STRATEGIES OF CIVIL SOCIETY TO ADDRESS AIDS IN ASIA: EMPHASIS ON THE SEX SECTOR

Sharifah H Shahabudin

Professor and Director, Center for Academic Advancement

Universiti Kebangsaan Malaysia

 

Introduction

Asia has about 3.3 billion people representing 60% of the world’s population, with a large population of children and the poor. It also has the world’s two most populous nations and systems of government that range from constitutional monarchies to republics and dictatorship. It is a continent of diverse people speaking hundreds of languages and subscribing to different cultures, beliefs and religions, living in a plethora of political, economic and social situations. The diversity in the continent is also mirrored within the countries. The tremendous diversity in Asia makes generalisation about HIV/AIDS meaningless because it prevents the appreciation of the specificity of the spread of HIV in the local social context, and the cultural sensitivity that make strategies effective in one setting but useless in another. Against the background of such diversity, this paper tries to highlight the key issues and strategies related to the sex sector that were brought up at the International Conference on HIV/AIDS in Asia Pacific held in Kuala Lumpur from 20-27 October 1999.

Asia is said to have the gift of time to learn from and to act early to prevent the kind of generalised epidemic that has engulfed the African continent. About 20% (7-8 million) of the world’s estimated number of people infected with the virus reside in Asia Pacific (MAP network, October 1999) but no country in Asia has a prevalence rate of more than 5%. However, the public health significance is large because of the size of the population and the rapid spread of the virus. Epidemiological surveillance shows injecting drug use and heterosexual transmission to be the major routes of infection. Prevalence is rising among women - young girls, spouses, pregnant women, migrant workers and sex workers. Countries are at different stages of response depending on the political commitment, organisational capacities of the government machinery, mobilisation of NGOs/civil society and community resources, private sector participation and socio-economic status of the population.

Civil society refers to citizens and citizen groups whose essential responsibility is to keep open such freedoms as assembly and association to allow and encourage citizen participation and influence in every aspect of society (O’Connell and Gardner, 1999). Civil-society institutions are often better than government at meeting human needs, especially of the most vulnerable (Glenn, 2000). The experience of Vietnam shows that in resource-scarce countries, community mobilisation appears to be the mainstay of HIV/AIDS prevention and care. The community is the centerpiece of HIV/AIDS education. Hundreds of thousands of voluntary and nonprofit organizations of every conceivable size and nature, form a third space--between the super organizations of government and business and the intimate sphere of family and kin. In that space, individuals find both personal meaning and a chance to join with others to reshape their worlds (Van Til, 2000). The 5th ICAAP highlighted many innovative community programmes and community based care and support, particularly those involving specific groups such as sex workers, truck drivers, male tourist workers, MSM, transgender kotis, and fishermen. The role of civil society is to negotiate among themselves and with governments and the private sector, to improve the prospects of an enduring democracy for a more equitable future. Networking and orchestrating the capacities of others to achieve a desired goal will become the most effective mode of operation. Educated, skilled and networked (physical and virtual) local citizens acting as global citizens may bring democratic politics for global public good. However in many countries of Asia there appears to be a need to further strengthen trisectoral partnership and networks among governments, NGOs and the private sector at local, national and international levels so that best and worst practices can be shared to improve accountability and capacity building.

Despite the diversity of Asia, one thing remains clear and common – the deleterious impact of prostitution on women. Regardless of whether prostitution is viewed as self determination and a form of work or as sexual slavery and violence against women, it is inarguable that the most deleterious effect is the increased risk of venereal diseases, HIV/AIDS in particular. Most of these women have difficulty protecting themselves because of economic dependency and the threat of physical force. Lesions and injuries in sexual intercourse, especially when they start young, also make them more prone to infections. The risk of infection is also increased when the women continue to prostitute through their menstrual cycle to avoid the fines levied by bars for taking time off for their periods. Besides those risks, the women often become hearing impaired because of the incessant loud music in the bars. They also suffer intestinal disorders because they are forced to throw up so as to keep ordering expensive drinks (Hitchens, 1986). Stripped of their dignity and forced to dance naked in front of strangers or sleep with them young shy Thai women make themselves "very empty" according to a former prostitute (Erlanger, 1991). This state of dissociation is a defence mechanism against feelings of shame. The physical and mental sufferings borne by these women are often unbearable without the aid of drugs. A shot of heroin enables them to handle five or six men in a single night and to keep themselves in working condition (Gay, 1985). A United Nations study of a thousand Thai prostitutes revealed that a quarter were regular users of speed, barbiturates, and heroin. All these serve to keep the women indebted to and dependent on yet more unhealthiness. Most do not have access to good health care. When they are too ill to work, they are sent home to linger and die.

