Myanmar’s ‘Big Sister’ Leads in HIV Fight
Image Credit: REUTERS/Damir Sagolj

Myanmar’s ‘Big Sister’ Leads in HIV Fight


Myanmar may have grabbed the world’s eye by opening its borders and ushering in a foreign investment surge, but one story has slipped quietly under the radar. The country has also significantly reduced the rate of HIV infections in its sex worker population from its previous high of 40 percent in females 2005, according to Population Services International (PSI) down to less than 10 percent today.

“Myanmar allowed sex worker-run programs to organize and scale up over the last eight years using an empowerment-based model, rather than a coercive testing model like the 100 percent condom programs in Thailand and Cambodia. The success of the program in reducing HIV rates so dramatically shows investing in sex worker-run programming works,” Andrew Hunter, program and policy manager of the Asia Pacific Network of Sex Workers (APNSW), told The Diplomat.

Myanmar’s HIV epidemic paralleled Cambodia’s, which peaked at over 42 percent for brothel-based workers and 18 percent for entertainment workers a decade ago, according to the National Center for HIV/AIDS, Dermatology, STD (NCHADS), but its peer-led outreach did so with far less media attention and international NGO fanfare.

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Not Smothered by INGOs

Melissa Hope Ditmore, one of the foremost researchers on worker-led initiatives in the sex industry, documented a case study of Targeted Outreach Program (TOP), the largest HIV prevention program in Myanmar initiated by PSI. The project has been unique for reaching up to 55 percent of female sex workers and 70 percent of MSM out of the country’s estimated 60,000 sex workers. From NYC, Ditmore told The Diplomat “TOP was very successful working against HIV and STIs. We know that community-lead initiatives are the most effective.”

Kay Thi Win started working in 2004 with TOP in peer education after being approached by them while employed as a sex worker. It was a job she came to from economic hardship after her father died in 1998, while she was studying at high school. Win’s mother could not support the family and they lost their home. In 2000, a friend introduced her to sex work as a way to support her family. Initially she told them she was working at a factory near the Thai border, but now they know about her work and support her. According to Raks Thai, an NGO that helps migrant workers, reports that migrants from Myanmar comprise the largest groups of all migrants in Thailand due to limited work options, but Win preferred to stay in the country.

She learned about the HIV epidemic sweeping the country from TOP and how to use condoms for protection. Win told The Diplomat from a conference on HIV in Bangkok that by 2012 the rate of HIV had declined to just 7.1 for sex workers. Though no longer working for TOP, she still refers sex workers to the project for health services.

Win now heads the AIDS Myanmar Association (AMA). AMA is Burmese for “big sister.”  Win says that AMA is the only 100 percent sex worker-led organization in the country.AMA does health education, referral health services for HIV, and STI counseling and treatment. [There is] sexual and reproductive health treatment, also for our members who are getting sick,” said Win.

Ditmore explained “Sex workers have since started a project that they direct, rather than being a subsidiary of another project. I expect that if AMA continues its work, which is lead by sex workers, that it will have great success and boost the reach of existing services to which they refer others.”

AMA’s work has also caught the eye of the Association of Women’s Rights in Development (AWID), the “only international feminist membership organization.” Win was invited to speak to AWID in the beginning of 2012 and surprised the organization by saying that sex workers do not see themselves as victims in need of rescue but are rather the empowered one in the financial transaction. She now sits on AWID’s board as the first sex worker to do so in its history.

Staying Safe in Sex Work

The feminist group awarded AMA a grant for teaching financial skills to sex workers. “We believe that sex workers earn a lot of income but do not know to how to save their money,” Win explained. “AMA advocates with bank staff and managers to provide training for sex workers [on the] banking system and information about bank savings.” Win adds, “Many of sex workers do not have a National Identity card,” which she says is needed to open a savings account.

Win thinks women working in entertainment clubs like beer gardens and karaoke clubs (KTV) make “around $100 to $200 money per month from drinking and pocket money (tips), with the salary.” Though no exact data is reported, a large number of people live on $2 or less a day in Myanmar (49 percent of Cambodians do so), so this is a large sum of money.

“The first job is to be an entertainer and they are paid about $30 a month, then they can be a sex worker. We also have ‘beer girls’ [beer sellers]. They sell beer in a bar, but they don’t have to drink beer. They are paid about $70 a month, but if they sell more beer, they get a percentage of that. A ‘bar girl’ [a term used to describe women who provide company to men visiting the bar] gets a salary of around $50 to $80 a month.” Bar girls and beer sellers are also common in Cambodia.

“We also have karaoke and night club workers. If a sex worker gets a drink at the club, she gets a percentage of the drink. If the client gets a session at karaoke, he will often drink with her and she can [get a percentage} of that as well. Massage workers don’t drink.”

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