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PAKISTAN: Sex Workers Come Together to Fight HIV/AIDS

Zofeen T. Ebrahim

KARACHI, Aug 7 2004 (IPS) - Placing her cell phone on the table, Zulekha runs her fingers through her long, streaked hair and smiles uncertainly. Next to her, Mariam, stifles a yawn and apologises. ”I had a late night,” she adds, reading the text message on her phone.

Then there is Bakhtawar who chews on the ‘ghutka’ (a tobacco and betel-nut concoction) – her stained teeth bearing testimony to it.

Looking up and down suspiciously, she sizes this correspondent up and asks bluntly if she’s from a newspaper.

Janat is the most welcoming, also the most advanced in age. She beams and says she has finally learnt to write her name through the female literacy programme that is currently being run in the neighbourhood.

The other two in the room, remain silent throughout the discussion and their input is just limited to smiling and acknowledging what others had to say.

These six female sex workers (FSWs), belonging to a community, especially vulnerable to the HIV/AIDS pandemic, have mobilised themselves and taken up social marketing of condom as one of their tasks.

They have not only begun to use them for prevention, but have convinced the women in their community that its use is not just for ”preventing pregnancies” but helps protect them from sexually transmitted infections (STIs). And best of all, they have started stocking them up in their homes for easy access for the rest of the community and for free too.

”It was embarrassing to go to the corner shop or a pharmacy and ask for a condom. Then there was always the fear factor of harassment by the police. This is far more convenient. We can just send a message through someone and in a couple of minutes, it is in our hands,” says Zulekha.

This group was formed as part of the pilot project under the aegis of Greenstar Social Marketing, in 2003, in Serey Ghat, the red light district in Hyderabad.

The only one of its kind with the aim of imparting awareness about STIs and HIV/AIDS among sex workers, without stigmatising or demoralising them. The project is funded by the Joint United Nations Programme on HIV/AIDS (UNAIDS )and the United Nations Population Fund (UNFPA)with Greenstar as the implementing partner in close coordination with the National and Sindh AIDS Control Programme.

Serey Ghat is the fourth largest red light area in Pakistan (others located in Karachi, Lahore and Multan). According to a KAP (Knowledge, Attitude and Practices) survey carried out by Greenstar the there are about 101 households, 70 active brothels and about 100 sex workers in this area.

Informants revealed that many of the FSWs had migrated to cities like Karachi and Lahore when a ban was imposed on their activities during Gen. Zia-ul-Haq’s military regime in the 1980s.

What makes it all the more befuddling is that the NGO decided to launch a pilot project in a place where all activities have been banned for sometime by the government.

Even more mystifying is that the government is one of the project’s partners. In fact, the National AIDS Control Programmes (NACP) sets the guidelines for all HIV/AIDS interventions, including those with sex workers.

For the public, Serey Ghat is out of bounds as far as prostitution is concerned, yet these activities are carried out on the sly.

“The government invited bids for this project. They have declared sex work as illegal, but are cognizant that this practice exists,” explains Alya Mian, Greenstar’s senior communications manager.

”Our task has become all the more complicated due to this policy of the government as the target population migrates to other cities and within residential areas where we cannot reach out to them or help them in a concerted and more organised manner,” explains Mian.

Zulekha, for instance, comes to Karachi for ‘private performances’ nearly every Friday, and leaves on Sunday. Her ‘private performances’ are in some of Karachi’s leading hotels where she meets up with individual clients and has ‘programmes’ of singing and dancing for mostly overseas clients – mainly from Dubai.

But these six FSWs have probably no idea of the huge role they have played in their neighbourhood, of breaking the silence surrounding HIV/AIDS.

Out of 168 FSWs, 158 decided to come to the primary health clinic, run by Greenstar, for voluntary testing for HIV/AIDS. And that is not all. The Sindh Aids Control Programme has given each 158 of them a clean bill for HIV – at least for now.

Since 1987, after the first case of HIV/AIDS was reported in Pakistan, the number of reported cases has gradually increased and if not nipped now, the disease will jump from the vulnerable group and spill over into the general population.

It is estimated that between 70,000 and 80,000 of Pakistan’s population of 140 million is HIV positive. Official figures are much lower. Towards the end of last year 1,942 cases of HIV and 231 of AIDS cases were reported to the NACP.

”Of course we had heard of HIV/AIDS (through television mostly) before these people came and told us,” says Janat.

But she says the early messages were not clear.

”For instance, we didn’t know we could get it, we perceived it to be a ‘western’ disease. We had no idea it could be transmitted through used syringes or that it can be transmitted to unborn and suckling babies,” adds Janat.

All the six FSWs who now work as peer outreach workers – as they are known in the development jargon – find their job of visiting house-to-house ”difficult and at times embarrassing.”

”It’s not easy to visit your relatives and talk about condoms, teaching them the art of negotiating about the use of condom with their clients or convincing them that it is alright to go to the doctor and get treated for STIs,” says Janat.

”But it gets easier with time,” adds Mariam, who has acquired a new-found confidence in herself.

”My friends and relatives tease me and call me Dr. Mariam. I feel good that I’m doing something positive for my community,” she beams.

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