Root causes of prostitution in Asia

Indisputable is the fact that prostitution becomes the highest paying job available to many women of Southeast Asia and Asia when governments and development agents disregard the development of women's opportunities for economic independence. As long as prostitution is seen as a valuable national resource and men, whether foreign or local are willing to use these women to satisfy their sexual needs at an incredible rate, often without regard to disease or any common moral restraints, women will continue to be oppressed. Whilst these countries have benefited from the tourist presence and the resulting foreign exchange, the women who actually put themselves out for their countries are to a large extent victims of the international political economy, poverty rooted in social class, illiteracy, ignorance, armed conflict and gender discrimination.

1. Prostitution boomed in Southeast Asia when the U.S. made its presence in Vietnam. The number of prostitutes in Thailand for example, skyrocketed twenty fold to 400,000 after the United States established seven bases in the country (Gay, 1985). Some $16 million was injected into the Thai economy annually during this period. When the Vietnam war ended the boom was replaced by tourism which introduced prostitution as a large-scale business to the region. Group sex tours is Thailand's largest single source of foreign exchange (Rhodes, 1991).Sixty percent of tourists to Thailand visit for sex (Harvard Business Review). Today it is a $4-billion-a-year business involving fraternal relationships among airlines, tours operators and the masters of the sex industry.

  1. In some countries, a lot of the demand is also coming from natives who patronise the cheapest establishments. Social norms provide much of the impetus sustaining the incredible rate of prostitution in some countries where prostitution has become integrated with initiation rights to manhood. A trip to the neighborhood brothel is a rite of passage, a tradition passed from father to son (Moreau, 1992). Reliable surveys of sexual behaviour in one Asian country show that every day at least 450,000 men visit prostitutes (Erlanger, 1991) and the majority of the men have their first sexual experience with a prostitute - the act is often a part of high school and university hazing rituals - and that 95% of all men over 21 have slept with a prostitute (Handley, 1992)
  2. Child prostitution is on the increase partly because customers are under the distorted thought that sex with juvenile prostitutes is safer than sex with adult prostitutes. This of course is a misconception because children are more prone to STDs than adults. According to the ECPAT/TAKSVARKKI* prevention project in Northern Thailand, children are usually lured into the sex industry through other service industry employment. Hungry and alone these children are vulnerable and they crave attention, affection and love. Initially the pimp provides the comfort, protection and understanding while he gains the child’s trust. As the child becomes more and more emotionally and financially dependent on him, he introduces the child to the world of sexual exploitation. The vast majority are assaulted by the pimps and abused by the customers. Those most at risk come from poor families where other family members have already entered the sex trade or where there are stresses such as death or divorce of parents, addiction to gambling, drugs or alcohol. However their pattern of entry is more hidden because of government policy and police raids.
  3. Stemming prostitution is an impossibility because issues are side stepped. On the one hand there is the official position that prostitution does not exist because it is illegal. On the other hand, despite official denial to the existence of prostitution, the view of prostitutes as a national resource (young country women are just another kind of "crop") has led to complicity of government officials in the "illegal" trade of prostitution as well as traficking: from soldiers, politicians, tourism bureau officials, police forces and to every sector of the powers-that-be. Some official complicity is taken to the point of collusion. For instance, escaping girls have been caught and handed back to their abusers by the police (Hornblower, 1993; Lintner et al, 1992). The interests of these officials are vested in ownership of brothels massage parlours, restaurants, motels and tea houses that offer sexual as well as other services, or benefiting from them. Another major factor is the growing cultural acceptability of prostitution as a legitimate form of employment in many rural areas. Side stepping issues pose a severe handicap to campaigns that seek to provide safeguards for prostitutes and to limit the spread of AIDS.
  4. Poverty is a vicious force that drives families to sacrifice their daughters to prostitution. Daughters are sacrificed because the concept of repayment to parents is based on the principle that daughters provide for this life while brothers enter the temple to atone for the sins of their parents. Census data on migration show the increased proportion of single females 10-19 years old migrating to cities such as Bangkok where income levels are at least nine times higher (Rhodes,1991). A study of 1000 Bangkok massage girls found that seventy percent came from poor farming families (Hantrakul,1984). Many are also from minority refugee families whose lands are confiscated by political conflicts. Most of these refugee families have to send their children out for work in order to survive. Ellen Bruno, on a CNN Q&A programme on October 26 reported how young refugees from the Myanmar-Thai border are kidnapped or lured into the sex industry by men whom they trust. The desperate families of these migrants are usually paid about US$100 and thus the women start off indentured to prostitute themselves to pay off loans their families had accepted from their future employers. Indebted, lacking skills and education, the women are put under lock and key, cajoled, coerced and condemned to take up prostitution as the highest paying job available. Once they have begun to make some money, they remit one-third to one-half of their earnings home - sums essential to their rural families' survival (Gay,1985). An International Labour Organization study found that of fifty prostitutes interviewed, all but four send money home.
  5. Rural poverty is perpetuated by the policy of artificially lowering the price of rice to encourage exports (Porpora et al , 1987), lack of opportunity for education, slower rate of development and differential allocation of development resources. Access to education is severely limited in countries that do not concentrate on a quantitative expansion of education. Thus fewer schools are built in the rural areas. In some countries the shortage of government schools and teachers in rural areas has meant the continuation of traditional pagoda education conducted by monks and therefore not available to girls. Evidence of this educational inequality can be found in illiteracy rates after a half a century of compulsory education, 6.3% for men and 17% for women (Hantrakul,1984). For women in poor villages, opportunities for development programs and information that might offer some hope of redemption or some opportunity to create viable income producing alternatives that can compete with the earning powers of prostitution are frequently denied them solely on the basis of their gender (Moreau,1992). This is because such aid is almost invariably channeled through men (Hantrakul,1984)..

