Do children of street sex workers in Montenegro know about Santa?
Montenegro is not an open or easy place for sex workers. Their way of earning for a living is still penalized and often they are victims of violence. Many are migrants not entitled to social or health care. According to the latest survey conducted by the National Institute of Public Health and the non-governmental organization Juventas, 55 percent of female sex workers have children and 80 percent are unemployed.
The survey showed that drug abuse and injection drug use is rampant in all types of sex work. When it comes to the use of condoms and drugs, significant differences were noted between street sex work and sex work in brothels. Namely, more than 90 percent of street female sex workers are long term injecting drug users, while in the last two years there were no reported sex workers in brothels who were injecting drugs. Also, street female sex workers sell sex at very low prices and rarely practice safe sex.
- HIV prevention services in the drop-in centre resulted in a steady increase of condom use as well as increased HIV and other STIs testing. Results from the bio-behavioural survey conducted in 2012 on the sample of 200 sexual workers indicate that 58% of them reported regular use of condom during the month preceding the survey, 77.5% reported the use of condom by the client during their last sex, while 31.5% said to have been tested for HIV at least once.
- Workers of the drop in centre have closely monitored pregnancies of nine of their clients.
- Among the clients of the drop in centre there are two sex workers living with HIV, while the percentage of persons with Hepatitis C is much higher. Thanks to the good cooperation with the Institute of Public Health and Clinic for Infectious Diseases, a strong link is being established between the systems that connect people living on the margins with the health care system, but still only for the citizens of Montenegro.
- Despite significant success in terms of service provision to sex workers and their impact to the behavior and health of sex workers, there are still challenges to tackle in regard to the sex workers’ human rights, especially of those who are not the citizens of Montenegro, and as such are not entitled to some of basic human rights such as health and social protection.
Activists from Juventas are partnering with UNDP and the Government of Montenegro in the implementation of the national AIDS strategy. As part of that strategy, these activists, with support from UNDP, have been working to improve the quality of life of sex workers since 2007.
Juventas activists are primarily helping sex workers and their sexual partners in preventing transmission of HIV and other sexually transmitted diseases. Juventas does it mainly by distributing free condoms, lubricants, needles and syringes as well as by providing information and referrals to health care institutions and institutions in charge of social welfare.
Ms. Tijana Žegura, Programme Director of Juventas, remembers the challenges and lessons learned in the beginning of the effort.
“It was only in the course of time that we realized that being on the street with sex workers, visiting them in their apartments or in places where they work, simply did not suffice to make positive change in the level of their risk awareness as well as their behaviour,” she says.
In response to this, and with support from UNDP and funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the activists from Juventas opened a drop in centre early in 2011, not only for female sex workers but also for their families and children.
A team consisting of a medical doctor, a psychologist, a social worker and several outreach workers offer advice and support at the drop in centre located in a quiet area in the centre of capital Podgorica. In the period July 2011-June 2012 sex workers also had a teacher to assist their children with school tasks and a hairdresser at their disposal. Due to severe budget constraints these services are not available any more although they were very well accepted and stimulating for the sex workers to come more often. During 2012, about 130 different female sex workers visited the centre.
Many of the female sex workers often drop by for no other reason than to have a coffee together and talk about sexually transmitted infections and get advice where to go for a gynaecological examination, or to discuss rights to social and child support.
“Some of our clients have become regular, and often we have spontaneous gatherings or social events,” Ms. Žegura says. “We also had a corner for children. Last year we organized a New Year’s party. It was sad to see some even older kids meeting Santa for the first time in their lives. When you see sparkles in the eyes of a 10 year old who believes Santa came that day just to be with them, you simply know that the opening of the centre was a meaningful and justified thing to do.”
Before, female sex workers who were injecting drug users would go to a drop in centre which was set up for injecting drug users only. The new drop-in centre, however, is a friendly environment where female sex workers apart getting counselling, sterile needles and syringes, free condoms are provided with referrals to health, social and child care institutions.
“I can only imagine how difficult it is to work in a place like this, and to think professionally when emotion prevails,” says one of the drop in centres clients, who asked that her name not be used. “But, Tijana and her colleagues made a huge difference in my life, and in the lives of my colleagues.”
Changes in social behaviour patterns are slow, but very important from the perspective of public health. Since sex workers are recognized as particularly vulnerable population in regard to HIV infection due to their risk behaviours, it is very important to ensure sustainable financing for this kind of services after the termination of GFATM’s financial support in the country in 2015.
Response to HIV/AIDS in Montenegro
The programme seeks to scale up and strengthen the Montenegrin national response to the HIV epidemic among the most-at risk populations, building on the experience, successes achieved and challenges faced during the implementation of the Montenegrin National AIDS Strategy 2005–2009.