This is the first phase (qualitative) of the current project we are working on with the supervision of University Malaya and Yale School of Medicine.It will be publish as IBBS 2013 by end of the year. This slide is just a rough picture of what we are doing at the moment. This is copyright protected!

2. HIV TRANSMISSION 101
THINGS THAT CAN TRANSMIT HIV
• UNPROTECTED VAGINAL OR ANAL SEX WITH
SOMEONE WHO IS HIV-POSITIVE
• UNPROTECTED ORAL SEX WITH SOMEONE WHO IS
HIV POSITIVE IF THERE ARE SORES/ULCERS IN THE
MOUTH
• INJECTING A NEEDLE AFTER SOMEONE WHO IS HIV-
POSITIVE HAS INJECTED WITH THE SAME NEEDLE
THINGS THAT CANNOT TRANSMIT HIV
• HUGGING/KISSING SOMEONE WHO IS HIV-
POSITIVE
• DRINKING AFTER SOMEONE WHO IS HIV-
POSITIVE
• SEXUAL INTERCOURSE BETWEEN TWO PEOPLE
WHO ARE HIV-NEGATIVE

3. HIV IS SPREAD BY ADDICTIONS AND ERECTIONS
WHO IS AT RISK FOR INFECTION?
• INJECTION DRUG USERS WHO SHARE INJECTION
EQUIPMENT
• INDIVIDUALS WITH MULTIPLE SEXUAL PARTNERS
• INDIVIDUALS WHOSE PARTNER HAS MULTIPLE
SEXUAL PARTNERS
*HIV MUST BE PRESENT IN A SEXUAL NETWORK FOR
THOSE WITHIN THE NETWORK TO BE AT RISK
WHO IS NOT AT RISK FOR INFECTION?
• INJECTION DRUG USERS THAT DO NOT SHARE
THEIR INJECTION EQUIPMENT
• MONOGAMOUS COUPLES/ABSTINENT COUPLES
• SEXUAL OR INJECTING NETWORKS WHERE HIV IS
NOT PRESENT
Credit: Elizabeth Pisani

4. WHO ARE SEX WORKERS?
• SEX WORKER: SOMEONE WHO PROVIDES SEXUAL OR SEXUAL-RELATED SERVICES IN EXCHANGE FOR
MONEY, DRUGS, OR OTHER GOODS/FAVORS
• FEMALE, MALE, OR TRANSGENDER
• DEROGATORYTERMS: PROSTITUTE, HOOKER, WHORE, MONEY BOY,
• MULTIPLE PARTNERSHIPS PUT AT RISK FOR HIV
• “BRIDGE” TO GENERAL POPULATION

5. TRAFFICKING OR SEX WORK:
SEX TRAFFICKING
• FRAUD/TRICKERY
• COERCION
• CAN BE UNDER 18
• NO INCOME
SEX WORK
• CHOICE
• CONSENT
• OVER 18+
• RECEIVE INCOME
WHAT IS THE DIFFERENCE?
See: The Working Group on Sex Work and Human Rights. “Sex Worker Myths vs Reality.” Urban Justice
Center. http://sexworkersproject.org/media-toolkit/downloads/08-Myths.pdf

6. DRIVERS OF SEX WORK ENGAGEMENT
Sex
work
Casual
Supplemental
Income
Social
Pressure
Addiction
Survival

7. ECONOMICS OF SEX WORK
• FAST CASH
• BEST INCOME OPTION
• ALWAYS A DEMAND
SUPPLY AND DEMAND
High
Demand
+ “Reusable” +
Low
Maintenance
=
High
Returns

8. NOT ALL THAT GLITTERS IS GOLD
•THE TROUBLE WITH ILLEGAL ACTIVITIES:
• EXPLOITATION
• POLICE BRUTALITY
• RAPE AND THEFT
• VERBAL AND PHYSICAL ABUSE
• TRAFFICKING
UNDERREPORTING OF VIOLENCE, MISREPORTING OF TRAFFICKING

