Patriarchy, Poverty, Prostitution And Hiv/Aids: The Philippine Experience

Patriarchy, Poverty, Prostitution And Hiv/Aids: The Philippine Experience
by Aida F. Santos
CATW-Asia Pacific October 1997

The assumptions of the biomedical model as embodied in the paradigms of gay plague and chronic disease have shaped scientific knowledge about AIDS as well as the medical and public health responses to this epidemic. The biomedical orientation has led to an almost exclusive focus on HIV and the mechanisms – as opposed to the social determinants – of its transmission. As a methodology, biomedical individualism has resulted in data being collected chiefly on individuals with or at risk of AIDS, and rarely on the social context of their lives. Working under the rubric of “objectivity” as defined by the biomedical model, scientists have failed to see how social biases affect the type of research questions they ask. Physicians and other health care workers have failed to see how similar assumptions, if not addressed, threaten to vitiate our still-inadequate response to the epidemic.

Elizabeth Fee and Nancy Krieger
“Understanding AIDS: Historical Interpretations and the Limits of Biomedical Individualism”

The best-intentioned prevention campaigns are bound to fail if they assume that education combined with free condoms and clean “works” are all that is needed to prevent the spread of HIV. Since there is more to risk than microbes, there may be more to preventing people from contracting HIV than telling them to “just say no” to exchanging bodily fluids or sharing needles.

Nancy Goldstein and Jennifer L. Manlowe
“The Gender Politics of HIV/AIDS in Women”

__________________
Read at the 4th International Congress on AIDS in Asia and the Pacific, 25-29 October 1997, Manila, Philippines.

Part 1

Introduction

The first reported case of HIV infection was a male overseas contract worker. That signaled the entry of AIDS in the Philippines, and the responses that followed are culturally expected: the religious prayed and decided to call it a heaven-sent plague to punish the sinners, i.e., the homosexuals and prostituted women and girls in prostitution; the policy makers and persons in authority began to file bills calling for the adoption of official “redlight” districts to monitor women in prostitution; some officials raided and closed down bars, “entertainment” establishments and arrested the women; foreigners and tourists were blamed and tighter immigration policies were instituted; the academe began to think up of research projects, the “horror” advertisements and public notices were raised. AIDS funds started to trickle into the country, and not long after, AIDS-focused organizations began to be entrenched in the NGO movement, with a few holding money bags that were simply dreams of the past for many generalist or issue-based development non-governmental organizations (NGOs).

A number of NGOs whose roots trace back to the dynamic women’s movement which in turn is historically linked with Left politics in the country entered the scene of AIDS intervention in the context of a vision of women’s empowerment and strategic social transformation. In fact, to date, these women’s groups which that have AIDS programs or projects work on HIV/AIDS programming in tandem with or more precisely under concerns such as women/gender and development, women’s health, reproductive health and rights and gender equality and other structural issues.

Limitations

This presentation is limited in its coverage in terms of the original expectation of being “The Philippine experience.” It does not claim to be one, as to do that requires an examination and evaluation of many programs on the ground. Due to time constraint built in the preparation of the present paper, I lay no claim to represent the total experience of groups working with women and HIV. What I will present will be WEDPRO’s experience which is imbued with a working knowledge of other experiences of some groups within my organization’s networks. It must also be stated that AIDS programs in the country are very much in its early years and while the Philippines continues to exhibit low rate of infection, the possibility of a real pandemic hangs over the heads of many Filipinos particularly when the alarming increase in the rate of trafficking of women and children for sexual exploitation including prostitution, and overseas labor migration have been identified as high risk situations for those caught, trapped or engaged in these activities.

Government and non-government organizations (NGOs) working on the issue of AIDS have yet to come together in a more systematic fashion to critically evaluate and plan together in order to push our work into a higher ground, imbued with lessons from which we can bring greater light into a more comprehensive understanding of HIV and related structural concerns.

Brief Historical Background

In Olongapo City, Buklod was established in 1986 initially as a program meant to organize women in the bars of the city and develop activities which assist them in transforming their lives as they journey out of prostitution and into less exploitative alternatives. In mid-1990, BUKAL, another women’s program that deals with the streetwalkers of Quezon City was formed to continue an earlier program started by the staff of BUKAL. In Davao, Talikala has been breaking grounds in terms of its work with women and girls in prostitution. Other groups that work with women and children in prostitution include HAIN, ISSA, Remedios AIDS Foundation, Samaritana, Third World Movement Against Exploitation of Women, Kabalikat, ReachOut in Metro Manila, Foundation for Huwomanity in Baguio City, to name a few. The approaches of the organizations vary according to various factors that define such approaches including level of funding, organizational capability and more importantly, the framework of analysis which frame the interventions. Needless to say, the range of political analysis and understanding of gender issues as they are implicated in the discourse on sex and sexuality, morality and biology define the commonalities as well as the differences among the organizations. The nexus that connects a number of these organizations is the membership to the HIV/AIDS Network a coalition of groups with AIDS program.

