1. www.aids2014.org Overlapping risks, overwhelming barriers: addressing HIV risk among adolescents selling sex in Asia and the Pacific Himakshi Piplani HIV Young Leaders Fund

2. www.aids2014.org So far we know… Examples of data on adolescents who sell sex in the Asia-Pacific region Individual studies have found that that in: Thailand, a third of females who sell sex in massage parlors and brothels reported starting to sell sex under the age of 18. In India 40% of the 3 million women in the sex industry are under 18. In one study, 17 percent of female sex workers reported starting to sell sex under the age of 15. Nepal, between 16% and 33% of females in the sex industry are below 18 years of age. The median age reported among female sex workers in the Maldives and Papua New Guinea was 17-19 Pakistan, hijras (transgender persons) and male sex workers reported entering the sex trade at a mean age of 16.

3. www.aids2014.org Increased Vulnerabilities Reasons include: adolescents are biologically immature; have a higher number of sexual partners; have more frequent unprotected sex with lovers, intimate partners or others, even if they use condoms with clients; work in more hidden/underground ways which decreases access to appropriate SRH and HIV services, including information on risks consequences and prevention, and peer outreach; may be more likely to use drugs -Studies from India, Nepal and Thailand have found that initiation into selling sex prior to age 18 confers increased risk of physical and sexual violence and relates to a two to fourfold increase in HIV infection

4. www.aids2014.org Health Equity For All Overall goals: 1)Understand the experience in accessing healthcare, esp HIV & SRHR 2)Identify what works + recommendations through dialogues with adolescents and stakeholders

5. www.aids2014.org Health Equity for All 1.Literature Review: what do we know and where are the gaps? 2. In-country focus group discussions 3. Regional consultation and stakeholder dialogue 4. Report on findings – sneak preview today!

6. www.aids2014.org Risk Landscape No one profile; demographics and circumstances vary greatly

7. www.aids2014.org Risk Landscape Nature of involvement (including sexual acts performed) Location & ways of working (informal, individual, organized) Clients – higher numbers, often include businessmen, government officers, army and police men.

8. www.aids2014.org Risk Landscape Intersection between health and law enforcement often contributes to additional risks ‘Police force three options – pay money, unprotected sex/rape or arrest, physical and verbal violence or arrested and published in the newspaper (Pakistan)’

9. www.aids2014.org Risk Management When adolescents under 18 are engaged in selling sex, they face major barriers to health services – including parental consent policies and/or blatant discrimination from health care providers. This hampers their ability to manage the multiple overlapping risks.

10. www.aids2014.org Barriers No independent access to HIV & SRH services in govt. clinics & hospitals; parental consent required “Even if policies allow certain young people such access to traditional services, this is denied in practice to young people who sell sex, especially MSM and TGs.”

11. www.aids2014.org Barriers Services are not youth-friendly. “In Bangladesh, MSM and SW identities are not open or accepted, so it’s difficult to go to a clinic or doctor due to fear of stigma, discrimination and breach of confidentiality.”

12. www.aids2014.org Barriers Criminalization obstructs access to HIV & SRHR services. “In countries like Myanmar and Bangladesh the law restricts you from being open about your sexuality and if you do sex work, it makes it difficult to disclose this to service providers, especially for young people.”

13. www.aids2014.org Barriers Services are not tailored to specific needs. “Transgender female youth who have had gender-affirming operations need specialized services – yet often health care providers service them as male sex workers and not as transgender people.”

14. www.aids2014.org Barriers Services are not safe. “Some NGO take blood by forcing us and blackmailing us that if you do not give blood for testing we will not give free condoms to you.”

15. www.aids2014.org Some survival strategies Use paralegals from the community for legal assistance when people are arrested Community manual – what to do if you’re arrested Social media help line to freelance sex workers Peer support group to take legal action or organize/share information about abusers/ dangerous clients

16. www.aids2014.org Recommendations Improving the quality and accessibility of healthcare services Train healthcare workers not to discriminate or violate the rights of adolescents who sell sex Multiple services can be provided in one place Provide more peer and community-based healthcare services, as well health care services that are provided outside of traditional settings such as through mobile clinics, weekend hours

17. www.aids2014.org Recommendations Legal and policy change Remove parental consent policies to access healthcare services States should recognize sexual orientation and gender diversity Sex work should be decriminalized for adolescents who sell sex Carrying condoms should be legal and should not be cause for arrest or detention from law enforcement More programs must address police violence and corruption, as well as exploitation from employers and clients

18. www.aids2014.org Recommendations Education and job skills Empowerment programs to build the confidence and self-esteem of adolescents who sell sex Tailored education programs for adolescents that meet their needs, such as offering classes at different times, scholarship funds Job skills training and opportunities that pay a good wage for adolescents and young people

19. www.aids2014.org Adolescent leadership UNICEF’s systematic review found that among HIV treatment, prevention, care and support interventions that targeted adolescents and youth, those in which adolescents created their own system or structure for intervention delivery were the only ones that had evidence of an impact on biological and behavioural outcomes.

20. www.aids2014.org Thank you!