Presenter: Liam Cochrane
Speakers: Dr Graham Neilsen, technical adviser for sexual and reproductive health in the Asia Pacific for the NGO Family Health International.

NEILSEN: Primarily in our work we are talking about female sex workers as well as men who have sex with men, including trans genders, but there are a number of other groups that we are increasingly looking at, including prisoners, migrant workers and others.

COCHRANE: And I imagine there are significant variations across Asia in the different countries. Where are we seeing particular high risk environments, for example, female sex workers?

NEILSEN: In fact most countries have very significant populations of female sex workers and MSM, men who have sex, with men. The most populous nations of course, India and China have vast populations of marginalised groups and they have responded to varying degrees.

COCHRANE: Now I understand that your presentation this week will be emphasising the risks of unwanted pregnancies among sex workers. So why are the policies that might encourage condom-use, which is trying to prevent HIV and STI infections. Why are they not working perhaps for unwanted pregnancies?

NEILSEN: One of the main reasons is that while we see quite dramatic increases in condom-use among female sex workers when they have sex with their commercial clients, that does not translate across to other sexual partners, particularly regular sexual partners and in some instances regular clients among whom condom-use is much, much lower. So female sex workers are at significant risk of unintended pregnancies when they are having unprotected sex with those partners.

COCHRANE: And those unintended pregnancies are I presume often result in abortions. How risky is that procedure for women in Asia?

NEILSEN; Well, in a number of countries, abortion is still illegal, so abortions are often performed by the women themselves. For example, in Laos they use medical abortions in other words taking pills that induce abortion and of course in many countries abortions are performed by unqualified personnel in unsafe conditions. So unsafe abortion poses a major health risk for the women.

COCHRANE: And what sort of services are you suggesting are needed to fill some of these gaps across Asia?

NEILSEN: Well, we're increasingly emphasising the need to integrate family planning services with HIV and sexual health programming. And we've been recently, I spoke recently at the ICAAP conference in Bali emphasising the need for female sex workers to have a back up method of family planning to try to reduce the number of unintended pregnancies and of unsafe abortions amongst the women.

COCHRANE: Now this area has become extremely politicised, especially in view of fairly conservative US policies over abortion and prostitution. Are you finding it increasing hard to get funding for projects and to get support from the US?

NEILSEN: No, in fact most of work is funded by the United States Government. We obviously have faced constraints certainly with the Mexico City policy, which was overturned by the Obama administration, but in terms of funding, we're quite well funded and we are well funded to work with sex workers across the entire region.

COCHRANE: And just briefly, any bright spots, any good news from working with marginalised populations?

NEILSEN: Well, one of the strategies that we have been using across the region in many countries with female sex workers is an approach called Periodic Presumptive Treatment of Sexual Transmitted Infections and this is a temporary strategy to reduce the very high rates of infections, particularly with gonorrhoea and chlamydia.

In some settings, we've seen roughly half of the women, the female sex workers, is actually infected with gonorrhoea or chlamydia and we lack the cheap accessible rapid tests to diagnose these conditions. But knowing that the rate of infection is so high, we're able to treat the women on the basis that we presume that they are infected and in some settings we do this on a regular basis. And the outcome of that is to dramatically reduce the rates of infections amongst the women and this occurs while we're increasing the quality of the services for the women, while we're also increasing their rates of condom use.

Source:ABC