As a general observation, it is perhaps apt to state that the AIDS programming in the country was initially a donor-driven concern. While such history allowed immediate response to the pandemic, and perhaps to some degree allowed the public to pick up some ideas about HIV/AIDS, albeit with strong biases deeply lodged in the cultural psyche of the people, it has also created some forms of a wedge in the NGO movement in the country, where the more focused AIDS organizations are perceived to gather a significant share of overseas development funds and in some instances a greater share of government support over other more generalist or women-focused or development-oriented NGOs. In a country where HIV and AIDS are seen by the majority of the people as simply another risk, another health and poverty related baggage that characterize their marginal and burdensome lives, the politics of AIDS funding, which in the beginning years and to a great degree continues to date, heavily targeted gays or homosexuals and women and children in prostitution and similar sexually exploitative situations, has been a subject that crops up from time to time in the NGO movement. Ethical concerns in AIDS intervention programs including questions of turfing or territoriality which deter or constraint working together for a common cause have been raised within some sections of the NGO movement, albeit in hushed tones. The kinds of programs and services that are meant to address the pandemic need a re-examination towards perhaps the development or enhancement of a more strategic and empowering paradigm that addresses AIDS both as a biomedical concern as well as a development issue and cement cooperation and solidarity rather than divisiveness.

A number of NGOs and particularly women’s groups, that ventured into AIDS intervention, including WEDPRO undertake the following activities wholly, singly or in combination:

research on women’s sexuality and sexual practices, gender relations, reproductive health and rights including reproductive tract infections, sexually transmitted infections; perceptions and knowledge on HIV/AIDS and women’s health seeking behaviors, and risk factors for women which were all made the basis for the establishment of an AIDS prevention program; this would include documentation of women’s lives in prostitution and trafficking situations;

organizing of and/or support for women and girls in the so-called entertainment establishments and in those in the streets who call themselves “jocards” (a Manila idiom);

provision and/or promotion of primary health services including community based health programs and training of community health workers;

gender sensitization and other forms of awareness raising activities to promote equality between women and men;

education and training in safer sex techniques including condom use, assertiveness training and similar empowering techniques to mitigate the circumstances of sexual exploitation inherent in prostitution and trafficking;

formation and training of peer educators specifically for AIDS education;

development and production of IEC materials for the use of the women and their communities, for policy makers and the general public;

crisis interventions including medical, legal and psychological assistance such as counseling and sheltering;

advocacy for women’s rights including local and national policy reforms in the area of violence against women (a local anti-rape bill was recently passed which redefined rape to include non-penetrative sex and some aspects of marital rape);

lobby work to protect women’s human rights especially in the area of abuse and violence as perpetrated by clients, establishment owners, police authorities, traffickers and other sectors involved in prostituting and trafficking in women, and in upholding and/or upgrading the existing labor standards for the “hospitality” sector as enshrined in the labor code under which women’s labor rights are supposedly covered;

campaigns for the raising of women’s status in Philippine society and the recognition of women’s human rights as embodied in international conventions and agreements, including support for the mainstreaming of gender concerns in official development policies and government agencies; and,

provision of new skills and micro finance support for women in prostitution and other sexually exploitative situations and for those who are at risk of being prostituted or trafficked especially in urban poor communities which are being developed as tourist enclaves and in areas of severe poverty and lack of employment opportunities particularly for women and children.

Undeniably, the more conservative NGOs including civic organizations see prostitution as a moral issue, blaming the women for immorality, the spread of AIDS and a host of other social problems including the high rate of abortion in the country. On the other hand the more progressive NGOs especially women’s groups see prostitution as a structural issue related to patriarchy and poverty.

WEDPRO’s experience

In WEDPRO, an important consideration in the decision to include HIV/AIDS in all the programs is based on the organization’s mandate to address issues that are related to women’s human rights and class / race and gender inequalities and how such impact on their status as women in the context of development and transformational politics. [1]

WEDPRO began to document the lives of women and girls in prostitution in 1990 through a survey of 300 women in Angeles City and Olongapo City, former sites of the two largest US military base facilities in the country. The survey served as baseline data for an indicative planning for the Comprehensive Bases Conversion Program which was then being undertaken by the Aquino administration in preparation for the withdrawal of the US military facilities and personnel. What immediately followed after that was the launching of WEDPRO’s Integrated Socio-Economic Program which went into direct organizing and social and economic assistance to the women who were displaced without alternative livelihood when the bases finally pulled out in 1991. A women’s empowering paradigm was then conceived to define the goal of the comprehensive intervention and which to date still frames the organization’s ongoing work in Metro Manila and Angeles City.

Using a women-centered, gender-sensitive frame and with empowerment as a strategic vision, it was clear from the start that the project has to address HIV / AIDS from a larger frame than the prevalent perspectives on immunology and virology, and that a whole range of gender and reproductive health issues which would frame the discussion on HIV/AIDS would have to be developed with the project participants decidedly and directly engaged in all the phases of program implementation.

One project involved the areas of Pampanga, Laoag and Baguio in Luzon; Bohol and Aklan in the Visayas; and Iligan City and Davao in Mindanao. The choice of sites was guided by the following criteria: (a) presence of NGOs working with women and gender concerns; (b) presence of partner organizations, e.g., Pampanga, Iligan, Davao; (c) poverty situation, e.g., Bohol; and, (d) actual or potential high risk communities due to presence of prostitution and promotion of tourism, e.g., Pampanga, Laoag, Baguio, Aklan, Davao. The second project focused on Pampanga, specifically Angeles, because of the fact that WEDPRO has existing programs in the area and has been involved in organizing women in prostitution and the perceived high risk communities.

This involved the selection of partner organizations which would serve as the area coordinators, the selection of training participants, conduct of a training needs assessment, production of IEC materials, conduct of a 3-day intensive education and training; monitoring and evaluation. The IEC materials (comics, posters and a 20-minute video production) contained the core messages as they were gathered from the participants and underwent pre-testing with a selected number of the participants.

Another project was a research involving 200 survey respondents. In summary, the results of the survey (1995) are the following:

while the women in prostitution agree that it is their responsibility to insist on condom use, their ability to do so is hampered by their lack of control over the sexual act which is a negotiated situation under a culture of male domination;

gender division of power in all aspects of human lives is further underscored by women’s poverty and marginalization;

economic empowerment of women is an essential element that needs to be addressed in a more sustained manner in any AIDS program that allow women to seek on their own terms pathways to leave prostitution;

STD/STI prevention and treatment is a dominant concern of the women if AIDS is to be addressed in a continuum of health-focused interventions;

alcohol and drug use is prevalent among the women, constraining some biomedical and psychosocial interventions; and,

traditional cultures, social mores and institutional barriers including the institutional church’s moralistic stand continue to impact on women’s consciousness such that the gap between knowledge about HIV and women’s actual life circumstances including sexual practices.

Some of the responses of the women to STIs and AIDS generated during the survey are the following: [2]

“People with AIDS should be segregated” (89%)
“The possibility of a Filipino customer with AIDS is lower than that of a foreign customer” (74%)
“Because of my work, there is real danger that I will have AIDS” (74%)

“I’m worried about AIDS but the possibility of my contracting the disease is low” (72%)

“AIDS is a punishment from God” (62%)

“For someone like me, having AIDS is a matter of luck” (62%)

“It is impossible for me to have AIDS” (40%)

“We should not worry about AIDS because all of us will die anyway” (36%)

What emerged from the FGDs (1996), on the other hand, merely reiterated some of the key findings in the earlier research and can be summed up in the following way: (a) the issue of HIV/AIDS is implicated within a discussion of gender relations and reproductive health and rights; (b) violence against women or gender-based violence and abortion are key issues that the women wanted to address; (c) sexuality issues are fundamental to an understanding of HIV/AIDS and preventive education programs; (d) the lack or absence of medical and health infrastructure and programs that are accessible to women impact on women’s health seeking behaviors; and, (e) HIV/AIDS are not considered as important issue as poverty and gender relations in the sense that women thought that their situation as women and other health issues more pressing concerns. The survey and FGDs showed that myths about health risks, including HIV/AIDS transmission were common and that the concept of reproductive tract infections as a gender issue was a relatively unknown area even to medical and health professionals.