     7. The uneven and unequal nature of globalisation and liberalisation processes in international finance, trade and investment      have also generated greater inequalities that have resulted in the wide and widening differences in incomes, wealth and resources among countries and also within countries. The financial crisis that started in Thailand in 1997 and which spread to other parts of Asia as well as Russia and Latin America gave rise to insecurity and greater instability with millions of Asians becoming impoverished.

8. The women of Southeast Asia and Asia are subject to age-old, deeply ingrained stereotypes and pre-conceptions. The continuing success of the prostitution trade rests on the perceptions of the clients that see Asian women as both desirable in their exoticism and willing participants in the exchange. Sex tours primarily market Asian women, described as "exotic and docile" (Tice,1992), "beautiful, obedient, available"(Neumann and Lin,1984) and "slim, sun-burnt and sweet ... masters of the art of making love by nature" (Robinson, 1993). These are the qualities that appeal to the foreigners who perceive Western women as too assertive.

Strategies of Civil Society

In addressing HIV/AIDS in the sex sector, civil society faces many challenges. In many countries it is even impossible to find a common ground for civil society to flourish. Conflict, alienation, bureaucracy, unbridled marketeering capitalism, loss of individual control do not nurture the civic virtue and community life that nourishes true democracy. In some societies, there is no freedom of speech and association whilst in others civil society is seen as small communities by free-marketeers who associate them with unfettered commercial activity (Barber, 1998).

Strategies of civil society to address AIDS as it relates to the sex sector must eliminate or reduce the factors that contribute to the root causes of prostitution, prevention of HIV infection and to address issues of care for individuals, families, communities and nations. In the information age the concept of civil society is also extended to virtual communities and this brings opportunities for exploring new methods of addressing the epidemic.

The 5th ICAAP highlighted the main areas of work of civil society. There are three types of beneficiary targets: (a) the population in general, (b) specific groups which include sex workers, the poor and marginalised and (c) those living with HIV/AIDS, again including those in the sex sector. The strategies are framed in the form of recommendations:

  1. Soliciting Political commitment from National Governments

Governments have the fundamental responsibility to prevent HIV/AIDS, to protect the poor and to eliminate poverty which is the major cause of prostitution. The recent economic crisis or resource scarcity should not divert the attention of governments from making decisions based on national priorities and capacities. HIV/AIDS is a development issue and there is a causal relationship between HIV/AIDS and socio-economic development. Civil society in many countries are collaborating with their government to provide citizens with winning conditions of transparency, good governance, trustworthy legal and judicial systems, sound financial and regulatory framework and people centred social programmes. During the 5th ICAAP the Prime Minister of Malaysia called for an Asian Leaders Summit on HIV/AIDS. The Malaysian AIDS Council has been instrumental in making this call a reality and HIV/AIDS is now on the agenda of the ASEAN Summit to be held in Brunei in 2001. Strong political commitment is solicited in many areas:

2. Human Rights Advocacy

HIV/AIDS is only one of the concerns in the daily struggles of PLWHAs, regardless of whether they are sex workers or other marginalised groups. Human right violation in the form of discrimination of their children, denial of housing, limited movement, mandatory testing, and deportation is the other epidemic they face. Those in the sex sector also face condemnation and arrest whilst the pimps and clients may go free. Civil society serves the interest of public health by protecting human individual rights through the following actions:

3. Use of faith organisations

Faith organisations play an important role because believers will not do anything they think their religion forbids. However these organisations are working in the dominant cultural context where sex and sexuality are taboo subjects. AIDS and prostitution are associated with sex and sexuality and therefore perceived as inappropriate to discuss. Many also encounter a disturbing trend of discordance between belief in religious values such as love and caring and the actual practices with regards to prostitution and AIDS. Efforts are made to intensify the involvement of religious leaders as ‘influentials’ to correct misconceptions. Activities include:

(a) incorporating universal core values in AIDS Education, for example:

right to life; right to dignity; harm reduction; salvation; equality; love and compassion; responsibility

(b) designing AIDS Education Program based on religious practices such as

fasting; marriage contract and partnership; purification; prayer; alms; meditation; pilgrimage

(c) recruiting religious 'influentials' to:

4. Use of the Media

In most countries media reports remain the major source of information on HIV/AIDS. Despite the contributions of medical research which have improved the understanding of HIV/AIDS, earlier homophobic portrayals and association of HIV/AIDS with sex workers seem to persist. There is a proliferation of cultural meanings that have been written and rewritten as a result of the biological manifestations of HIV (Treichler, 1999). Words or acronyms such as "AIDS," "HIV," and "epidemic" and the process of creating new concepts such as "safe-sex" to replace the moralistic, value-laden proscription against promiscuity are occurring within a cultural context of stigmatization that tolerates and promotes sexism, racism, third-worldism and homophobia. Sensationalism is another disturbing news media practice and negates the effectiveness of the media for education and advocacy. Civil societies are showing innovative ways in which the media can be used in the context of diverse cultures. These include:

training media practitioners to adopt emphatic journalism in their advocacy role

encouraging investigative journalism by creating special media awards and other forms of recognition

media practitioners forging relationships with NGOs to seek a balance in the representations of HIV/AIDS issues

reinforcing the interpersonal elements of media effectiveness in the HIV/AIDS messages particularly through street drama, opinion leaders and counseling, public service advertising and campaigns as well as entertainment media such as soaps, dramas and films

5. Working with migrant labour and mobile populations

Many Asian countries are hosts to migrant workers (including sex workers) from their neighbours. Many have left their spouses behind and they seek sexual gratification with sex workers. Migrants make a contribution to society, doing jobs shunned by natives. Yet they face discrimination everywhere they land. The role of civil society becomes even more crucial because many are also alienated due to social and language barriers. Civil society working with these groups often have to address the following problems:

6. Involving Youths

Today’s youths, both boys and girls, need to be empowered to lead rather than follow in the fight against AIDS because the new millenium belongs to them. In many societies youths are not getting enough correct information about sex and sexuality and messages that are consistent with their needs. Further, some youths such as street kids, poor rural youth, abused children and homeless children, have special needs because they are also at risk to drug abuse, crime and prostitution. A significant part of the work of civil society is the recognition that the participation of youth and harnessing their energy in the prevention of HIV/AIDS are important and critical. Peer education programs have been initiated in many countries with considerable success. In mobilising youths, the following activities are key components:

7. Working with IVDUs

The population of IVDUs is rising, amongst whom are sex workers. Similarly, the HIV infection amongst them is also rising. Complicating factors are the high risk sexual activities commonly found in this group and the difficulty in changing behaviour. Another obstacle faced is the reluctance of many governments to accept harm reduction strategies although they have been shown to be effective. The energy of civil society is directed at the following: