1. Washington D.C., USA, 22-27 July 2012www.aids2012.org HIV prevention needs of transgender sex workers in Serbia Dr.Dragan Ilic Association Against AIDS – JAZAS Institute for Students’ Health Belgrade, Serbia

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org THE FACTS (from previous research) 1.Sex workers are “hard to reach “ group for preventive activities Reasons Illegal status High level of stigma Discriminatory treatment in institutions Persecution by police Violence by police, pimps, clients, others

3. Washington D.C., USA, 22-27 July 2012www.aids2012.org THE FACTS (from previous research) 2.Transgender sex workers are a subgroup among others SW Reasons Higher degree of isolation More frequent drug use Added risk (non sterile injecting equipment for hormone therapy) Multiple form of stigma and discrimination

4. Washington D.C., USA, 22-27 July 2012www.aids2012.org The reasons for selecting this group  Very little is known about transgender people in Serbia  Even less is known about transgender sex workers  No specific preventive or any programs targeting them

5. Washington D.C., USA, 22-27 July 2012www.aids2012.org Research goals  To learn about preventive needs of transgender SW  To provide necessary data for strategy and planning  To determine the similarities and differences of transgender SW in comparison to others. Research methodology Snow ball sample Inclusion criteria *all sw ( M, W and TG ) who sold sexual services in last 12 months *18 or older *working on the street and indoor

6. Washington D.C., USA, 22-27 July 2012www.aids2012.org RESULTS -1 Overall 250 SW were included 55 MEN 44 TRANSGENDER 155 WOMEN  Education Tg. do not differ 40% have no education  Ethnicity Tg. are mostly of Roma ethnicity-which adds anoter level of preventive needs MULTIPLE DISCRIMINATION

7. Washington D.C., USA, 22-27 July 2012www.aids2012.org RESULTS -2  Violence Percentage of TG persons (52,5%) who were victims of violence –significantly higher than other SW. Fear of violence is the reason why transgender sex workers work on the streets statistically significantly less than other sex workers: exposure to violence from clients and from the police is much higher on the street  Auto-stigma,feeling of shame and quilt Among TG SW (47,5%) significantly higher than among others

8. Washington D.C., USA, 22-27 July 2012www.aids2012.org RESULTS -3  Condom usage 87% claim to have used condom during last sexual intercourse  Psyshoactive druge use and intravenous drug use. TG do not differ  Health servicess accessibility TG do not differ - 25% of TG have given up from trying to access any kind of services for fear of being exposed as SW or transgender

9. Washington D.C., USA, 22-27 July 2012www.aids2012.org CONCLUSIONS what make trans gender SW a subgroup Mostly Roma Multiple discrimination High level of violence Very low socioeconomic and educational status Inability to access health services High level of auto stigma Double HIV risk (drugs and hormones non sterile injections) Inadequate self assessment of risk Numerous sexual partners

10. Washington D.C., USA, 22-27 July 2012www.aids2012.org RECOMMENDATIONS Their preventive needs cannot be met through preventive programs designed for all SW. Special programs and interventions are needed Expected results  Awareness raising about human and HIV preventive rights of TG people, SW.  Visibility and affirmation of transgender identities  Raising self efficacy and self confidence  Diminishing HIV risk