Assessment of female sex work in ho chi minh city, vietnam assignment

Women’s Health in Ho Chi Minh City Project (1/11/2004 ??? 30/9/2006) Implemented by Ho Chi Minh City AIDS Committee with technical and financial support from Family Health International (FHI) Assessment of Female Sex Work in Ho Chi Minh City Submitted to Family Health International, Hanoi by Nguyen Nguyen Nhu Trang Hang Thi Xuan Lan April 2005 Acknowledgements This assessment was conducted with invaluable support from the collaborators of Quality of Life Promotion (Life) Centre and FHI/HCMCAIDS Project staff and under the thorough guidance of Dr Luu Thanh Tue from FHI.

Dr Truong Trong Hoang from the HCMC Health Information, Education and Communication (HIEC) Center provided insightful advice from a sociologist’s perspective. The assessment also received valuable input from Dr Dang Thi Nhat Vinh from the HCMC AIDS Committee and Ms Nguyen Ngoc Hanh, Vice Chairwoman of the HCMC Women’s Union. Interviews of the target group and key informants were arranged by Ms Le Dinh Hoang Phuc, the Project liaison officer and Ms Nguyen Thi Ngoc Hanh, Women’s Union staff and Director of Anh Duong Centre as well as the peer educators. Special thanks to the women who gave their time and stories in our discussions.

Table of Contents Executive Summary4 Chapter 1: An Up-to-date Overview of Female Sex Work in Ho Chi Minh City7 Chapter 2: Research Overview10 2. 1Research Objectives10 2. 2Research locations10 2. 3Research Duration10 2. 4 Research Methods10 2. 4. 1 Research Sample10 2. 4. 2 Sampling method11 2. 4. 3Data collection instruments11 2. 4. 4 Data analysis method12 2. 4. 5 Ethical considerations12 2. 5 Research Team12 2. 6 Limitations of the Research12 Chapter 3: Findings13 3. 1 Social, cultural and economic characteristics13 3. 1. 1 Social characteristics13 3. 1. 2 Educational and cultural characteristics13 . 1. 3 Economic characteristics14 3. 2 Situation and scope of work of FSWs15 3. 2. 1 Categories of FSWs15 3. 2. 2 Areas and modes of operation15 3. 2. 3 Estimations of FSWs17 3. 2. 3 Mode of operation17 3. 2. 5 Location for transactional sex18 3. 2. 6 Income and time for sex activities19 3. 2. 7 Sex trade activities and intermediary system20 3. 2. 8 Clients21 3. 2. 9 Impact of eradication campaigns on sex trade activities22 3. 3 Safe sex practices of FSWs and affecting factors23 3. 3. 1. Condom use23 3. 3. 2 Use of substances25 3. 3. 3 Health care and access to health services26 3. HIV/AIDS information and FSWs27 3. 4. 1 Knowledge and perceptions of FSWs of HIV related issues27 3. 4. 2 Information channel and access of FSWs to information28 3. 4. 3 Life values, figures and events that positively affect FSWs28 3. 5 Existing HIV/AIDS prevention intervention programs for FSWs in HCMC29 3. 5. 1 Major HIV/AIDS prevention intervention programs for FSWs29 3. 5. 2 Advantages and disadvantages of the HIV/AIDS prevention program for FSWs31 3. 6 Experiences and needs of all respondents in the development and implementation of HIV/AIDS interventions for FSWs33 Chapter 4: Discussion36 . 1 How different is female sex work from before? 36 4. 2 How vulnerable are FSWs to HIV? 37 4. 3 What are the internal factors that contribute to the increased risk of contract HIV among FSWs? 37 4. 4 What are the external factors that affect the practice of safe sex among FSWs? 38 Chapter 5: Conclusion and Recommendations40 Executive Summary The “ Women’s Health in Ho Chi Minh City (HCMC)” Project (1/11/2004 ??? 30/92006) is being implemented by the HCMC AIDS Committee with technical and financial support from Family Health International (FHI).

The project aims to minimize the vulnerability of women with high risk behaviors to HIV/AIDS in HCMC. In the past few years, various research studies have been conducted on female sex workers (FSWs) in Vietnam in general, particularly in HCMC. However, in order to have the most-up-to-date information on female sex work, the project team commissioned Ms Nguyen Nguyen Nhu Trang and Dr Hang Thi Xuan Lan from the Life Centre to conduct a rapid assessment of female sex work in HCMC.

This assessment has three objectives: (1) analyze the current situation of female sex workers who are working in the project districts; (2) identify and analyze the full range of factors that contribute to risk-taking behaviors and the introduction, acceptance and continuing adoption of safer sexual behaviors; and (3) make recommendations about the project intervention areas, project intervention approaches and the key HIV prevention messages targeting female sex workers.

The assessment began in late December 2004 and completed data collection, analysis and reporting were conducted in the period of January to March 2005. District 1, 7, 11 and Binh Thanh were selected for the assessment because of these districts’ diversified characteristics in terms of demography, variety, and scale of development of entertainment establishments, and the level of access to different HIV/AIDS education and intervention programs.

The assessment is a qualitative research project that recruited 124 FSWs (40 individual interviews and 12 group discussions with 84 FSWs) and 12 business-owners, managers and female pimps. In addition, three representatives of local authorities and city level-police and three professionals working in the HIV/AIDS were interviewed. Although the representatives from the local authorities in most of the research districts report that sex work has been significantly reduced, the assessment shows that sex work is on the rise in these locations.

A report provided by the representative from the city-level police reveals similar findings. Generally speaking, FSWs’ operation types are unchanged ??? “ direct FSWs” work in brothels, on the streets or in side-walk cafe and “ indirect FSWs” work from entertainment places such as restaurants, hotels, massage parlors, dancing halls, bars. However, the sex industry is becoming more complex and well-organized in response to current social developments, client taste and the political environment. The majority of FSWs migrate from southern provinces and a small number of them are from HCMC.

Almost all sex workers are young and, according to various respondents, the FSW population is becoming increasingly younger. Most of FSWs have not completed primary school. A large number of FSWs have been married but are either separated or divorced from their spouses. FSWs who have children leave them in the care of relatives in their home town. Almost all respondents, whether they were from the provinces or from HCMC, live in a rented house or room, either alone or with co-workers. All of the respondents report having worked in other jobs prior to sex work.

Reasons to do sex work cited include family’s economic problems, break-up of marriage, or influence of friends and lifestyle. Despite earning more money, from 3, 000, 000 to 10, 000, 000 Vietnam dong per month, which is quite high compared with the Vietnamese’ monthly average income (average of 1, 000, 000 dong/month), a majority of the respondents are in debt. Outside of sex work, daily activities and pastimes of FSWs include sleeping, playing cards (gambling), shopping, and watching television. In general, relationships between FSWs are competitive and jealous.

