Employmentweb_low

EmploymEnT, woRk, and hEalTh inEqualiTiEs - a global perspective
case study 75. Health benefits for sex workers through empowerment. - atanu sarkar
sex workers, as a group, are the most vulnerable victims of sexually transmitted diseases (including Hiv/aids) due to
the very nature of their occupation and also due to all forms of inequity, lack of negotiating power with clients to use
condoms, and social stigma. sonagachi is a red-light district in Kolkata (formerly calcutta), india, with more than 9,000 sex
workers who once had no economic independence, savings, or social security including medical services; they were also
harassed by pimps, brothel owners, agents and local gang leaders. in 1992, the all india institute of Hygiene and public
Health (aiiH&pH) in Kolkata, with the technical guidance of the WHo, started an std intervention programme by using sex
workers as peer educators (pes). pes soon realised that sex workers were vulnerable to stds not because of unsafe sexual
behaviour but rather for reasons due to the structure of society: power brokers within the sex industry who coerce, exploit,
and oppress and a mainstream society that stigmatises sex work and sex workers and prevents them from gaining access
to services otherwise freely available. From this realisation emerged the durbar Mahila samanwaya committee (dMsc), a
forum by and for sex workers and their children with a current membership of 65,000 sex workers throughout the state of
West bengal who also started their own cooperative bank to get rid of exploitation by moneylenders. they have been
successful in compelling clients to use condoms and in preventing harassment. dMsc has been explicit about its political
objective of fighting for the recognition of sex work as work and sex workers as workers, as well as a secure environment
for sex workers and their children. the ownership and management of the std intervention programme was taken over by
dMsc from the aiiH&pH in 1999. an epidemiological study shows that, while less than 2 per cent of sex workers regularly
used condoms in 1992, that number increased to 85.7 per cent in 2005. the prevalence of syphilis decreased from 25.4 per
cent in 1992 to 4.83 per cent in 2005. While the current prevalence of Hiv/aids among sex workers in other indian cities
ranges from 30 to 60 per cent, in sonagachi it is only around 6 per cent.
Sources
durbar Mahila samanwaya committee. retrieved from http://www.durbar.org/index.html
ghosh, s. (2006, april 1). empowerment of sex workers: the Kolkata experience. Economic and Political Weekly, 1289-1291.
nag, M. (2005, december 5). sex workers in sonagachi: pioneers of revolution. Economic and Political Weekly, 5151-5156.
World Health organization. (2001). STI/HIV sex work in Asia. Manila, philippines: World Health organization, regional office for
the Western pacific.
case study 76. A national occupational health care system integrated with primary health care: the brazilian
experience. - vilma santana, Marco antónio gomes pérez, Maria graça luderitz Hoefel and elizabeth costa dias
although social protection is defined in the brazilian constitution of 1988 as a citizen’s right and the state’s duty, in
reality the only realms with universal coverage are education and health care. social insurance, such as paid retirement,
and sick and maternity leaves, for instance, are social benefits limited to those who hold a formal job contract or contribute
their own parcel of social security payments. Unemployment benefits (wages) are available only for those working in the
formal sector of the economy. Macro-economic changes have generated new types of work arrangements (temporary work,
informal work, etc) thereby leading to modifications in the workplace structure. these new forms of work arrangement leave
many workers without proper benefits and protections. Most worker benefits are available only for those holding a formal
category of work agreement.
according to 2004 data from the Health Ministry, more than 1 million workers are affected by some accident or illness
due to work (dias & Hoefel, 2005). in brazil, the Unified Health system (sistema Único de saúde, sUs) is the only one
universally accessible for all workers, regardless of their work situation. therefore, sUs assumes a crucial social role,
serving as the only public policy of universal coverage for all workers (dias & Hoefel, 2005). in 2002, brazil implemented a
model of workers’ assistance called the network of comprehensive assistance for Worker’s Health (rede de atenção
integral à saúde do trabalhador, renast). renast is a network developed to mediate between the Health Ministry and the
state, Federal district and Municipal Health secretariats. its objective is to articulate, within the sUs, actions to prevent,
promote and recover the health of urban and rural workers, regardless of workers’ employment linkage or their type of
participation in the labour market. although workers have always been users of sUs, renast proposes improvements by
ensuring that the sUs system functions from a workers’ health perspective. the system must favour the establishment of
connections, when they exist, between sickness and work, information that would be useful for eventual surveillance,
preventive programs, and public policies.
beginning in 2003, renast has been prioritised as the main strategy of the national policy of Workers‘ Health. the
network is organised hierarchically into three levels of management: federal (Ministry of Health), state (state secretariats),
and municipal. its organisation is based on an intra- and inter-sectorial structure composed of administrators and health
professionals who undertake actions of promotion, prevention and surveillance in worker’s health. the most important
principles guiding renast are: (1) comprehensive attention to workers’ health; (2) intra and inter-sector articulations; (3)
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