On the other hand, from the training needs assessment done in Angeles City involving six (6) communities, the following problems emerged as important issues for the project participants:

Common colds/cough/headaches and backache due to fatigue and lack of sleep

Sexually transmitted diseases and infections; nearly all the 60 project participants had experienced vaginal itch, and smelly vaginal discharge; genital warts was especially mentioned

Stomach and headache which the women attributed to excessive smoking, drugs / substance abuse, marijuana and excessive alcohol intake; for the women involved in the so-called “entertainment” industry, these problems were related to the work style that they lived

Insomnia due to alcoholism

Abortion; the women said that they had to do this to avert the possibility of the fetus being infected by their sexually transmitted infections

“Binat” or relapse because of their inability to have proper rest after pregnancy, i.e., they were forced to work immediately after giving birth

Dysmenorrhea and other menstruation related concerns such as “pagkahilo” or nausea and “paglaki ng suso” or swelling of the breasts

Interestingly, despite the fact that Angeles City is one of the high risk communities and one of the key centers of prostitution and drugs, HIV / AIDS never came up as a priority health need for the project participants. “Gut” economic issues and reproductive health problems were listed down as the women’s priority concerns.

The following were some of the myths that the women were holding onto in terms of reproductive health knowledge:

To treat genital warts and lice, they used fresh meat which was put on the vagina

Taking of antibiotics for 2 months to treat women’s infertility

Women get sick if they do not have sexual relations (in the context of marriage)

STIs are contracted in swimming pools or if they have sexual relations other than their husbands

When women get high on drugs, they would not be able to detect if they are being infected with diseases

Women’s health seeking behaviors were also documented. Asked on how they availed treatment, the following responses were generated:

Taking antibiotic, and one capsule would be sufficient; or of Alaxan (a muscle relaxant) and Medicol (a common colds tablet)

Drinking of herbal tea and taking steambath

Drinking Red Bull (advertised as an instant energy boost drink)

Putting on a lemon peel on the temple to relieve headache

Taking Midol (ibufropen), beer, sioktong (“black beer”), sambong leaves (known for its medicinal value) and having massage to relieve dysmenorrhea

Vaginal douche using water with vinegar, suppository and vaginal cream to relieve vaginal pain

When asked about their knowledge on HIV/AIDS, the following responses were generated:

HIV/AIDS is transmitted through the blood

HIV/AIDS is transmitted due to many kinds of infections including “unclean blood” and drug use

HIV/AIDS cannot be transmitted through the saliva

HIV/AIDS is transmitted during anal sex, that is why many male homosexuals are now infected

HIV/AIDS can be transmitted during pedicure and manicure through the use of the nipper

HIV/AIDS is transmitted through sex with dogs

HIV/AIDS came about when Africans had sexual intercourse with infected apes

“GIs”, i.e., American base personnel, were/are safe from HIV/AIDS because they had/have regular medical exams

Women’s empowerment as a paradigm

The findings and lessons so far gained by WEDPRO and the program participants can be summed up in the following manner:

Women thought initially that susceptibility to or contracting HIV/AIDS is something that is beyond their control; the fatalistic culture where the communities found themselves in and helped to entrench as well denied to a large degree women’s ability to construe a life where they can exercise some forms of control over their bodies and their sexuality. In key informants’ interviews conducted, women spoke about their sexuality and sex life much more openly; one woman from Aklan in the Visayas whose husband was an overseas contract worker shared her constant anxiety about being infected with sexually transmitted diseases every time her husband comes home for a visit. In FGDs, others spoke about their violent husbands and the threats they received when they refused to have sex.

The dichotomy between “bad” and “good” women came out strongly in the sessions; it was interesting to note the dynamics between women in the “entertainment” industry and women who were not. Yet when discussions around sexually transmitted diseases came about, it was clear that nearly all the participants in both projects have had occasional bouts with STDs/STIs. In many occasions, the women shared their personal pains when upon refusing sex with their husbands or partners the men threatened to seek out or actually bought paid sex. Towards the end of each training, the dichotomy began to be lesser, empathy for each other was noted (Angeles City), or the “other” woman became a lesser evil (Luzon, Visayas and Mindanao training) in the eyes of wives. This does not mean, however, that the concept of “good” vs. “bad” women has disappeared altogether; the sustaining socio-cultural and economic environment outside the training sessions need to be developed for a long-term internalization of such common experiences of women.

Marriage and monogamy were considered initially by the women as antidotes to contracting HIV/AIDS. When faced with scientific explanations about how HIV / AIDS can actually be contracted, and how sexually transmitted infections and other reproductive tract infections can actually increase the risk of HIV transmission, the women were surprised at the very least; others were observed to have become reflective and afraid or anxious.

Women’s vulnerability to HIV/AIDS and disease in general is directly related to gender relations but more than teaching women to say “no” it was important for them to crystallize their own experiences and grasp deeper why saying “no” maybe difficult or even impossible in certain circumstances. The unequal gender division of labor within the domestic sphere, for example, was constantly mentioned by the women, such as lack of appropriate rest and relaxation hours related to the traditional reproductive roles that women played.