However, it is well-noted that FSWs develop close relationships with female pimps. Being the ‘ career master’, client coordinator and protector, female pimps have a strong influence on FSWs. Research findings reveal that although most FSW respondents have good knowledge of HIV/AIDS, transmission routes and preventive measures, they have vague understanding about sexually transmitted infections (STIs) and especially the connection between STIs and HIV/AIDS. Almost all respondents know that they and their co-workers are at high risk of contracting HIV, thus they are conscious about condom-use.

However, many FSWs still unknowingly engage in high-risk behavior. For instance, some report not using condoms with regular partners or regular lovers, believing that these partners are HIV free. Some believe that the risk-factor was low if they skipped using condoms once or twice. There is also a growing trend of FSWs using stimulants (such as Ecstasy) and other drugs. “ Indirect FSWs” tend to smoke or sniff illegal substances while street-based FSWs tend to use injecting drugs. Indirect sources of information (e. g. from non-drug using FSWs) reveal that most intravenous drug using (IDU) FSWs use their own syringes and needles.

However, there may be cases where FSWs share needles should individual ones be unavailable at time of injection. Under the pressure of current “ social evils” eradication campaigns, FSWs might not carry needles or condoms for fear of being identified and arrested by the police. Although the make-up of clientele has not changed, this research project shows that awareness and practice of clients in regards to condom use is generally good. A new group that has emerged as potential clients is overseas Vietnamese (Viet Kieu). Many respondents reported that most overseas Vietnamese do not want to use condoms.

A large number of clients seek FSWs while drinking heavily, which poses challenges for FSWs in negotiating safe sex with those clients. It is noted that most FSWs have acquired good negotiating skills for condom use and handling clients. This research also identified that almost all FSWs have access to HIV/AIDS-related information through friends and mass media. Television is the preferred mode of communication and most easily accessed by the respondents. Many FSWS report feeling concerned about HIV prevalence and are affected by watching documentaries of people living with HIV/AIDS (PLWHA).

However, most FSWs do not have frequent access to such information. A majority of the interviewed FSWs do not or have limited access to communication activities conducted by peer educators. Furthermore, respondents report infrequent use voluntary counseling and testing (VCT) services because of inconvenient location. All of the above factors contribute to the increase of risk of contracting STIs, including HIV, among FSWs in HCMC. To reduce risk, it is recommended that intervention projects: 1. Prioritize or mobilize a large proportion of available resources to support FSWs who engage in street-work and in side-walk cafes. . Expand and strengthen the capacity of peer educator teams. Consider involving female pimps and working FSWs in peer education activities. 3. Increase communications with FSWs not only at their work places but outside of work places as well. 4. Enhance capacity-building potential of peer educator teams in project planning, monitoring and evaluation. 5. Increase communication and dissemination on HIV/AIDS and condom use to FSWs and their clients via mass media. 6. Expand and integrate VCT services into existing medical and social support services. 7.

Direct HIV/AIDS/STIs communication messages to potential risks of contracting HIV/STIs through oral and vaginal intercourse without condoms and inconsistent condom use. 8. Establish a network of simplified VCT offices, either mobile or located at a convenient place. 9. Minimize risk of FSWs contracting HIV through enhancing communication of risks from unsafe drug injection 10. Create alternative career opportunities for FSWs who are determined to quit sex work. Chapter 1: An Up-to-date Overview of Female Sex Work in Ho Chi Minh City Since Vietnam adopted a market economy in 1986, the country has experienced rapid economic growth.

Opening of the economy has resulted in business development, rapid urbanization and increased tourism. In this context, more and more young women have been tricked, coerced or voluntarily enter the sex industry to meet the increased demand for commercial sex. Various studies report different estimates of female sex workers (FSWs) in Vietnam. The Ministry of Labor, War Invalids and Social Affairs of Vietnam has reported an estimate of 70, 000 in 1995 (cited by Elmer, 2001) while unofficial estimates range between 300, 000-500, 000 throughout Vietnam (Elmer, 2001), with an estimate of 70, 000 in Ho Chi Minh City (HCMC) (Vinh, 2004).

Demographic-Socio-Occupational characteristics The average age of FSWs is 25 and most of them are unmarried, separated, or divorced (Elmer, 2001). Most FSWs have a low level of education (Hanh et al. , 1999; Starink and de Bruin, 2001; Vinh, 2004). Reasons cited for entering sex work are: poverty, family debt, breaking up with boyfriends, marriage breakdown, domestic violence (Hong, 1997; Vinh, 2004) and despair from losing virginity (Hanh et al. , 1999). FSWs working in HCMC come from the Mekong River Delta, the Central region of Vietnam and within HCMC.

FSWs from the provinces tend to be less mobile between working places because they are unfamiliar with the city and have not yet established a social network. Once they become familiar with sex work and the city, they will become more mobile (Starink and de Bruin, 2001). FSWs are differentiated by two types ??? “ indirect FSWs” and “ direct FSWs”. Indirect FSWs, generally younger and more attractive, work in entertainment establishments such as hotels, restaurants, bars and massage parlors. Direct FSWs, who tend to be older and less attractive, work on the streets, in parks and brothels (Elmer, 2001).

The former group earns a much higher income than the latter group. (Starink and de Bruin, 2001). Among the FSW subgroups, indirect FSWs are generally better protected by establishment owners, and female or male pimps. Often working under contract or agreement with the businesses owner, indirect FSWs have the advantage of a continuous supply of clients with good incomes, protection from police arrest and violence from clients, and regular health check-ups (Starink and de Bruin 2001). FSWs engaged in street-work tend to work alone or work under he control/coordination of male pimps, drivers, husbands or boyfriends who provide protection, transportation and contact with potential clients. Compared with indirect FSWs, direct FSWs work in difficult conditions and are the least protected ??? they generally work under tension due to fierce competition from peers, fear for being arrested by the police, and risk of being abused by clients. Direct FSWs are often in need of income since they do not receive as much money per sex act and in many cases are addicted drug users.

This leads to tendencies to engage in unprotected sex, making indirect FSWs more vulnerable to contracting STIs and/or HIV (Hanh et al. , 1999; Elmer, 2001; Starink and de Bruin, 2001; Vinh, 2004). Clientele Clients vary with group of FSWs. Indirect FSWs tend to receive men with higher socioeconomic status such as businessmen, high-ranking government officials, overseas Vietnamese and foreigners, whereas indirect FSWs are generally approached by clients who have lower income e. g. traders, drivers, migrant/construction workers, and students.

Clients of indirect FSWs usually come to restaurants and bars with friends or business partners and often request sex after drinking (Elmer, 2001). Lower-income clients such as workers and students prefer to go to direct FSWs where they can quickly satisfy their sexual desire. Income also determines place of transactional sex. Usually, FSWs try to avoid going to places designated by clients for fear of collective sex/rape or lack of payment. All FSWs do not like receiving drunken clients as it is a “ harder job” to serve these clients.

Drunken clients are more likely to refuse to use condoms and also use physical violence to force FSWs to perform acts that FSWs find distasteful (Hanh et al. , 1999; Starink and de Bruin, 2001; Vinh, 2004). Some clients are aware of HIV and potential risks of having sex with FSWs but decisions about condom use often depend on their judgment of FSWs based on appearance (cleanliness, attractiveness), province of origin and sex work experience (Vinh, 2004). Knowledge of HIV/AIDS/STIs Most FSWs have heard about HIV/AIDS and are aware of the transmission modes.

However, some FSWs are still misinformed about how to contract HIV or STIs. Many believe that they cannot contract HIV or STIs if they take “ protective” measures such as checking clients’ genitals, withdrawal for ejaculation, and washing or rinsing their genitals after intercourse (Hanh et al. , 1999; Starink and de Bruin, 2001; Vinh, 2004). A few FSWs are fatalistic about HIV infection, perceiving HIV as a danger that is beyond their control and unavoidable (Vinh, 2004). Risk behaviors

An increasing number of FSWs are also using drugs, including injecting drugs, with some research reporting certain levels of intravenous drug use among FSWs in HCMC (Trang Vu, 2001; Starink and de Bruin, 2001; Vinh, 2004). However, there are no estimates of the prevalence of drug-addicted FSWs or information on whether they turn to sex work to support their drug use or are attracted to drugs while doing sex work. Drug-addicted FSWs often do not care about their own health or health of clients as long as they have access to drugs. These FSWs are more likely to share needles and engage in unprotected sex.

Condom use among FSWs is still low. 35-47% of the respondents reported use of condoms usually or always, 26-50% sometimes, and 2-26% never (cited by Vinh (2001). A survey conducted in HCMC in late 2000 found 42% of FSWs reported condom use with casual clients, 40% with familiar clients and 17% with their husband and partner (Giang, 2001). Insisting on condom use means losing clients. Most FSWs do not use condoms with their husbands or lovers, because unprotected sex is regarded as a symbol of faithfulness and trust in an intimate relationship. STIs Many FSWs have a history of STIs.

One survey reported that approximately 33% to 50% of the respondents have contracted an STI (Vinh, 2004). Other studies reported that a majority of FSWs rely on self-medication by buying medicine directly from pharmacies. Reasons cited for not using public clinics include FSWs feeling ashamed and uncomfortable, poor treatment by health staff, and long waiting times compared to private clinics. These experiences further marginalize FSWs from society and prevent them from seeking appropriate treatment and support (Hanh et al. , 1999; Starink and de Bruin, 2001).

Impact of “ social evil” eradication campaigns FSWs are extremely vulnerable because they are categorized as ‘ social evils’ by the Vietnamese government. To cope with “ social evils” eradication campaigns, FSWs have become very mobile ??? direct FSWs use motorbikes or bicycles to solicit clients and cruise around the streets whereas indirect FSWs switch between entertainment services. Given the current policy that condemns people associated with the sex industry, FSWs seldom carry condoms for fear that condoms could be considered evidence of doing sex work.

Furthermore, many direct FSWs do not use make-up and dress modestly so that they will not be targeted by police. Agreements between entertainment places and some local policemen are also established. Informants from the police will notify establishments prior to inspection. Generally, local police know most FSWs working in their area and have transactional sex with FSWs. However, during social evils campaigns, police must arrest some FSWs, especially those without an identity card, for reporting purposes (Vinh, 2004). There are certain places in HCMC where two or three districts merge.

Given this system of district borders and the fact that police work in specific districts, it is common for FSWs simply to run across the road to avoid police arrest (Starink and de Bruin, 2001). National HIV/AIDS education programs Outreach and peer education for FSWs were introduced in HCMC in 1992, providing HIV/AIDS information, condoms and STIs treatment (Vinh, 2004). Starink and de Bruin (2001) report that most FSWs rarely attend health education programs or visit support centres as they were too busy or due to conflict with working hours.

Initially, peer educators have proven to be effective in communicating behaviour change messages (Elmer, 2001). However, as former FSWs, peer educators have difficulties in reaching indirect FSWs as permission of the business managers and owners is necessary to make contact. It is easier to reach direct FSWs (Starink and de Bruin, 2001). Research also shows that some peer educators are from the Women’s Union and other government agencies, and may be considered ineffective due to their moralistic approach and dissemination, and they are thus not warmly received by distrustful FSWs.

REFERENCES Elmer, Laurel (2001). HIV/AIDS Intervention Data on Commercial Sex Workers in Vietnam. Hanoi: National AIDS Standing Bureau. Giang, Le Truong (2001). Facing AIDS in Ten Years 1990 ??? 2000 ??? Annual Report. Ho Chi Minh City AIDS Committee. Hanh Le Thi; Marise St Pierre, Trang, Nguyen Nguyen Nhu (1999). Preliminary Results of Sex Workers Research. Vietnam: CARE International and CARAM Asia. Hong, Khuat Thu (1997). Study of Sexuality in Vietnam: The Known and Unknown Issues. Institute of Sociology in cooperation with the Population Council, Hanoi.

Starink, Markus and de Bruin, Liselotte (2001). Mobility and Vulnerability: An Explorative Study among Female Sex Workers in Ho Chi Minh City, Vietnam. Vietnam: Mobility Research and Support Centre. Trang Vu. 2001. Harm reduction for injecting drug users in Vietnam ??? A situation assessment. Victoria Public Health Training Scheme. Vinh, Dang Thi Nhat (2004). HIV Preventive Behavior of Street Sex Workers in Ho Chi Minh City, Vietnam. Masters Thesis. Thailand: Mahidol University. Chapter 2: Research Overview 2. 1Research Objectives Research objectives of this project are to: 1.

Analyze the current situation of FSWs who are working in the project districts 2. Identify and analyze the full range of factors that contribute to FSWs’ risk-taking behaviors and to the access, acceptance and continuing adoption of safer sexual behaviors 3. Make recommendations about the project intervention areas, project intervention approaches and key HIV prevention messages targeting female sex workers. To achieve these objectives, the following main study questions need to be answered: 1)What is the current situation of FSWs who are working in the project districts? )What are the factors that contribute to their risk-taking behaviors? 3)What are barriers for FSWs’ access, acceptance and continuing adoption of safer sexual behaviors? 4)What HIV communication messages are effective for FSWs? 2. 2Research locations This research was undertaken in Districts 1, 7, 11 and Binh Thanh in HCMC. These locations were selected for their diversified characteristics in terms of demography, types, development and scale of entertainment establishments as well as level of access to HCMC HIV/AIDS education and intervention programs. . 3Research Duration Research commenced in late December 2004 and completed data collection, analysis and reporting was compiled from January to April 2005. During the data collection process, it was extremely difficult for the research team to arrange interviews with local authorities, which lengthened the duration of data collection and impacted the schedule of presentation of the preliminary report to the project partners ??? the AIDS Committee (PAC) and the Women’s Union of HCMC. 2. 4 Research Methods 2. 4. 1 Research Sample

The research team applied a qualitative research method and employed in-depth interviews, focus group discussions and key informant interviews as data collection techniques. In addition, the research team also reviewed project documents for project context. A total of 124 FSWs (40 individual interviews and 12 group discussions with 84 FSWs) and 12 business-owners, managers and female pimps (the “ gate keepers”) participated in this research. The research also interviewed three representatives from the district authorities and city-level police and three professionals working in HIV/AIDS.

Table 1 lists the number of respondents for each data collection instrument. Table 1. Research respondents across districts Respondents Dist. 1Dist. 11Dist. 7Binh Thanh Dist. Total Direct (street-based) FSWs ??? IDI22228 Karaoke FSWs ??? IDI22228 Massage FSWs ??? IDI 22228 Bar/Cafe/Restaurant FSWs ??? IDI22228 Hotel FSWs ??? IDI22228 FSW IDIs40 Entertainment establishment owners 22228 Female or male pimps11114 Gate-keeper IDIs12 Women’s Union Leader11 Department of Labor, War Invalids and Social Affairs (DoLISA) official11 HCMC Police11 PAC official 11 Local authorities or HIV/AIDS program officer-in-charge 112 HIV/AIDS programmers and ocal authorities IDIs6 Direct (street-based) FSWs ??? FGD 11114 Bar/Cafe/Restaurant FSWs ??? FGD 11114 Hotel FSWs ??? FGD11114 FSW FGDs12 groups 2. 4. 2 Sampling method Recruitment of study units was supported by PAC and HCMC Women’s Union staff familiar with the selected districts. The first study unit (FSWs, female pimps and business owners) was recruited through peer educators working in the HCMC Women’s Union Peer Education project and honda-om (motorbike taxi) drivers that the study team knew previously. Subsequent study units were recruited using a respondent-driven sampling method.

Specifically, after the first study unit had been interviewed, they were then asked to recruit other study units/members among their social network who met the study unit criteria to voluntarily participate in the study. These recruiters received 50, 000 dong for each recruitment that was accepted by the study team. Meetings with representatives of the district authorities and other concerned agencies were arranged by the Project Liaison Officer based in the HCMC PAC. It was extremely difficult to set meetings with these representatives as it was between the end of year 2004 and the threshold of Lunar New Year 2005. . 4. 3Data collection instruments The study utilized in-depth interviews (IDIs) and focus group discussions (FGDs) as data collection techniques. Different interview guides were developed for the IDIs with FSWs, gate-keepers and key informants. An interview guide for FGD was also developed to further investigate on issues highlighted in the IDIs. 2. 4. 4 Data analysis method Data collected was transcribed and presented in Microsoft Word and then coded in Excel by the themes and sub-themes developed by the research team.

In-depth analysis and reporting was undertaken with the researcher contracted by FHI. 2. 4. 5 Ethical considerations ? All respondents gave verbal consent for participating in the research study. ? The interview transcriptions and notes for all respondents were anonymous and coded to maintain confidentiality. All tapes and transcripts of the interviews were given to the FHI project officer in HCMC. ? The opinions shared by the respondents were treated with respect (ie without moral judgment) in all stages of the study. Their contribution is formally acknowledged in this report. 2. Research Team All interviews were conducted by eight interviewers supervised and led by the national consultant contracted by FHI. The FHI consultant trained two project staff working in Anh Duong Center and all research team members on qualitative research, interviewing skills, the interview guides and data processing. The consultant was supported by a researcher from Life who coordinated the data collection, analysis and reporting. 2. 6 Limitations of the Research Research commenced in late December 2004. Data collection analysis and reporting was undertaken during January ??? March 2005.

It was extremely difficult to set up interview meetings with representatives of the district authorities. Several scheduled interviews with the local authority representative were cancelled at the last-minute. The time representatives allowed for each meeting was approximately 45 minutes but most of the scheduled time was spent waiting for other officials to join the meeting. The lengthened data collection process resulted in delays in presenting preliminary findings to the project partners, HCMC PAC and the Women’s Union. Chapter 3: Findings 3. 1 Social, cultural and economic characteristics 3. 1. Social characteristics FSW respondents reveal that the majority of them are from the Mekong Delta provinces, such as Tien Giang, Tra Vinh, Ben Tre and Can Tho, rather than from HCMC. A small portion of FSWs originate from the central or northern part of Vietnam. Most cite entering sex work via being introduced, deceived or lured by their friends. Nevertheless, significant causal factors leading them to doing sex work are related to familial matters: (1) Many FSWs from the provinces often experience financial difficulties as a result of a large extended family, unemployment, or parent(s) who are divorced or separated. 2) Others cite depression, disappointment in love, marriage breakup or disorientation in life. The last reason was identified among younger women who are local residents with characteristics of being unmarried, well-to-do, and indulging in extravagant, high-risk lifestyles. These young women usually frequent bars, cafes or discotheques. Due to use of stimulants and other substances, these women began working in the sex industry to cover their expenses. The average age of FSWs working in massage parlors and hotels ranges between 19 and 21 while their street-based counterparts are 28 to 30 years old.

Most of the married respondents report having one or two children, however nearly all of them were either divorced or separated. Their children are being raised and cared for by relatives, usually their mothers in their hometown. Many of the interviewed FSWs maintain a sexual relationship with a regular partner, usually also with their pimps, who provide protection from violent clients or police investigation. Some respondents state that they need regular partners who they could rely on for emotional support due to the unstable life of sex work.

Female pimps report that young FSWs tend to support their partners while older ones often chose regular partners who could pay their expenses. Two FSWs report having immediate family members who also engage in sex work and drug use. Some FSWs report relatives being detained in rehabilitation and reeducation centers or having died of HIV/AIDS and/or drug overdose. 3. 1. 2 Educational and cultural characteristics A great majority of the respondents did not complete primary education. Some were illiterate and a few graduated from college.

Almost all of the FSWs, including the HCMC residents, live in a rented room or house. The rent is usually shared among three or four women. Many FSWs became friends from working in the same place or in the same area rather than because they are from the same town. FSWs in the same buddy system are highly influenced by one another in many ways. However, FSWs who work in the same place are sometimes competitive in terms of physical attractiveness and the ability to solicit clients. Most of the interviewed FSWs pay little attention to their living conditions.

These places are rarely adequately furnished or decorated. Many FSWs go over to their neighbors’ or landlord’s homes to watch TV. Most respondents tend not to change their living place except when (1) they begin work in another area, (2) the rent increased or (3) the area was considered unsafe. There are cases that if one FSW member planned to move elsewhere, the rest of the group often followed. Daily activities of the respondents include shopping for clothes and cosmetics, watching soap operas, listening to the radio, sleeping and gambling.

The respondents say they usually sleep through the morning to make up for lack of sleep after a late working night. Afternoons are usually spent gambling. Indirect FSWs are also familiar with drinking alcohol and smoking as a result of their work. Yet, those who are not based in bars or restaurants also drink alcoholic beverages and smoke. Despite what their drinking and smoking habits would indicate, none of the FSWs report being forced to drink while entertaining their clients. Though all respondents are currently active in sex work, they state that they are scornful of their job, which they deem immoral and inappropriate.

With that in mind, many respondents say they led dual lives ??? on one hand selling themselves to clients but also hiding their work from their families and neighbors from their place of origin. Families of FSWs are often unaware of their sex work, including family members living with FSWs. In response to the question regarding aspirations, all respondents express desire to quit work after having saved enough to start a new business and to find a considerate husband. 3. 1. 3 Economic characteristics

Almost all respondents report having various jobs prior to sex work such as assisting in shops, washing dishes/glasses in restaurants or cafes, with an average wage of 700, 000 dong per month. According to the respondents, with these wages, they could only cover one-half or one-third of their monthly expenses and was not enough to support their families. Thus, under peer influence, these women gradually entered sex work hoping to earn more money. Practicing sex work, their income may increase four to five times. Those who work at massage parlors or hotels earn even more, with at most ten million dong per month.

Some FSWs report having quit sex work but only to restart since they could earn much more money from selling sex than any other occupation. Nevertheless, most respondents say that the more money they earned the more they spent and they saved very little. It is a common among FSWs to borrow money at exorbitant interest rates, approximately 20% per month. Apart from the money sent home on a monthly basis or every two or three months, the rest of the respondents’ income was spent in gambling. Some FSWs state that they would save more if they did not gamble.

If gambling or using drugs, FSWs tend to have little savings and large debts. Furthermore, some FSWs reveal that their spending is not necessarily dependent on the amount they earn and that they can easily take loans with exorbitant interest fees. As a result, these FSWs are barely able to repay their loans. This situation thus requires them to solicit as many clients as possible. The following table shows the estimated allocation of the FSWs’ monthly expenditure (the number of asterisks illustrates the proportion of expenses). Supporting family or children**********

Gambling******** Regular sexual partner(s) expenses******* Clothes and cosmetics****** Food***** House/room rent, utility bills, etc**** 3. 2 Situation and scope of work of FSWs 3. 2. 1 Categories of FSWs Generally, FSWs are divided into two categories: direct and indirect FSWs. Given the diversity and flexibility of FSWs nowadays, the differentiation is very relative. Direct FSWs are often found working independently, directly soliciting clients on the street and thus keeping all earned income. Some of these FSWs also sit in cafes to look for potential clients.

This group of FSWs often works under the supervision of male pimps who control their working area. For security, some street-based FSWs have to pay 50, 000 dong per client to these “ protectors”. FSWs working in bars or restaurants are categorized as indirect FSWs. These FSWs work in an organized system under the management of entertainment establishment owners and/or female or male pimps. Under this system, FSWs are well-protected and receive clients solicited and coordinated by these supervisors. The FSWs under this category can be further divided into two sub-groups.

The first sub-group has contracts with business-owners and is considered staff of the entertainment establishment. If FSWs are working without a contract, they will be questioned by the local police and suspected of being sex workers. To cope with this, the business owners usually sign contracts with about four to five women. These women receive a fixed monthly salary while the occasional (freelance) FSWs do not receive a salary but are allowed to assist in the bars or restaurants and to solicit clients. 3. 2. 2 Areas and modes of operation

In order to avoid campaigns launched by police and authorities, FSWs often move from place to place, from downtown to outskirts of HCMC. Excepting the local authorities’ representatives’ statements, all other respondents confirm that there is an increase of sex trade related entertainment establishments in the last three years. Many of these establishments have diversified types of sex trade operation. The number of FSWs in each place range from 10 to 20 “ girls”, especially in street-based hot spots. These hot spots stretch along the bridges, national highways, main streets, bus tations or parks. As mentioned earlier, modes of sex operation have become more diversified. Apart from the modes of sex operation that the research targeted, other modes also mentioned by respondents include street-based masseuses, cigarette hawkers, street soup shops etc. According to the respondents, an attractive and highly-desired type of sex work is reflected in the amount of money paid by a client each time rather than the number of clients per sex worker. The following chart shows different levels of attractiveness of different sex operation mode as perceived by the respondents:

Among the women interviewed, most of them confirm moving to other places at least once or twice, either voluntarily or involuntarily. If they desire to move to a new place, their friends often help them without any charge. Moving to a new area provides new opportunities rather than causing any negative impact. There is no fixed cycle of changing work places but for cafe-based FSWs, the average interval period is approximately six months. The reasons accounted for this phenomenon are (1) clients frequently demand variety of FSWs (2) the flow of clients is small and (3) better opportunities.

Other reasons include moving to a new living neighborhood, being harassed by police or authorities, or conflict with peers or female pimps. Freelance FSWs working in bars are often exchanged or “ lent” by managers or female pimps to other businesses. 3. 2. 3 Estimations of FSWs All respondents except the representatives of some district authorities state that FSWs are much more in number and many begin sex work at a younger age than previously. “ Now most of them are teenagers… they are no more than kids,” (Cafe-FSW). It was reported that most of the women working in bars or cafes are more or less engaging in sex work.

It should be stressed that the more desirable the mode of operation, the younger the FSWs were. Street-based and cafe-based FSWs are the largest groups. According to the interviewed HIV/AIDS programmers, the number of street-based FSWs has decreased and many of them have moved into cafes or food shops in search for clients more discreetly. This was further confirmed by some respondents. “ When I worked in a food store in Thu Duc district, it was a common thing to see many FSWs standing along Dong Nai bridge waiting for clients. Recently, it’s getting harder to see them.

It appears they operate in a more discreet way,” (A female pimp). 3. 2. 3 Mode of operation The FSW and female pimp respondents indicate that many women working in entertainment establishments have two jobs ??? service staff and sex worker. They wear trendy and provocative clothes to attract clients. As for street-based FSWs, the threat of being arrested leads them to cruise around by motorcycle or walking along the street. In many cases, they disguise themselves as vendors and street masseuses. It was also reported that to avoid being arrested, these street-based, direct FSWs prefer to wear casual clothes. Earlier, people like us used to wear clothes in a way that made us stand out in the crowd. Now things have changed. We tend to wear casual clothes in order to blend in with the public. We now look more like normal women or wives. It makes it harder to tell if we are ‘ girls’ or not. ” (A karaoke FSW) In addition, the simplicity of clothing was interpreted by many clients as inexperience with sex work, and therefore clients believe they have little chance of contracting infections. The popularity of the mobile phone makes it easier and more convenient for FSWs to communicate with clients.

FSWs who work under supervision of female pimps also make use of this communication tool to secretly negotiate with their clients and escape the necessity of paying a fee to their intermediaries. To maintain mobile phone services, they pay approximately 500, 000 dong monthly. The concept of “ call girls” has gradually started to emerge. FSWs offer clients different types of services; namely (1) quick service (2) hourly service and (3) overnight service. Direct, street-based FSWs often provide quick service while cafe and massage parlor FSWs provide the second and third services.

In comparison to indirect FSWs, direct FSWs put more effort in soliciting clients and receive more clients as well. On average, FSWs on the street and at cafes receive 3 or 4 clients daily. They receive as many clients as possible ??? one FSW reports having 12 clients in one day. FSWs at the bars, massage parlors or karaoke establishments are more selective of clients since they have to do other contracted service work. These FSWs tend to pick up wealthier men. “ You know, we worked in a bar so did not have much opportunity to receive many clients. Normally, I picked up only one and serviced him overnight. (Bar FSW). As a result, their income is basically double or triple that of street-based FSWs (see further information in 3. 2. 6 Income and time for sex activities). Competition among FSWs in search of clients is often tense but not severe. Each sex worker has to find ways to maintain attractiveness and please clients. However, the key to success relies predominantly on age. Older FSWs often turn to street-work after becoming too old for direct sex work. 3. 2. 5 Location for transactional sex Each FSW has a preferred venue to service clients. Venues are recommended by friends in the network.

Cheap mini-hotels or inns are preferred by a majority of FSWs. Generally, venues are selected based on three criteria: (1) security (2) being located at a quiet place and (3) inexpensive. Many street-based FSWs sold sex ‘ on the spot’ at parks and deserted places. Occasionally, some FSWs have sex in their homes, at the client’s designated place or in the entertainment establishment. From experience, providing sex at the client’s choice of place means high risk of collective sex ??? a FSW respondent reported that one of her friends was forced to have sex with 42 men at one time.

To minimize the risks of collective sex or rape, FSWs prefer to make their own choices regarding where to have sex. Yet, because of financial pressure, many women follow clients’ choice of place as long as such places are within the city. Cheap inns are preferred by FSWs who work on the street or in cafes. Hotels are not considered too expensive and thus preferred by other groups of FSWs as well as clients who also wanted to pay for sex in a comfortable setting. Common prices for quick, hourly and overnight services were 20, 000, 50, 000, 100, 000 dong respectively for a common inn (or guest house) or 30, 000, 100, 000, 120, 000 dong for a hotel.

If clients are foreigners, the average price is between50 and 100 USD for quick and overnight services. 3. 2. 6 Income and time for sex activities Fees for sex exchange are relatively uniform. FSWs are aware that it was important not to overcharge clients so that clients will return for services. “ Our norms? You are not allowed to overcharge or undercharge clients. We will fight to death with those who violate the rule. ” (Hotel based FSWs) The prices vary according to the type of sex services provided. The service women working under contract at an entertainment establishment receive a monthly salary of 400, 000 to 500, 000 dong on average.

The occasional (freelance) women do not have a work contract but are allowed to assist and stay in the venues to solicit clients. These FSWs do not receive a salary but live on payments and tips from clients. Tips have to be shared with business owners or female pimps at an agreed rate. The table below outlines prices per visit of each type of sex service mode and monthly income as reported by the FSW respondents. Place of work Quick serviceHourly serviceOvernight serviceMonthly income (based on an average of four clients/day) Streets 50, 000100, 000-150, 000300, 0003, 000, 000

Restaurants and cafes 50, 000-70, 000200, 000300, 000-400, 0005, 000, 000 Bars, karaoke150, 000300, 000500, 0007, 000, 000 Restaurants and massage parlors300, 000500, 000700, 000-1, 000, 000over 10, 000, 000 Note: exchange rate 1 US dollar = 15, 800 Vietnam dong Sex trade activities peak from 7 pm to 1- 2 am. While street-based FSWs spend most of their time soliciting clients, establishment-based FSWs are usually allowed to pick up clients after 10: 00 pm except when there are few customers during the day. However, for regular or ‘ long-standing’ clients or those who make an appointment in advance, FSWs may arrange time off with the managers.

Weekends are the busiest time, with more clients both day and night. Most respondents report working 20 days a month on average. All state that the number of clients did not fluctuate greatly but February, August, September and October are the ‘ low season’. Meanwhile, festive times such as Christmas, national holidays, the Lunar New Year as well as big events like soccer cup season are peak season when clients usually gathered for drinks. 3. 2. 7 Sex trade activities and intermediary system Entertainment establishment owners, managers and female pimps have strong associations with FSWs in entertainment establishments.

The link between these people with street-based FSWs is weaker or none at all. Depending on the scale of sex operation, each bar requires one to three female pimps. The proportion of female pimps in discotheques is greater. “ You mean madams ? Oh, many! One big discotheque can hold hundreds of girls. For some karaoke businesses, each madam takes care of 20 ??? 30 girls. ” (A business owner) Business owners are often key actors of the entire sex operation. Depending on the scale of business, the sex trade network might comprise of a manager or supervisor, female or male pimps, and FSWs.

Usually, those owners interacted with some staff or officers of local authorities or policemen to establish an information system. According to the respondent from the HCMC Police Department, the sex trade network has become more solidified and established. The following diagram outlines the organization of a medium-size business: In small-scale establishments, the owners are also managers who supervised the FSWs whereas in larger-scale businesses, the owners often authorized a manager for overall supervision of sex trade and several female pimps to directly manage the sex workers.

Managers are also responsible for recruiting and managing contracted service staff. Female pimps are often 30 ??? 35 years old and mostly former sex workers. To be selected for this role, procurers must be good-looking and sexually attractive. Some procurers receive clients when especially requested. One reported receiving 4-5 clients per month. The main tasks of female pimps are to seek, recruit or introduce new women to the manager or business owners. They also train new FSWs. Female pimps do not receive salaries from businesses but from income made by the FSWs.

Specifically, female pimps receive a share of clients’ tips to the FSWs (the share ratio between FSW: female pimp is 7: 3 or between FSW: female pimp: manager being 5: 3: 2) and from the agreed-upon payment for sex service. The FSWs are not obliged to share the sex service payment to female pimps but if they do, they increase chances of introduction to more clients by female pimps. The relationships between business-owners, managers, female or male pimps, and FSWs are built upon mutual benefits. The closest relationship is between female pimps and FSW.

This finding was shared by some FSW respondents who state that working under the protection and management of female pimps brings security and frequency of clients. Female pimps solicit and coordinate clients among the FSWs. The advantage of this system is that when FSWs cannot find clients for themselves, they still receive an amount of 150, 000 ??? 200, 000 dong per week, which is coordinated by female pimps who take shares from the others’ income. In addition, with this system, FSWs are protected from the police and violent clients.

Female pimps also visit FSWs who are detained in reeducation centers to give them emotional support as well as to process their release. This investment aims to reinforce loyalty and commitment of FSWs to the establishments where they work. The expenses paid for the early release are paid up-front by business-owners and will be repaid in installment by the FSWs once they are released. “ Honda-om” (motorbike taxi) drivers play a decisive role in the sex industry for direct FSWs. These drivers take FSWs from home to working places, kept an eye on clients and keep watch for patrols or the police.

Each driver receives 70, 000 to 100, 000 dong for their work per night on average. 3. 2. 8 Clients The respondents report receiving different types of clients from all strata of society. Clients come from different age groups and reside in HCMC permanently or temporarily. In most cases, clients do not reveal their job and economic status but some respondents say that they can categorize the clients through their clothes and manners. Some FSW and female pimp respondents indicate that clients who prefer to negotiate with FSWs directly (ie not through the system) are mostly middle-aged, students or very experienced with the sex trade.

This group of clients, however, has lower incomes, and tends to be construction workers, motorcycle repairmen, and street vendors ??? mainly migrant workers. Such clients tend to pick up FSWs on the street or in cafes to avoid paying intermediary fees or to minimize potential trouble with business owners, female or male pimps. Clients who solicit sex through managers or female pimps are identified by the respondents as governmental officials, well-positioned and wealthy men who did not want to be seen associating with FSWs or to save time.

It is easier for these clients to choose young, sexually attractive girls that meet their criteria simply by making a request to female pimps, or other intermediary people. The number of clients seems to remain unchanged over time. The majority of clients are local people with a small proportion of foreigners and overseas Vietnamese. There is an increase of overseas Vietnamese clients, as reported by most FSWs and female pimps interviewed. In addition, young people, especially students and migrant workers, add to the variety of clientele.

Sex workers have their own regular customers, however, such relationships did not last long. “ It is only sex that links them to us. But after no more than 20 receptions, they got tired of us and looked for new ‘ girls’” (A bar FSW). Many clients solicit sex after drinking with friends or colleagues. However, very few of them were so drunk that they became completely unconscious. From the view of some FSWs and female pimps, foreigners pay lower for services than previously. This is likely due to foreigners being more informed about ‘ market’ prices. 3. 2. 9 Impact of eradication campaigns on sex trade activities

Most respondents working in the sex industry agree that the worst time of the year is during the ‘ social evils’ eradication campaigns??? raids of businesses related to the sex industry The campaigns were previously conducted prior to national festivals or holidays such as Independence Day September 2, Liberation Day April 30, Labor Day May 1, New Year etc, now such activities are carried out more frequently. However, most respondents stated that despite these challenges, sex trade activities are not reduced but on the contrary, the mode of operation has become more sophisticated and strictly organized.

Interviews with female pimps and FSWs reveal that most large-scale sex trade-related businesses have established a strong informant network. It runs so well that in most cases, brothel owners and FSWs are informed in advance about the time and location of each upcoming ‘ social evils’ raid campaign. Nevertheless, respondents still express fear of being arrested and sent to re-education centers. To cope with the situation, various measures are adopted by the sex businesses and FSWs during the campaign period: Most business owners reduce the number of freelance FSWs in the venues. The rest of FSWs would be called in when needed. “ We always worked through the campaigns but to be safe, only the ‘ girls’ with a labor contract stayed at the shop. The others will be called when the supply was short. ” (a cafe owner) ? Only contracted workers are allowed to work at the venues. These FSWs are usually dressed in uniform or unassuming clothing during the campaigns. “ On a normal day, the girls can wear whatever they want but during the ‘ hot’ period they have to wear uniforms. ” (A cafe owner). For street-based FSWs, during the campaigns, instead of standing in groups waiting for clients along the streets, they cruise around on motorcycles by themselves or with ‘ honda-om’ drivers. In this way, they can easily escape from the police and actively solicit clients in new areas. ? Regular clients are contacted via telephone. During the campaigns, most FSWs only received familiar clients to reduce the risk of being “ trapped” by disguised policemen. “ We must be very careful in selection of clients. We might be trapped at any time. We have heard that police disguised as clients come to recruit the ‘ girls’.

It costs them only 20, 000 dong to catch one girl on the street. But to catch a girl at the discotheque, they have to spend at least 5, 000, 000 dong – they must go there several nights to become regular clients before dating the girls there. ” (A discotheque based female pimp) 3. 3 Safe sex practices of FSWs and affecting factors 3. 3. 1. Condom use Most respondents state that in the past two years there has been a “ boom” of condom use among FSWs. All FSWs in this research study reported using condoms with clients. Negotiation and persuasion skills with clients extensively account for this success.

Rationale for negotiation used by the respondents centers on the importance of prevention of sexually transmitted diseases to clients and their wives as well as pregnancy prevention. Factors that contribute to the consistent use of condoms among FSWs are various: ? Being warned, guided and encouraged by peers ??? “[Are you all committed to not going with clients who do not want to use condoms? ] Oh yes. Everyone does the same. I think only those girls who are already infected do not care… To survive in this work, none of us want to go with clients who refuse to use condoms. ” (a street-based FSW) ?

Witnessing their colleagues infected and dying of HIV/AIDS ? Clients request condoms ? Encouraged to use condoms by managers or female pimps since pregnancy is considered bad for business. ? Increased availability of condoms in all settings: from managers/female pimps, pharmacies, restaurants, mini hotels, etc. FSWs reported easy access to condoms. “ Condoms are supplied everywhere, you can easily find them at one end of the bed. ” (A guesthouse owner). ? Vietnam-made condoms are affordable ??? “ 2, 000 dong for three, you see. ” (A street based FSW) ? Condoms are also freely distributed from HIV/AIDS intervention programs.

There is no difference with regard to condom use and negotiation skills of condom use among different groups of FSWs. It is noted, however, that the consistency of condom use corresponds with age and experience of sex workers, meaning those who are older and have done sex work for a longer time practice condom use more frequently than those who are younger and new to the job (especially those who came from provinces). When asked the reasons for low frequency of condom use among young sex workers, the female pimps stated that: ? Young FSWs are more willing to take risks Younger FSWs are under pressure to make money to cover their expenses for clothes, fun and substances. ? Younger FSWs are less able to control their behavior under the influence of substances ? Younger FSWs tend to value sexual satisfaction and believe that condoms reduce pleasure. Less experienced sex workers say that they do not use condoms regularly because they: ? are unfamiliar with condoms and found them uncomfortable. ? have trouble with using condoms correctly and experience breakage of condoms. ? cannot persuade clients to wear condoms. Other factors that hinder condom use are: Loving and trusting husbands, regular sexual partners or regular clients. FSWs believe these partners are HIV-free ??? “ I use condoms with all clients except with the one who really loves me and wants to have a long term relationship with me. ” (A discotheque FSW) ? Some FSWs became more sexually aroused under the influence of substances and so do not prioritize condom use. ? More payment is offered by clients who don’t want to use condoms. This happens more often with street-based sex workers and/or drug abusers where payment for sex was lower. “ After taking it [drugs] I do not care about anything. No condom, just do it, money is everything. (A hotel-based FSW) ? The fear of being arrested for carrying condoms–“ They [the sex workers] never bring condoms along to my shop. ” (A cafe owner) ? Some clients show contempt and sneer at FSWs for requesting condom use ??? “ It seems that doing this sort of work, we have nothing to lose including our dignity. ” (A bar FSW) The most common mode of sexual service is vaginal sex with condom. Rarely did FSWs agree to anal sex because it is “ painful”. Most FSWs state that anal sex would make them “ more vulnerable to diseases” so if they do not persuade clients to use condoms, they will refuse to have sex with clients.

Nevertheless, many report practicing oral sex without condoms during foreplay. Oral sex is believed to heighten sensation and quicken the process of ejaculation, so it is repeatedly requested by clients. Some respondents report making use of the foreplay to put condoms on to the client’s penis. Most of the respondents are unaware of the risks of contracting HIV when performing unprotected oral sex. It was confirmed by most FSWs, female pimps and business-owners in the research study that the awareness of clients, both locals and foreigners, of condom use is very high.

The exception of condom refusal is drunken clients – FSWs found that they took more time and effort to persuade. Another group of clients who refuse to use condoms are overseas Vietnamese. The respondents also mention that they can easily find a variety of condoms on sale but most are male condoms. Very few respondents knew about female condoms. Foreign condoms are preferred by FSWs who work in bars, discotheques, hotels because of their pleasant smell. These respondents expressed distrust in Vietnamese condoms Yes, OK or Super Trust and report that these condoms were odorous and broke easily.

However, these brands are more commonly used by street and cafe-based FSWs. 3. 3. 2 Use of substances The consumption of alcohol depends on the FSW’s work place. Those who work at restaurants, karaoke bars or hotels report frequently drinking while serving clients. However, none of the respondents report being drunk during their working hours. This is further confirmed by female pimps who directly supervise them. Most of them drink beer or spirits with friends outside working hours “ but only one or two bottles at most, just for fun. ” (Restaurant FSWs)

Only one respondent admitted to currently taking drugs while three others report using drugs in the past. Yet, most of the respondents confirm that drug use has increased dramatically, especially among young HCMC-based sex workers. A female pimp gave an estimate of 10% drug use among FSWs. ??? “ For instance, 30 to 40 out of 300 girls are using drugs. ” Other respondents state that “ Many. At least 5 or 6 in one shop. ” (Cafe-FSWs) These respondents report seeing their colleagues using drugs and they have also been offered drugs by friends and clients. Respondents report that stimulants or heroin are the most common drugs taken by FSWs.

Opium (referred to as “ black powder” by the IDU FSWs) is cheaper and more popular among street or cafe-based FSWs. Respondents report that some FSWs use drugs three or four times a day, which can cost from 500, 000 to 1, 000, 000 dong per day. Drug use is not permitted by most managers, in most cases sex workers secretly take drugs in the restrooms. Some inject drugs outside their workplace, in a karaoke room or at home. Drugs are normally purchased for FSWs by ‘ honda-om’ drivers. One respondent reports that she could buy drugs from clients or her manager (which is exceptional since drug use is discouraged in the venue).

Shooting drugs as a group is popular among these FSWs, it is considered a way to share the costs of drugs and also provide friend/peer support. Addicted women prefer to inject drugs alone. Still, these women do not share syringes for fear of HIV/AIDS infection as well as the availability of low-cost syringes. “ They [Syringes] are quite cheap, you can get it for 1, 000 dong. ” (A street-based FSW) In response to the question regarding reasons for FSW many report that FSWs who use drugs: ? have no financial responsibility for family or dependants ? like to take drugs with other wealthy friends introduced to drug use by their partners ? pressured by friends who sold drugs for benefit Those who were born in urban areas are more tempted to drug use compared to those from rural areas. The majority of FSW respondents state that they refuse to use drug because they are aware of the consequences of drug-use while working. In the group discussions, FSWs claim that: ? This type of job requires sex workers to appear neat and clean. “ Clients are disgusted by pale, skinny women, you know. You can not have clients with a horrible appearance. ” ? Costs of drugs are exorbitant. We can’t afford drugs with the money we earn. You will spend all the money you have on drugs, then how will you live? We don’t see anything good in it! ” (hotel FSWs) ? Drug use has negative effects on appearance and attractiveness is important to FSW livelihood “ Drug kills your youth. I’ve witnessed some addicts who look more like ghosts than women. I don’t want to be one of them. ” (hotel FSW) ? Using drug means losing your job ??? “ If I hear anyone using ecstasy, that girl will be gone immediately. ” (A karaoke owner) 3. 3. 3 Health care and access to health services

The scope of the research does not allow the study to obtain an estimate of incidence of STIs among FSWs. However, five among the FSW respondents report contracting STIs previously and knowing many friends who are also infected with STIs. The study shows that newer sex workers are more vulnerable to STIs and most of them seek treatment at private health establishments. Some continue receiving clients during the course of treatment while others wait until the pain is gone before resuming sex work. Coverage with medical insurance is extremely low except for FSWs with work contracts.

In this case, these FSWs are requested to have a health check up every three to six months. The remainders medicate themselves and only seek medical assistance when infections persist. Some have taken blood tests and believe if the results are negative, they do not need to regular check-ups. In cases where respondents have access to medical care, they prefer going to ward health stations or district health centers close to their home or work place. One barrier to access to well-known hospitals is the distance from their work place to the health facility, waiting time and high costs of treatment.

The respondents also do not like the negative attitudes of health care providers at these hospitals. During interviews, only one or two mentioned going to the clinics organized by projects or programs specifically designed to serve marginalized groups. Most of the respondents did not hear or know about those serv