent by 2015.

  With a budget of VND629 billion ($30.5 million), the program looks to free communes and towns from prostitution and minimize harms on society.

  Rehab and healthcare centers, job training for former sex workers and public awareness are among the measures the government said will be taken to battle prostitution.

Weblink: http://www.thanhniennews.com/2010/Pages/20110601115436.aspx


    国际人口服务组织(the Population Services International),Sun Quality Health (SQH)组织与其姐妹组织--Sun Primary Health乡村健康工作者网络于2010年在缅甸全国提供超过210万次健康咨询服务。于2007年接管该项目的John Hetherington接受健康市场创新组织(Center for Health Market Innovations-CHIMI)的采访,介绍SQH如何在缅甸--这个亚太地区最贫穷的国度之一,基于目前可利用的社会特许经营网络,集合最广泛的服务为当地人群提供高质、管理完善的医疗服务。

CHMI:贵机构以Sun Quality Health为商标提供各种各样的服务,你们是如何选择将要提供的服务类别的?








CHMI: 说到这里,你们如何保证医疗质量?



CHMI: 让医护人员加入这个项目是否困难?




缅甸卫生部部长也看到了Sun Quality Health项目的影响力。我们的计划生育服务占该服务全国总量的25%,我们也对全国12%的肺结核病例开展追踪治疗,这并不是个小数目。

Asia Report 翻译

组织: the Population Services International (PSI)-- 国际人口服务组织

了解社会特许经营(Social Franchising

原文链接: http://healthmarketinnovations.org/blog/2011/may/26/how-engage-private-sector-doctors-deliver-high-quality-and-affordable-priority-care

作者:Alex Delamare


    当Thida Win因在街边从事性交易而感染艾滋病后,她转而向其他性工作者,而非医疗机构寻求帮助。

    几乎完全是由性工作者开展的"顶端"项目为Thida Win提供治疗,使她避免了来自社会对艾滋病和性工作的双重污名化。





    "顶端"项目发起人和主管Habib Rahman表示为大家提供一个不受社会禁忌约束、能够与同仁共同讨论问题的空间是这个项目的主要目标。







    Myint Myint在离婚之后进入一家按摩院工作,之后她立刻感染了艾滋病毒。她表示顾客们(其中大部分是卖豆或卖鱼的小贩)对于使用安全套都表现的非常迟疑。

    联合国艾滋病规划署缅甸事物官员Soe Maing表示:"缅甸艾滋感染呈下降趋势,关键受影响群体的感染率也在下降,但是基数仍然非常高。"



    该项目由国际人口服务(Population Services International)组织于七年前展开,目前雇员来自全国19个市镇,总人数达350人,其中95%为女性性工作者和男男性行为者。


    Thida Win第一次参与性交易的时候还是一名大学在校学生,她表示婚姻和抚养下一代的经济负担使她不得不继续从事性服务。


Asia Report 翻译

原文链接: http://news.yahoo.com/s/afp/20110522/hl_afp/myanmarhivhealthsocial_20110522185905

By Alex Delamare (AFP) 

YANGON -- When Thida Win contracted HIV after selling her body on the Yangon streets, it was her fellow sex workers that she turned to, not Myanmar's crumbling health service.

The Top project, run almost entirely by those in the sex trade, gave her treatment, a place to be herself away from the dual stigma of HIV and prostitution -- and eventually a job.

"I am now a health worker for my community and I can forget I am positive. I am so proud to work for the programmes, I will work for them for my whole life," the 33-year-old told AFP.

Top and similar projects are a vital resource in army-dominated Myanmar, where a chronically underfunded health service, large itinerant populations and poor education fuel one of Asia's worst HIV epidemics.

Nearly one in five of Myanmar's estimated 60,000 sex workers were infected with HIV in 2008.

A United Nations report from August last year said legal constraints and discrimination made it hard to reach those in the trade, which is illegal. Surveys suggested police even used condoms as evidence for arrest.

Top founder and director Habib Rahman said providing a place free from taboos and letting people share their problems with contemporaries was a key aim for the project.

Rahman said many women enter sex work without knowing about the risks.

"In general in Myanmar I do not think there is any sex education in school," he said.

The project recruits former and current sex workers to help educate others about HIV, spreading the message from a position of trust within the community.

"We cannot tell anyone to stop selling sex even though they are positive but what we do is tell them how they can keep healthy and protect the client by using condoms," said Rahman.