9. THE SPECTRUM OF VIEWS ON SEX WORK
ABOLITION
• ALL SEX TRADE ACTIVITY IS TRAFFICKING
• OTHER OPTIONS FOR INCOME
• POLICING REDUCES SEX WORK
• HUMAN RIGHTS ISSUE: ENGAGING IN SEX WORK
• SEX WORK LEADS TO VIOLENCE/CRIME
EMPOWERMENT
• SEX WORK IS WORK, TRAFFICKING IS SLAVERY
• BEST OPTION FOR INCOME
• POLICING DRIVES SEX WORK UNDERGROUND
• HUMAN RIGHTS ISSUE: CHOOSING SEX WORK
• SEX WORKERS SHOULD BE PROTECTED FROM
VIOLENCE/CRIME
VS
IS THERE MIDDLE GROUND?

10. ARE SEX WORKER RIGHTS HUMAN RIGHTS?
SEX WORKERS RIGHTS?
• TO HAVE CONTROL OVER WHAT THEY DO WITH THEIR BODY?
• TO ENGAGE OR NOT ENGAGE IN SEX WORK WITH A CLIENT?
• TO HAVE ACCESS TO CONDOMSAND LUBRICANT?
• TO HAVE A SAFE WORKING ENVIRONMENT?
• TO NOT BE BEATEN/HARASSED FOR BEING A SEX WORKER?
HUMAN RIGHTS DECLARATION
• ARTICLE 23: (1) EVERYONE HAS THE RIGHT TO WORK, TO FREE CHOICE
OF EMPLOYMENT, TO JUST AND FAVOURABLE CONDITIONS OF WORK AND
TO PROTECTION AGAINST UNEMPLOYMENT.
• ARTICLE 23: (3) EVERYONE WHO WORKS HAS THE RIGHT TO JUST AND
FAVOURABLE REMUNERATION ENSURING FOR HIMSELF AND HIS FAMILY
AN EXISTENCE WORTHY OF HUMAN DIGNITY, AND SUPPLEMENTED, IF
NECESSARY, BY OTHER MEANS OF SOCIAL PROTECTION
• ARTICLE 5: NO ONE SHALL BE SUBJECTED TO TORTURE OR TO CRUEL,
INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT
United Nations. “Universal Declaration for Human Rights.” http://www.un.org/en/documents/udhr/

12. SEX WORK IN MALAYSIA
• LARGELY UNTOUCHED BY RESEARCH
• SUSPECT STATISTICS/METHODOLOGY
• ~60,000 SW TOTAL*
• ~8,000 IN KL & ~12,000 IN SELANGOR = ~20,000 IN KLANG VALLEY
• HIV PREVALENCE = ~4.2%+
• 10% IN SELANGOR
*Lim, H.; Ang, C.; Teh, Y.; “SIZE ESTIMATION FOR LOCAL RESPONSES IN MALAYSIA FOR HIV PREVENTION IN SEX WORK.” Unpublished. August, 2010.
+IBBS, 2012.

13. WHERE IS IT HAPPENING?
PRETTY MUCH EVERYWHERE.
Female
Transgender
Male

14. METHODOLOGY
• Locations of SW
• Concerns for SW
• Access to clients for qualitative
Meet with Key Informants
• Social Network (size,
heterogeneity, locations)
• Health Seeking Behaviors
• Health Concerns of Community
• Experiences of Violence, Stigma,
Discrimination
QualitativeInterviews with
Female, Transgender,and
Male Sex Workers • Survey on sex work, health,
substance use, etc.
• HIV, G/C, and syphilis screening
Respondent-Driven
Sampling for Biobehavioral
Surveillance

15. WHERE ARE WE NOW?
• 19 INTERVIEWS AND 1 FOCUS GROUP
• 8 TRANSGENDER, 11 FEMALE
• AGE RANGE: 25 – 63
• MALAY (10), MALAYSIAN INDIAN (6), INDONESIAN (2), MALAYSIAN CHINESE (1)