Technical or biomedical discussion on HIV/AIDS made more sense to the women when they are directly related to their life’s experiences especially in the area of sexuality and gender relations; it became important therefore to speak in the language of women’s experiences. For women in prostitution, the discussion underscored their vulnerability to their clients and partners especially when negotiated sex is more often than not a difficult task and in certain instances actually impossible to achieve.

The issue of HV/AIDS among women in urban poor communities, from which the greater number of women and girls in prostitution come from emerges directly from their experiences of extreme poverty and marginalization, and unequal gender relations.

For women in prostitution, the issue of HIV / AIDS takes second priority to their overwhelming desire to leave the industry which has trapped them due to their subordinated status which in many instances included background of childhood neglect and/ or sexual abuse, poverty and lack of other income opportunities.

Problems which surfaced and which needed to be addressed by the program included reproductive health and rights, basic health knowledge including a more scientific and systematic understanding of herbal medicine, gender relations and tools for empowerment, such as community organizing. Of the women selected for the project, the women who were then involved with prostitution were the ones who had a relatively better knowledge of HIV/AIDS while the women from the communities tended to have lesser understanding of the diseases. Some forms of HIV/AIDS education, the training team concluded, had reached some sectors of women in the City, but it was clear that the knowledge was more technical rather than comprehensive and that the sector that relatively benefited from those information were the women in the “entertainment” industry. It was obvious from their responses that gender relations and racial biases had to be addressed by the training team of the project. The women’s contexts have to be a central concern of the HIV/AIDS program.

Part 2

Women’s Human Rights, Prostitution and AIDS

According to conservative estimates, there are around 300,000-400,000 women in prostitution and 75,000-100,000 streetchildren.

The continuum of the phenomenon of streetchildren and adult prostitution had been shown in other studies. “Childhood sexual abuse is often at the root of adolescent `misbehavior’ and has been associated with later participation in illicit drug use and sex work (sic).” [Cucinelli and De Groot in Goldstein and Manlowe, 1996: 224]

Any discussion of HIV/AIDS framed in the context of prostitution must be premised on the conceptual framework of human rights and not simply or dominantly as a public health concern. Not strangely, for many HIV/AIDS programs, the centrality of HIV/AIDS as a public health issue and prostitution as well has effectively diminished or blunted a more comprehensive understanding of the problems. Oftentimes, female sexual behaviors are scrutinized, and male sexual behaviors and the violence that often accompanies such are held invisible or considered marginal in HIV/AIDS preventive programs. I have had the personal experience of how even well meaning health organizations deal with prostitution and HIV/AIDS.

Prostitution and HIV/AIDS are political issues of global dimension and implications that urgently need a bigger frame of analysis other than being a public health issue. HIV/AIDS implicate considerations that go beyond the official core messages of A=abstinence, B=be faithful and C=condom, or monitoring and surveillance. Prostitution on the other hand is an issue that goes beyond poverty and HIV/AIDS prevention. Prostitution is not centrally about women and girls and their involvement with the industry or their risky sexual behaviors, because in fact prostitution is about male need for sexual services anytime, anywhere, with whoever is available. Prostitution is about profit. A convergent frame for both concerns is patriarchy.

Women’s groups’ choice to use a community-based and participatory approach combined with elements of an immunologic perspective with a women-centered, gender-based framework of analysis is something that has come about as a result of its experience with the women. Other women’s groups working with women and girls in prostitution and other sectors of women are also using the same approach. To a large degree, this perspective is shared by a growing number of women’s groups and coalitions such as the Philippine Network Against Trafficking in Women, SIBOL, the legislative advocacy network which is responsible for the drafting of the original anti-rape bill and the five-year lobby work before its enactment into law, the Coalition Against Trafficking in Women and other women’s groups and NGOs which have been consulted by the said coalitions all over the country. It is perhaps not imprecise to state that such a perspective therefore is a shared view and set of principles that dominate on the whole a significant if not the largest section of the Philippine women’s movement.

The immunology approach states that, “AIDS is a syndrome, not a disease; the goal is to prevent people from contracting HIV in the first place or to help HIV-infected people maintain health. Virology, on the other hand, takes a microscopic view of AIDS in which `HIV disease’ begins the moment a person is infected with HIV… the search for HIV’s origins and the search for a cure both take place in the human body… and the goal is to stop the virus from replicating there.” [Goldstein and Manlowe, 1996: 3] The immunology methods of intervention include, “designing programs to educate people behaviorally, attending to the lives of people living with HIV, and trying to strengthen their immune systems; for the virology inclined, they include contact tracing, mass testing, and searching for a cure in the form of a vaccine.” [Ibid.]

The observation in the North and particularly the US for example that the focus on poor people and people of color as the source of disease in our society [Goldstein and Manlowe 1996] holds true for the Philippines. Moreover, the prevailing moralistic climate has xeroed in on not just the poor, but the most marginal of the poor and people not considered “normal” by society. The “gay male scourge” and the “immoral women” especially dominated the discourse and work during the initial years of AIDS programming in the country. It was only when statistics started to reveal the dominance of heterosexual transmission that the anti-gay sentiment began to diminish among certain sections of Philippine society, but not necessarily in the minds of the general public. From 1984-July 1997, heterosexual contact accounts for 487, as opposed to the heterosexual contact at 149 and bisexual contact at 48. [Department of Health AIDS Registry] Public service announcements coupled with a growing research / information base both from government and non-government organizations are helping to take away the heat from the gay community. Unfortunately, the so-called “bad” women theory continues, such that the more public PWAs who have courageously come out and chosen to do high profile advocacy are women whose background of infection is traced to their past connection in the “entertainment” or “hospitality” (read prostitution) industry. The case of Sarah Jane, the most infamous of them, has been a tabloid sensation, exploited to the hilt, her private life pre and post infection chronicled dutifully by media. It does not help any that the general public and to a degree even public officials have lapped it all up, engaging themselves in both direct and subtle fashion, in criticizing her most recent romantic involvement with a young man. One can agree that the role she agreed to play in national and even international advocacy has parameters and that role modeling is one of them, but to subject her to constant moral inquiries, and sometimes outright ridicule, led by the media is an injustice uncalled for in an already tragic circumstance of past history. The Sarah Janes of this country are perhaps many, but it is interesting to note that their male counterparts and their sexual lives are not as salaciously portrayed, or examined, by media and other institutions and authorities. In doing so, premeditated or not, the male face of AIDS has been made invisible, and female immorality has been made a hot copy in advocacy.

The biomedical construction of HIV among women [2] is a prevalent approach in many programs, notable in the level of funding given to monitoring and surveillance especially among women and girls in prostitution. The social hygiene clinics (SHCs) which conduct regular smear test among these population have now incorporated HIV test among its services. This is commendable as it allows a government agency to assist in AIDS prevention; however, on the other hand, to a degree this also deepens the stigma against the women as public perception regarding “bad” women as transmitters of the dreaded disease is further reinforced.

While the structural nature of HIV is beginning to have slow appreciation from some quarters, even WEDPRO has to come to terms with lessons it has gained in its HIV program. Admittedly the biomedical approach has tended to overwhelm most preventive education, training and advocacy, including ours, perhaps clouding over the gender-based approach that saw women’s vulnerability as structural concern at its core.

Women’s sexuality in prostitution and HIV

Too often and especially when the AIDS problem began to scare the world, that the re-examination of women’s sexuality in prostitution and similar sexually exploitative circumstances has been relegated to inquiry about their sexual health and intervention programs and services for safer sex. There is an obvious need to reiterate that female sexuality is a socio-cultural construct that has been shaped to become subservient to male sexual needs anchored within the context of patriarchal institutions. While there is wisdom in promoting immediate intervention programs which directly and immediately address HIV transmission and making people in general aware of the scientific explanations of AIDS, the more comprehensive approach needs to be heavily biased towards the promotion of women’s status in any given society. Sexual violence which characterize many women’s lives – in and out of prostitution – need to be taken into serious consideration in AIDS education and service provision. Promotion of condoms merely alleviate the situation of women in prostitution but does not create pathways of empowerment for women to control their own bodies and re-shape their own sexuality and take control of their lives.

Safe sex in sexual exploitation?

A study on HIV stated: “… the greatest risk for HIV infection is to belong to a group of individuals who are underprivileged, discriminated against, or marginalized in any culture even before HIV is introduced. Thus distribution of condoms to sex workers [sic], provision of clean needles to drug addicts, and dissemination of HIV education programs will not have any effect on HIV infection rates if members of these marginalized groups are not empowered to use the HIV protection resources that are provided to them.” [Cuccinelli and De Groot in Goldstein and Manlowe, 1996: 225] The call for safer sex practices as a strategy to prevent HIV transmission thus can only be fully effective when the subordination of women and its structural roots are addressed.