He said Top's part-time "peer educators" who chose to continue in the sex trade were encouraged to always use protection, while full-time employees were instructed to stop selling sex altogether.

Myint Myint contracted HIV soon after being recruited to work in a brothel following the break-up of her marriage. She said her clients, mainly local bean and fish traders, had often been reluctant to use protection.

HIV transmission in Myanmar occurs "primarily through high-risk sexual contact between sex workers and their clients", as well as men who have sex with men and their partners, according to the UN report.

It said while injecting drug users have the highest HIV prevalence, at 36 percent, they are also likely to pay for sex and "this interaction may refuel the sex-work-driven epidemic".

Years of neglect by the ruling generals -- Myanmar spent just 0.9 percent of its budget on health in 2007 -- have left foreign donors facilitating most of the country's HIV treatment.

A new government, which came into power after controversial November 2010 elections, has raised hopes of more investment from overseas donors -- but not the state, which is expected to spend around 20 percent of outlay on the army this year.

In 2009 the UN estimated 240,000 people in Myanmar were living with the virus and while there have been improvements, the situation remains worrying with prevalence rates the third highest in Asia after Thailand and Papua New Guinea.

"The HIV epidemic in Myanmar is on a decreasing trend and among the key population groups it is also reducing -- but it is still really quite high," said Soe Naing of UNAIDS in Myanmar.

He said some state provision for HIV treatment does exist in big cities, "but of course the standards and situations are not ideal. People are reluctant to go to them because of privacy issues and quality".

Top clinics provide everything from testing and counselling to routine medical care.

Last year it gave treatment and consultation to 11,770 female sex workers and 10,727 men. It also accounted for 40 percent and 82 percent of all HIV tests for those groups respectively in the country.

The programme, which was formed by Population Services International (PSI) seven years ago, now employs 350 people -- 95 percent of whom are from the sex worker community and men who have sex with men -- in 19 towns and cities.

In Myanmar, where the US estimates around a third of people were below the poverty line in 2007, money worries are likely to continue to drive people into sex work.

Thida Win, who was still a university student when she first sold sex, said the financial burden of marriage and children only pushed her further into the trade.

"I got my degree with sex work, I supported my family very well with sex work," said the chemistry graduate, who said her earnings still help support seven family members.

Weblink: http://news.yahoo.com/s/afp/20110522/hl_afp/myanmarhivhealthsocial_20110522185905

Times of India

  KOLKATTA: Seema Folka is excited, nervous and proud that she will be rubbing shoulders with the state's who's who on Friday. The 43-year-old will be attending Trinamool Congress leader Mamata Banerjee's swearing-in ceremony.

  Folka is a sex worker who will be in the invitee's gallery when Banerjee and her ministers take the oath.

  "We are thankful to Didi for showing a humane gesture by including sex workers in her invitee list. This quality in her will keep her connected with people from every section of the society," said Folka.

  Driven to the profession by abject poverty, Folka entered the professiion at a young age. Her father used to work as a daily wage earner to feed five mouths till he became bed ridden due to gastric ulcer. Her mother's meager income as domestic help was too insufficient for the family. Most of the time Seema and his two siblings would go without food for days. And when Seema's marriage was arranged, the groom's family broke the engagement as Seema's father could not meet the dowry demand. That was when Seema left her Murshidabad dwelling for Sonagachi, the biggest red light area in Kolkata to salvage the family out of poverty.

  "I will be wearing a green colour tant saree for the ceremony. I am a little nervous because I have never been a part of such a formal function. But I am sure I will remain composed and witness the historic event like any of those in the guest gallery," said Folka.
Durbar Mahila Samawaya Committee (DMSC), an advocacy organisation of the sex workers is elated about the prospect of their representative being present at such an important event.

  "It is great on part of Mamata Banerjee to have remembered us on such an important day. This infact is the first time a sex worker has been invited to be a part of an event like this.

  We hope her government will continue to support our cause in future," said DMSC secretary Bharati Dey.

