[afro-nets] Male clients of Sex Workers... Experiences from Vietnam

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

Male clients of Sex Workers... Experiences from Vietnam
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MALE CLIENTS OF SEX WORKERS: A MISSING LINK IN HIV PREVENTION
PROGRAMMING?

Introduction

Commercial sex between men and women (this consultation focused
on heterosexual transmission, although some male 'clients' may
have both female and male clients) is without doubt one of the
major drivers of HIV in many Asian countries:

* Men and women who buy or sell sex are more likely to be ex-
posed to HIV and other sexual infections than those who do not.

* More men and women buy or sell sex than those who engage in
other behaviours that carry an elevated risk of HIV infection,
such as drug injection, and,

* Many of the men and women who buy and sell sex are also in-
jecting drugs or have drug injecting partners.

While male clients of female sex workers have long been regarded
as a "bridge population" for HIV transmission from high-risk be-
havior groups to the general population, it is sex workers who
have received most of the attention in national HIV/AIDS strat-
egy documents and prevention efforts. Male clients have rarely
been targeted, even though they constitute the key decision mak-
ers, often deciding when and where to have sex, with whom, and
whether or not a condom is used. These 'clients' remain a poorly
understood, incoherent social grouping with few easily recogniz-
able characteristics. Even when their characteristics are known,
most are similar to those of men who have little behavioural
risk at all. For example, most targeting of men is based on em-
ployment related risk; generally mobility or migration. Among
any group of men identified only a proportion will be at risk,
and fewer will be at high risk.

Targeting the actual clients of sex workers makes good HIV pre-
vention sense. In concentrated epidemics-where HIV is found pri-
marily in particular vulnerable groups-working directly with
male clients is paramount to controlling HIV/AIDS. But it does
raise some perplexing questions:

a. In our male interventions, are we reaching the right men?
b. How do we identify 'clients?'
c. Are we reaching clients in sufficient numbers to have an im-
pact on the epidemic?
d. Are there other male clients who are not being reached
through existing interventions?
e. What works in male client prevention programming? How do we
know? How can we improve our interventions?

On 1-2 December 2004, approximately 20 representatives from NGO,
donor and multilateral agencies in Hanoi, Viet Nam came together
to "re-think" HIV prevention programming for the male clients of
sex workers. The purpose of the consultation was twofold:

1. To review project experiences at targeting males-specifically
those expected to reach the male clients of sex workers-in Viet
Nam; and
2. To formulate recommendations for better programming.

The report that follows presents the outcomes of these discus-
sions. It is hoped that this consultation and other succeeding
discussions will help programmers in Viet Nam to develop, en-
hance and expand quality HIV/AIDS interventions for this vulner-
able population.

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