Moving on to women’s empowerment

Our experience working with women and girls in prostitution has given us valuable lessons in terms of the above mentioned concerns. Training in the proper use of condom, assertion exercises, negotiation techniques with clients are good coping skills for the women as intermediate set of responses to AIDS prevention and other problems related to reproductive tract infections, but they do not change the essential gender-based power relations that make women and girls vulnerable to sexual abuse or violence, elements that are stark in the lives of women in prostitution.

The construction of Filipino women’s sexuality needs to be understood in the context of our colonial history, religious ideology, patriarchal institutions, and now the frightening march to globalization where women’s labor and sexuality are placed on the international market as one of the commodities for sale and profit. The growing dominance of Filipino women in overseas migration as domestic helpers and “entertainers” is a proof of this global exploitation which unfortunately has brought about and continues to breed constructs of female sexuality on the one hand and male sexuality on the other hand that are inimical to the promotion of women’s empowerment, social justice and economic equity.

The twain meets

In many ways, HIV/AIDS and prostitution share common perspectives as human rights issues.

A review of the basic human rights guaranteed by human rights instruments outline the following rights:

Right to life and security of persons

Right to human dignity

Right to expression/speech

Right to highest attainable level of health

Right to work

Freedom of movement/travel

Freedom of organization

Freedom from discrimination

Freedom from all kinds of violence

Implicated in those rights are rallying calls both by AIDS activists and advocates for and women in or survivors of prostitution. However, the exercise of those rights to their fullest possible degree and access to services and programs related to the fulfillment of those rights are affected by gender, class and ethnic positions of both HIV/AIDS victims/patients and women and girls in prostitution.

AIDS transmission when it happened in situations of domination and subservience in sexual relationships in a way is a form of violence, as it exists in the lives of women and girls in prostitution. The Vienna Declaration against VAW states that, violence against women is “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or other arbitrary deprivations of liberty, whether occurring in public or private life.” It has to be noted at this point that all the studies of WEDPRO point to the continuum between childhood sexual abuse of female and prostitution in later years, and that the impact of such abuse in early years of a child has a bearing on her future decisions which by then would be marred by the trauma and other psychological scars.

In the merging discourse on prostitution and human rights as articulated in research and other documents, human rights violations related to practices of prostitution and trafficking for prostitution include the following:

rape

sexual harassment

beatings

torture (physical and psychological)

denial of freedom of movement / papers/food

detention

debt bondage

bonded labor

deceit /manipulation

abduction/kidnapping

verbal abuse

drug abuse

sodomy and other cruel and inhuman practices

This perspective also implicates the following concerns which are the political assumptions inherent in a women-centered, gender-sensitive discourse:

prostitution perpetuates patriarchy;

it reinforces female subordination and male domination;

it denies women’s right to self-defined/autonomous sexuality;

it perpetuates the notion that women are a commodity that can be sold and bought freely; and,

it reinforces the notion that women and girls are sex objects.

Therefore prostitution strengthens and deepens gender and class, and in many cases racial inequalities. It must also be said that:

prostitution is not about female’s exercise over her sexuality, it is about male sexuality and male power;

it is about capitalism and the making of profits on women’s and girls’ sexuality and their poverty situation;

it is about the socio-economic and cultural marginalization of women; and,

it is about state’s neglect of women’s poverty and marginalized situation

Language as Perspective

In the ongoing debates on perspectives in prostitution, the “prostitution as work / choice” camp claim that prostitution is work and must be recognized as such, thus the coining of the terms “sex work” and “commercial sex worker” – which has been mainstreamed in AIDS programs and the gay groups. The right to work as claimed by followers of this perspective however negates the right to life and security of persons, right to human dignity and right to achieve the highest attainable level of health, and freedom from all kinds of violence. Without questioning the ideological basis of the use of these terms, we are not empowering HIV-infected persons and particularly women.

Language on the discourse on prostitution and AIDS prevention presupposes the neutrality of prostitution, and normalizing it as “work” effectively makes invisible the political dimension of the phenomenon.