OrganizationDurbar Mahila Samawaya CommitteeDMSC

Weblink: http://articles.timesofindia.indiatimes.com/2011-05-19/india/29559770_1_swearing-in-ceremony-mamata-banerjee-dmsc

    Durbar Mahila Samawaya委员会(DMSC)是亚洲第一个性工作者工会,成立于1997年,该联盟立刻接管了当地政府的艾滋项目。DMSC在西孟加拉地区拥有6万 名男、女性会员。委员会主要致力于倡导性工作合法化、平等工人权利,以及促进与改善工作环境与工资。

Times of India


    Seema Folka兴奋、紧张并非常骄傲,因为星期五她将有机会与国家重要领导人肩并肩站在一起。这位43岁的性工作者将参加催那木国会(Trinamool Congress)领导人Seema Folka的就职仪式。



    "在典礼那天我将身着绿色的纱丽服。我有点儿紧张,因为我从来没有出席过这么正规的场合。但我确定我将保持镇定,并和其他人一起见证这个历史性的时刻。" Folka表示。
对于其成员出席如此重要的活动,性工作者倡导组织Durbar Mahila Samawaya委员会(DMSC)感到非常骄傲。DMSC秘书长Bharati Dey 说:"Mamata Banerjee能在这么重要的日子仍记得我们,让我们感到很欣慰。事实上这是性工作者第一次受邀参加这一类的活动。我们希望政府今后能够继续支持我们的工作。"

Asia Report 翻译

组织:Durbar Mahila Samawaya委员会(DMSC)


作者:Siena Anstis



组织委员会成员Collette O'Regan表示,组织2011年骄傲周这样密集的一周活动打开了柬埔寨LGBT权利的新篇章。从前,大部分的倡导活动都以男男性行为者(MSM)为目 标群体。妇女被排除在外,变性者和性取向问题都与艾滋问题联系在一起,收到不应有的污蔑。她说:"你能想象这样做的后果,可怕的歧视、暴力、自我伤害和自 杀现象频发。"

柬埔寨社会对待LGBT群体并没有达到某些国家对LGBT群体的公众歧视和暴力的程度(虽然最近LGBT就报老板Kye Poirrie遭殴打的案例引起人们的担忧)。O'Regan认为柬埔寨社会并为对LGBT产生仇视与暴力的原因跟柬埔寨的官方宗教--佛教密不可分,佛教 对于同性恋持一个更为容忍的态度。柬埔寨LGBT维权倡导者Pisey Ly也表示,除了柬埔寨家庭法(family law)规定只允许异性伴侣结婚以外,其它法律并没有以性取向为基础的歧视(在乌干达,同性恋是非法的。)。她说:"我国的宪法保证所有公民的权利,无论 /她们持有何种性向,都能够充分享受这些权利。"Pisey Ly也并未要求特殊的对外,她表示:"虽然没有为LGBT权利而特别设立的法律,但LGBT团体也并为觉得需要针对自身的特别的法律,因为我们希望被看做 和别人一样的公民。"

然而,要让每一个LGBT个体确确实实获得这些基本的权利,还需经历一个奋斗的过程。她讲述了一下几个案例:一个同性恋女孩遭到家人威胁表示要找人强奸她 的同性爱人;另一个家庭向警察行贿,让他恐吓女儿的同性恋伴侣。一个同性恋女孩告诉Ly,她的家人威胁说要杀死她。Ly怀疑如果这件事情真的发生了,可能 警察也不会出面干涉。 Ly认为对于法律在基层的实施问题,政府部门很难获得相关信息。"他们不理解性取向是什么,并认为同性恋是不正常的。"

虽然一般来说政界人物对于同性恋的容忍度较大,但也有例外。例如柬埔寨总理Hun Sen公开与其同性恋女儿断绝关系。这也使得社会对同性恋的容忍度降低。在家庭内部,同性恋很难发表意见。O'Regan 表示""对于女同性恋来说,他们没有出柜或表达自己痛苦的机制。因此很多人自杀或离家出走,只为了逃避强迫的婚姻。"一份2010年由柬埔寨人权中心 Cambodian Center for Human Rights)发布的报告显示,总体来说,如果不影响传统的家庭结构,柬埔寨社会对男同性恋行为比较容忍。但妇女担负着早婚和生育的职责,所以面临的压力更大。


虽然和某些其它国家相比,柬埔寨社会对同性恋的接受度较高,但O'Regan仍很肯定地表示此类活动必须低调地进行。"如果我们要高调宣传的话就没办法开 展现在这些活动了。同时,我们也不能依靠NGO来调解,因为NGO对于任何跟维权相关的话题都望而却步。" O'Regan说。

在柬埔寨组织LGBT骄傲周这样的活动依靠的是非正式的志愿者网络。"为了确保处于社会边缘的群体不被一刀切,我们必须利用一些非正式网络,很多资助方对 此非常理解。"她表示。长远来说,LyO'Regan都希望柬埔寨LGBT骄傲周能够增进柬埔寨社会对不同性取向的接受度与理解。

Asia Report 翻译

组织:Rainbow Community Kampuchea (RoCK).


