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Power imbalance seen in condom campaign

Cambodia's authorities had a good story to tell at the recent Barcelona AIDS conference.

In the past two years the country has become one of only a few that has turned around

its HIV/AIDS infection rate, at least among the target groups studied.

Health authorities said a major reason was the implementation of a '100% Condom Campaign',

which aims to enforce condom use in every brothel-based sex act.

But also at Barcelona, and with a different interpretation, was the Network of Sex

Work Projects (NSWP), an activist group representing sex workers. The group protested

that such campaigns were coercive and have "obvious origins in misogynist public

health approaches".

In a statement released at the conference, NSWP noted that similar campaigns had

led "to a range of human rights abuses such as women being taken to STD clinics

under police 'escort' and photos of women being displayed so that men can identify

any woman whom he alleges infected him or agreed to sex without a condom with him".

The group asserted the campaigns "do not prevent clients who want high risk

services from purchasing them, they just shift and hide the demand and supply of

unprotected services".

Recent research from the National Center for HIV/AIDS (NCHADS) certainly indicates

Cambodian men are seeing fewer brothel-based sex workers, where condom use is enforced

under the campaign, but more indirect sex workers where condoms are used less often.

The campaign was adapted from a similar program run in Thailand and trialed in Sih-anoukville

in 1998. By last year "100% Condoms" had been extended to most provinces.

Under the campaign a committee of provincial government, health and police representatives

is formed to enforce condom use in all brothels. Each sex worker is registered and

compelled to attend regular health checks.

If a girl contracts a sexually-transmitted infection (STI), the brothel owner can

be punished: first with a verbal warning, then a written warning, a week long suspension

and finally permanent closure.

"We had been running outreach activities with sex workers since 1995 and the

girls had a good knowledge of how to prevent HIV," says Dr Hor Bunleng, deputy

director of NCHADS, "but they were still under pressure from brothel owners

and clients to have sex without condoms."

Bunleng said the campaign helped turn that situation around by involving brothel

owners, the police, district officials and military police in the campaign.

"Our evaluation in 2000 showed the campaign made a significant contribution

to reducing STIs. Syphilis, for example, dropped from 9 percent in 1998 to 1.8 percent

in 2000," he said.

But it is the involvement of the local authorities that opponents of the campaign

criticize.

"It's fundamentally flawed because it puts the onus, control and power in the

hands of the people who already have power over the women," says Rosanna Barbero

of Oxfam Hong Kong/Womyn's Agenda for Change.

"There is a power imbalance and the only way to change that is to put power

in the hands of the women. If you don't give the most vulnerable groups the power

to negotiate, you can't have change," says Barbero, who advocates brothels be

owned, managed and operated by sex workers.

Bunleng defends the program, arguing that women are empowered through programs that

teach condom negotiation and by government support for condom use.

By regulating brothels rather than closing them, he says, health authorities have

been able to reach all brothel-based sex workers and compel them to make regular

visits to local health clinics.

In an area such as Koh Kong those visits are vital in controlling the spread of HIV.

In 2000 when the province entered the campaign HIV prevalence among sex workers was

53.7 percent. Local authorities are hoping that figure will be significantly lower

when new data is collated.

But the campaign cannot guarantee brothel owners or clients will willingly comply

with the regulations. Dr Soy Simoeum of Koh Kong's health clinic concedes that drunk

clients often "try to force sex without condoms, and foreigners come to Koh

Kong and force girls not to use condoms".

While girls can refuse condoms with the support of their brothel owner, the owner

also has the power to force sex workers to provide sex without condoms if the client

offers to pay more.

Brothel-based sex workers are typically trapped in a form of bonded labor by the

brothel owner. They, or their families, borrow money from the brothel owner then

work to pay it off. But by the time the brothel owners take half the girl's earnings

and money for rent, clothes, electricity and food costs - with interest rates

of up to 100 percent - it is usually impossible to repay the debt.

Some brothel owners use even more coercive tactics. In early July the police, the

Ministry of Women's Affairs, and human rights groups cooperated to rescue five sex

workers from a Koh Kong brothel. The girls had been forced to work and had been tortured.

Staff at the Koh Kong health clinic conceded that girls often try to escape from

the clinic when they come for their STI checkup but clinic staff prevent them.

"We have to promise the brothel owner that we won't let them escape," said

Dr Soy. "If we assist them then the owners will stop bringing their girls to

see us."

Bunleng argues that while incidence of imprisonment and torture still occur, they

are much less likely than in the past because the campaign ensures brothels are more

closely monitored.

In Sihanoukville, where the program has been running the longest, five brothels have

been temporarily closed and two closed permanently.

But Sum Satum, director of local NGO Khmer Women Cooperation for Development, said

local NGOs had been shut out of the campaign by powerful committee members, and sex

workers had been intimidated into cooperating with aspects of the campaign.

"They only agree to let the police take their photograph [for the registration

file] because they are afraid of the authorities," she said. "They don't

want their photo taken because they are afraid that the police will show the photo

to the public and their home village will know they are sex workers."

Satum also accused the police of intimidatory tactics in forcing compliance with

the campaign. If a brothel was suspected of providing condom-free sex then a plain

clothes policemen would be sent to investigate. NSWP labels that 'entrapment'.

"I am worried about the police spying in civilian clothes. It's a bad thing

to use these tricks and spy on sex workers," says Satum, adding that police

regularly extort money from the women.

"We can educate them and explain the benefit of using condoms, explain to them

how to negotiate with the customer, but this is simply a matter of bullying because

the women are poor."

Opportunities for extortion could increase if one plan of the health authorities

is carried through. Currently only brothel owners are subject to sanctions, but Bunleng

said the authorities are thinking about extending the same sanctions to sex workers

even when they were outside the brothels.

For Bunleng everyone benefits from the campaign if HIV prevalence declines.

"On its own 100% Condoms won't reduce HIV, but [along with other programs] if

we can secure the budget to make it sustainable then we could see a sharp decline.

It could have a very big impact."

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