Trends in human rights struggle

There are two trends affecting women [De Dios 1997] in the human rights struggle which impact on AIDS and prostitution as violence against women. On the positive side we see the following development:

International consensus on standards of equality, justice, human rights, women’s human rights

Commitment of governments in promoting equality

National and international mechanisms to ensure equality

Involvement of civil society

Women’s movements

On the negative side, we see the following trends:

Gap between de jure and de facto equality

Continuing violence against women (e.g., prostitution and trafficking)

Backlash – strengthening of conservative forces, religious fundamentalism and the use of culture and tradition to continue the oppression of women

Conclusion

Seeing and learning slowly from these, the HIV/AIDS program that WEDPRO and other women’s groups have established adopt the following initial critical assumptions:

one, that preventive AIDS interventions including education can only anchor on a comprehensive understanding of women’s situation in the country in the context of the prevailing structural inequalities including class and gender differentials;

two, that while women and girls / children in prostitution are one of the sectors more susceptible to HIV transmission, male needs and sexual behaviors have to be examined vis-à-vis women’s vulnerability;

three, that while poverty is an overarching factor in the transmission, patriarchal structures and practices fundamentally contribute to women’s vulnerability; those who have been infected and reported particularly those whose life stories have come out in public for advocacy purposes show that the HIV infection had been in the context of unsafe sex where the women’s subordinated and marginal status in the intimate relationship is one of the root causes of unprotected sexual encounters;

four, that prostitution per se needs to be addressed strategically especially outside of AIDS programming due to the fact that xeroing on those in prostitution and other sexually exploitative circumstances tend to further stigmatized an already highly stigmatized sector among women / girls;

five, that on the whole, the level and quality of health infrastructure in the country, despite the principle of integration stated in official health policies, are inappropriate and gender-insensitive, with many health workers and professionals inadequately trained to assist women in prostitution and those in other sexually vulnerable circumstances; and,

six, that preventive AIDS education cannot be isolated from economic empowerment of women and other marginalized sectors of a society.

*****

ENDNOTES

1 The program has been supported by Asian Partnership for Human Development (APHD), The Ford Foundation and the Philippine HIV/AIDS NGO Support Network (PhanSup).

2 Current understanding of HIV among women is discussed by Bill Rodriguez, among others, in the article Biomedical Models of HIV and Women, cites the following: “Several key elements can be discerned from the biomedical construction of HIV among women. First, the history of infectious diseases tells us that epidemic disease arise along complex paths that are intimately connected to structures of human society such as trade patterns, urbanization, migration, and in particular class and gender inequalities and the perpetuation of poverty. The biomedical concept of infectious disease has changed over time, however, as the role of health and disease has come to take on new meanings…. Second, epidemiologic construction of the disease has continued to characterize women in the context of male risk behaviors, and perpetuated traditional constructions that characterize women as victimizers rather than victims. The initial descriptions of HIV ignored the impact of the disease on women, and initial constructions that included women perpetuated earlier constructions of women as immoral sexual `vectors’ of disease. Moreover, within epidemiology there has been an increasingly reductionist approach to understanding the nature of epidemics, with an attendant disregard for large-scale or even local, social, economic, and gender issues…. The emergence of retrovirology allowed emphasis to be placed on understanding the molecular biology of the virus, rather than the social welfare of its victims. Women in this construction became equated with their vaginal epithelium and their CD4 cells, and the ability of the virus to infect them was felt to be an immutable facet of their biology and gender, and of the virus’ genetic make-up.” [Rodriguez in Goldstein and Manlowe: 36-37]

REFERENCES

Commission on Population Policy Core Group. A Gender -Responsive Population Policy Framework with Reproductive Health Perspective (Draft Report). Muntinlupa, Metro Manila, 1996.

Cuccinelli, Debi and Anne S. De Groot. Put Her in a Cage: Childhood and Sexual Abuse, Incarceration and HIV Infection, in Goldstein, Nancy and Jennifer L. Manlowe (eds). The Gender Politics of HIV / AIDS in Women Perspectives on the Pandemic in the United States. New York, New York University Press, 1997.

HAIN and AHRTAG. AIDS Action (Asia Pacific Edition), several issues.

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Lin Lean Lim and Nana Oishi. International Labour Migration of Asian Women: Distinctive Characteristics and Policy Concerns. International Labour Office, Geneva, 1996. Originally published by the Asian and Pacific Migration Journal, vol. 3 no. 1, 1996.

Miralao, Virginia A., Celia O. Carlos and Aida Fulleros Santos. Women Entertainers in Angeles and Olongapo A Survey Report. Women’s Education, Development, Productivity & Research Organization (WEDPRO) and Katipunan ng Kababaihan para sa Kalayaan (KALAYAAN), Quezon City, 1990.

Murrain, Michelle. Caught in the Crossfire: Women and the Search for the Magic Bullet, in Manlowe and Goldstein (eds.).

Plant, Martin A. (ed.) AIDS, Drugs and Prostitution. London and New York, Routledge, 1993.

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WEDPRO. From Manila, Angeles and Olongapo to Cebu and Davao: The Continuing Lives of Women in the `Entertainment’ Industry. Quezon City, Manila, 1995.

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