Sex Workers and HIV Prevention in Fiji - after the Fiji Crimes Decree ...

As a result, that NGO no longer provides HIV preventioneducation to a sex worker group nor does it conductoutreach services. Other sex worker specific socialservices have also been lost. In the past this programprovided not only counselling, advice services andworkshops for sex workers in a safe environment, butalso supported trips to the STI testing services, socialactivities, wider community engagement with sex workersand police liaison work.Sex workers also noted that the NGO had mainstreamedthe services they offered since the Decree, that they hadbeen reoriented towards job training and counselling,and that there was nothing now tailored for, or availableexclusively to, sex workers. Maria describes this change:There’s this organisation that sort of looks after us,and before we used to have a weekly day where weget to meet up at the centre and on those weeklydays we’re given our condoms. But ever since theDecree, the organisation has also sort of changedthe way they are, what shall I say – approaching us.Now it’s more like when you come in then you getyour names written down and you become a clientfor [general services] instead of just registering in asa sex worker.Bree believed that the NGO felt constrained by theprovisions of the Decree, saying: ‘it stood still for onceand couldn’t move eh.’ In the face of uncertainty, itsresponse was to be risk averse. Sex workers havenoticed the difference that the NGO reorientation ofservices away from education and HIV prevention hasmade to condom access on the streets at night:Access to sexual health servicesAs a vulnerable population, it is critical that sex workersare engaged by and encouraged to use sexual healthservices. However, clinical services for sex workers areonly offered by mainstream clinics. There are no targetedservices for sex workers at Hub Centres and STI andsexual health clinics, nor are there currently any specialefforts to encourage this important population to test.Service providers say that they are sure that sex workersdo use their services, but they do not document any use,nor do they monitor levels of use (nor would sex workersfeel safe if they did) so cannot be sure of any changes.HIV and STI testing, like many other HIV preventionefforts, rely absolutely on voluntary accessing ofprevention and testing services. Gaining the confidenceand trust of sex workers is a crucial task if these servicesare to be effective – and this task is made more difficultby provisions of the Decree which are perceived to be,and experienced as, more punitive.Some workers stated that their ability to access serviceshad been eroded since February 2010. Samantha said,‘Before the Crimes Decree I used to visit the clinicsregularly. When it came effective, I’ve stopped’. Herstatement is reinforced by the claims of a sex workergroup who reported that their members:do not use the government health centre because ofthe snide remarks and bad treatment from the staff.Most of the sex workers use private doctors for safetyand confidentiality of identity.Some sex workers have noticed more stigma when theyaccess services:Sex WoRKeRS and HIV PreveNTIon in Fiji - After The Fiji Crimes Decree 2009For one month now no one has come to us. No one isgiving out condoms, and the young ones don’t evenknow about it. (Mona)Mona goes on to identify who is the most affected:We know how to look after ourselves because of thetraining that we already had. But the new ones, theydon’t know and they have nowhere to go, there isnowhere for them to go to find out or no one’s gonnatell them.When this Crime Decree came into effect, it’s like sexworkers did not want to go and have their check-up.It’s like they made us known to those working in theclinic. When we come outside we hear them saying‘that one is a sex-worker’ like that. (Maria)Interviewees also described how the loss of supportiveand trusted staff, as a result of the project closures,affected sex worker use of STI clinics:There is no blood testing anymore. When [the NGOproject officer] was there, nearly everyone wasgetting testing. But now it’s embarrassing [to go tothe clinic]. (Mona)22