Despite a decreasing prevalence of HIV/AIDS among commercial sex workers, health workers say the stigma associated with prostitution and the harsh laws against it are undermining sex workers’ access to HIV-related services.
Burma has made remarkable progress, given the limited resources it’s had to combat HIV.
Resources are usually misspent by targeting the general community rather than at-risk groups. However, the country’s national strategy has included some strong targeting.
Burma currently allocates just 3.9 percent of its budget to health [ http://www.irinnews.org/report/96014/myanmar-health-snapshot ], but the figure will rise to 5 percent in 2014, which represents a fourfold increase since the end of military rule in 2011.
The Global Fund to Fight AIDS, Tuberculosis and Malaria [ http://www.theglobalfund.org/en/ ] resumed operations in Burma in 2011 and in September 2013 provided US$160 million for HIV services until 2016 – an increase of $90 million.
According to the Burma Ministry of Health [ http://www.moh.gov.mm/file/Ministry%20of%20Health.pdf ], there are 200,000 people living with HIV/AIDS, and approximately 15,000 people die of AIDS-related illnesses every year.
Prevalence has been decreasing in all risk groups other than drug users [ http://www.psi.org/myanmar ].
Surveys reveal that in 2008, prevalence among sex workers stood at 18.4 percent [ http://www.aidsdatahub.org/sites/default/files/documents/sex_work_hiv_myanmar.pdf ], whereas 7.1 percent of sex workers were HIV positive in 2012.
While government data estimates that there are currently 60,000 sex workers in Burma, PSI puts the real number at closer to 80,000. The national HIV infection rate is 0.5 percent, making HIV/AIDS a concentrated epidemic. However there have been quite a lot of deaths due to a lack of access to treatment [ http://www.irinnews.org/report/94943/myanmar-urgent-need-for-hiv-treatment ].
Laws curb access to health services
The stiff penalties for commercial sex work contained in Burma’s Suppression of Prostitution Act (1949) are a major barrier to accessing HIV treatment. The punishment is one to three years in prison for sex workers, but clients are not punished under the law.
Very harsh laws are in place against sex workers, instead of the mobilizers, the traffickers and the gangs who push women into sex work.
Even possessing a condom could be used as circumstantial evidence of prostitution until 2011, when the Ministry of Home Affairs issued a directive to the contrary, yet according to UNAIDS most of the public are unaware of the directive.
People are still not comfortable about carrying large amounts of condoms because they could be targeted as sex workers.
Another barrier to the prevention and treatment of HIV is the stigma surrounding commercial sex work – the word “prostitute” literally translates to “bad woman”.
Burma isn’t like other countries where sex work is more organized, with red-light districts which are brothel-based. There’s a great deal of indirect sex work, such as in massage parlours and karaoke bars.
In 1998 an amendment broadened the 1949 legal definition of a brothel to include any place used habitually for sex. This was done in response to the growth of sex work conducted in karaoke bars and massage parlours, which frequently change locations due to harassment by police. The managers of these establishments often deny health workers access to employees for fear of prosecution.
Naing said as a result of this, trying to provide HIV services was “like trying to pin down a river. The next day you go back and the sex workers are no longer there.”
Is parliament ready?
In July 2013, the founder of the Sex Workers in Myanmar network (SWIM), an advocacy group for commercial sex workers, spoke in parliament about the legal barriers to accessing HIV services. “This government is so different from when I set up the network in 2009. I think the laws could even change before the 2015 general elections,” she said.
The legislature has a number of promising members who are trying to raise the issue. But there are also very vocal conservatives, and many who agree in conscience but fear they will be seen as attacking traditional values.
Burma may not be ready to decriminalize sex work. However, before the 2010 elections, there wasn’t even any public debate. With more advocacy… we may be able to turn the tide of opinion.