16. WHAT HAVE WE LEARNED?
• HIGHLY MIGRATORY
• EVERYONE EXPERIENCES VIOLENCE
• DIFFERENT MOTIVATIONS
• VARIOUS DESIRES FOR INTERVENTION
• DESIRE TO CONTINUE
• VARIED CONDOM USE, HEALTH CARE ACCESS, HIV
AND STI SCREENING
• UNSAFE „PREVENTION‟ BEHAVIORS

17. SEX WORKERS TELL ALL:
RESULTS FROM A FOCUS GROUP OF 5 SEX WORKERS FROM A SEX WORKER ADVOCACY NGO
“I say don't talk about sewing machines...
[an NGO] gave sewing machine…That is
not changing [us], you know. People want
[us] to change, [they] must ask what [we]
want.”
[We need to reduce discrimination for
transsexuals. I have always been discriminated
against so I would like to stand for it. There is no
freedom to work. We cannot do anything, but
others, they can do everything. They talk bad about
us, they punish us, they keep on blaming us.]
-translated from Malay
[Sex workers like me, a woman, even though I
get a different job, I will work for 3-4 months to
get enough salary but then I will want to go
back to sex work to get more money.]
-translated from Malay
[I was caught a few years ago and put in lock-up. They
forced me to get naked and do 10 push-ups in front of
all the men and everyone saw my breasts. At that
moment, I felt so embarrassed. Very sad.]
-translated from Malay
[We Malaysians get free first-line ARVs but
have to pay for second and third line ARVs. But
you have to understand that we have clients
who are homeless migrants and can get
deported. We must find a way to get them their
medicine.]

18. WHAT SEX WORKERS WANT
“FREEDOM!”
“Health Care Treatment
for All”
“No Violence to
Sex Workers”
“Support us,
don‟t punish us”
“We know our rights
for protection and
safety. We want these
things”
“I want to learn
English and
learn how to
type”
“I want salon classes
and how to do massage”
“I‟m tired of being
homeless. I want a
proper home to stay
in.”
“I don‟t want
counseling. I don‟t
trust anybody.”
“I want a loan to start
my own business.”

19. “
”
WHEN PEOPLE KNOW I AM A SEX
WORKER, THEY THINK I AM DIRTY AND
CHASE ME AWAY. BUT I AM NOT DIRT. I
AM A HUMAN, JUST LIKE YOU.
FEMALE SEX WORKER, CHOW KIT
WHAT WE‟VE LEARNED:
SEX WORKERS ARE GOOD PEOPLE. THEY EACH HAVE THEIR OWN STORIES AND STRUGGLES, JUST LIKE WE DO.
THEY DESERVE TO HAVE BASIC HUMAN RIGHTS. THAT MEANS ACCESS TO HEALTH CARE, FREEDOM FROM DISCRIMINATIONAND STIGMA, AND
TO BE HIV-FREE OR LIVING POSITIVELY WITH HIV.

20. WHY WE ENGAGE THE COMMUNITY
• THEIR STORIES ARE IMPORTANT
• THEY TEACH US WHAT TO ASK AND HOW TO ASK IT
• IT ALLOWS THE COMMUNITY TO SPEAK FOR THEMSELVES
• INFLUENCE PUBLIC VIEWS BY PROVIDING HOLISTIC PICTURE
• MUST ENGAGE COMMUNITY TO GET PARTICIPATION IN RESEARCH
• RESEARCH INTEGRITY

21. TERIMA KASIH! NANDRI! XIE-XIE! THANKS!
• A BIG THANK YOU TO THE FOLLOWING:
• OUR COMMUNITY PARTNERS: PAMT, WAKE, PT FOUNDATION, AND THE GLOBAL FUND
• OUR RESEARCH PARTNERS: CERIA AND YALE UNIVERSITY AIDS PROGRAM
• PROF. ADEEBA, PROF. RUSLI, PROF. RICK, AND DR. JEFFREY WICKERSHAM
• MY ABSOLUTELY AMAZING STUDY COORDINATOR, DR. RUBY BAZEER
• AND OF COURSE, OUR PARTICIPANTS!