Siena Anstis

Last week, Cambodia finished celebrating its third official lesbian, gay, bisexual and transgender (LGBT) pride celebration, a week of movie screenings, workshops and other activities organized by Rainbow Community Kampuchea (RoCK).

The celebration of LGBT rights in Cambodia has come a long way. Between 2003 and the first official LGBT pride week in 2009, these celebrations in Cambodia were limited to just one evening a year.

Collette O'Regan, a member of the organizing committee, says that the hosting of such an extensive and well-organized week, like Pride 2011, marks a new beginning for LGBT rights in Cambodia. Previously, it was mostly the 'men having sex with men' or MSM community that was organized and supported by donors. This necessarily excluded women and stigmatized transgender and sexual orientation by linking it to HIV/AIDS. "You can imagine what this leads to, including horrific discrimination, violence, self-harm and suicide," she said.

O'Regan agrees that discrimination towards the LGBT community in Cambodia is not on the same publicly homophobic and violent scale as in other countries (although there are worrying instances of violence, such as the recent beating of LGBT bar owner KyePoirrier).

For example, in Uganda, David Kato, a Ugandan LGBT rights activist, was murdered after appearing on the front page of Rolling Stone, a Ugandan newspaper. The newspaper had published a photo of Kato and other people it said were gay under the headline "Hang Them."

O'Regan suggests the relative lack of violent homophobia in Cambodia is linked to the country's official religion, Buddhism, which is more tolerant of homosexuality. Pisey Ly, a Cambodian LGBT rights activist, also points out that - save for Cambodia's family law, which only allows for opposite sex marriages - laws do not discriminate on the grounds of sexual orientation (in other countries, like Uganda, homosexuality is illegal). "Our constitution guarantees all citizens rights, to enjoy those rights no matter what your sexual orientation is." Nor does she ask for special treatment: "There is no specific law protecting LGBT rights, nor [does the LGBT community] feel like they need a specific law. They want to be treated like other citizens."

The struggle, however, is in having these basic universal rights enforced for LGBT individuals. She tells the story of a family who threatened to have their lesbian daughter's partner raped. Another family paid a bribe to the police to have their daughter's partner intimidated. One lesbian girl told Ly that her family threatened to have her killed. Had that happened, Ly doubts that the police would have intervened. Ly suggests that this type of behavior among law enforcement officials can be associated with a lack of information, "They do not understand what sexual orientation is and think it is unnatural."

While political figures have generally been tolerant of homosexuality, there have been some notable exceptions, for instance, when Cambodian Prime Minister Hun Sen publicly disowned his lesbian daughter. This also suggests a less tolerant environment. Homophobia is also particularly pronounced within the family. "For lesbians, there is no mechanism for them to come out and express what they are suffering. They are also committing suicide or running away from home because they are being forced to marry," says O'Regan. As detailed in an extensive report published in 2010 by the Cambodian Center for Human Rights (CCHR), Cambodian society is generally tolerant of male homosexual behavior if it does not affect the traditional family structure. Women, who are expected to marry young and have children, are faced with more family pressures.

O'Regan believes one critical way to combat homophobia in the family in Cambodia, particularly for lesbians, is to focus on helping LGBT members become economically independent.  

"Everyone, like most Cambodians, is poverty challenged. People just want to be able to have a decent life, so they need decent work," she explains, "One hugely effective way of getting family acceptance in Cambodia is to have a job, to be able to help your family very practically."

She says that some of the lesbians who are economically independent are not only accepted by their families, but also by their communities since they can contribute to community fundraising. "This is another way in which the rest of the community stands back and says well I guess they are alright, they are doing what everyone else is doing."


Despite a greater general public acceptance of homosexuality in Cambodia compared to other countries, O'Regan is still firm that these types of events could not happen unless they remain under the radar. "There is no way we could do what we are doing if we were blowing it from trumpets. If it were being mediated by NGOs it would also not be happening because NGOs are terrified of anything to do with rights."

The real success in organizing an event like the LGBT Pride Week in Cambodia is the use of informal voluntary networks. "There are a couple of donors who understand that [informal networks] are what one needs in a civil society in order to make sure that marginalized groups don't get cut out altogether." In the long-run, both Ly and O'Regan hope that the LGBT pride celebration in Cambodia will contribute to greater acceptance and understanding of different sexual orientations in Cambodia.

Organization: Rainbow Community Kampuchea (RoCK).



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