Implementing Comprehensive HIV/STI Programmes with Sex Workers (SWIT Training), Yangon

APNSW members from Bangladesh, Indonesia, Mongolia and Vietnam took part in a five-day training in Yangon, Myanmar, from 20-24 June 2016. The training focussed on how to implement HIV/STI testing, treatment and prevention strategies that are directed by sex workers and that empower sex workers.Indoor group photo of participants at the SWIT training

The training gave me a much closer look into how specifically we can use these activities to empower our community. It gave us the skills and knowledge in how to connect with other state agents as well, and that is very informative and helpful to us,” said Ms. Do Thuy An My, from the Vietnam Network of Sex Workers.

The training was based around the structure of the "Sex Worker Implementation Tool", also known as “The SWIT” - a set of human rights based guidelines compiled by the World Health Organisation in partnership with other UN Agencies and Global NSWP.

Community Empowerment

The hidden nature of life and work for many sex workers creates a big challenge to empowering communities. Sex workers who are unwilling to be identified in public are reluctant to get involved in outreach work. Limits to women’s mobility at night make the job of outreach workers even harder, and even a simple gathering of sex workers can draw unwanted attention.Other obstacles to community organising include low knowledge of human rights among police, government officials and parliamentarians. There is even resistance to sex workers organising for themselves from bigger NGOs that conduct programs ‘for’ sex workers and do not like the idea of programs run ‘by’ sex workers.Participants chose two slogans to summarise community empowerment:

Knowing challenges, to solve challenges”“We are not problems, we are part of the solution.

Addressing violence against sex workers

Participants summarized the wide range of types of violence sex workers experience in their countries, from low level to extreme. They also identified how these forms of violence overlap with other issues, such as:

  • society’s perceptions of gender and gender roles (women are lower);
  • society’s perceptions of sex workers (like a disease or pest, or as criminals);
  • social and religious values that lead to stigma/discrimination; and,
  • domestic abuse, often influenced by a partner’s drug or alcohol use.

To prevent and respond to violence, the top priority among all participants was community organizing: providing human rights training for sex workers to know their rights, to improve their negotiation skills, and recognize and respond to injustices.

Community-led services

Everyone at the training was involved in community outreach and mapping exercises in order to provide a basis for making plans, and estimating resources that will be needed. Outreach was vital in order to connect sex workers with services, and this meant keeping up to date with changing ‘hot spots’, and building relationships and trust with sex workers and venue operators.Participants were very clear:

Being a leader is not being the boss. Being a leader is about being willing to face hardship when standing up for the rights of the community.”

Condom and lubricant programming

Male condoms and lubricants were familiar aspects of all participants’ work, but participants reported different levels of knowledge and availability of female condoms. Most knew the advantages of female condoms, but reasons for not using them included:

  • price (they can be 10 times more expensive than male condoms),
  • lack of free distribution or availability,
  • not always a good size/fit, and,
  • misunderstandings about how to use them (such as incorrectly believing they must be inserted 30 minutes before sex).

Laws, regulations and police practices around condoms were a common problem. Sex workers or venue operators can be fined, punished, harassed or arrested if found with condoms. Only Vietnam reported a major improvement in this area since a new law was announced in 2014.

Clinical and support services

Participants shared their perspectives on what makes a good clinic for the sex worker community. Confidentiality, informed consent and informed choices were most important. Clinics must also be accessible, affordable, and have good referral systems. To be acceptable to the community they must provide counseling, be friendly, free from stigma and discrimination, and accountable to sex workers.

Programme management and organisational capacity-building

All participants agreed that the role of sex workers should be central when planning and implementing programs, including decision-making and management roles. Programs should be based on sex workers needs and human rights.In a final practical exercise, participants listed priority activities for sex workers in their countries, and drafted a 2 year costed Project Development Plan. The last day of the workshop was spent presenting their project plans and sharing feedback.Indoor photo of a participant wearing a blindfold walking through twenty waters bottles positioned on the floorThroughout the workshop interactive games and activities were used that can be shared with sex work communities back home.Ms. Nguyen Thi Thuy from VNSW, said:

"The thing that impressed me the most was the games ... they are different but relevant to the training content. The second thing that also impressed me were the way the instructors encourage the participation of their students. They gave us time so everyone could participate meaningfully ... this created a very warm and close atmosphere among us in the training."

 APNSW Regional Coordinator Kay Thi Win and APNSW Consultant Habib Rahman facilitated the training, with support from members of Aye Myanmar Association and funding from RCNF.