The Wisdom of Whores

Today’s post is copied wholesale from Laura Agustin. In the poster, the product of a workshop by the Thai sex workers rights organisation EMPOWER, sex workers relate what being “rescued” in brothel raids means to them.

• We lose our savings and our belongings.
• We are locked up.
• We are interrogated by many people.
• They force us to be witnesses.
• We are held until the court case.
• We are held till deportation.
• We are forced re-training.
• We are not given compensation by anybody.
• Our family must borrow money to survive while we wait.
• Our family is in a panic.
• We are anxious for our family.
• Strangers visit our village telling people about us.
• The village and the soldiers cause our family problems.
• Our family has to pay ‘fines’ or bribes to the soldiers.
• We are sent home.
• Military abuses and no work continues at home.
• My family has a debt.
• We must find a way back to Thailand to start again.

Many of these women are Burmese. They’ve worked hard to get to Northern Thailand, and their hard work while they are there is often a mainstay for their families. For me, the most telling of their comments is the last: after going through all of the nightmares associated with being “rescued” from a life selling sex, they have to start again from scratch. That means paying more bribes to get across the border, more jostling to get back into pole position at the brothel. It must be a consolation to the anti sex-work organisations that for the time between their rescue and getting back to work, at least, the souls of these women are safe.

Among anti sex-work organisations, some would include the Poppy Project, the originators of a somewhat lurid it’s-all-about-trafficking view of the London sex scene was featured on IRMA recently. I’ll let friends and colleagues who are closer to the London trade than I am respond to that more fully.

Bhutan is not exactly crumbling under the weight of HIV infections. Between 1993 and 2006, a total of 90 cases were reported. Each is dilligently listed by the Ministry of Health — age, sex, how they became infected, how their infection came to light, whether they are still alive (19 had died by August 2006). Perhaps that’s because this rather eccentric but extraordinarily organised little country has been quite open about the virus from the start. I remember being at a temple festival some years ago with one of the kingdom’s princesses, cheering on a giant condom in a boxing match against the HIV virus.

Now, Bhutan intends to tackle HIV among drug users in prison, according to a report in the Bhutan Observer. There’s actually no evidence of much drug abuse in prison in Bhutan (unlike in virtually every other country in the region, where prisons are widely known to be HIV factories). But still, it’s great that they are showing willing, after some chivvying at a UNODC-sponsored workshop. Prizes to any reader who can interpret this somewhat cryptic comment from the nation’s Chief of Police:

“I found the recommendations appealing, and if it helps the prisoners, we will implement it. We will have a drug research centre, religious talks and yoga after the coronation.”

(Image stolen from Downward Facing Blog, with thanks)

A little while ago, CDC estimated how many people were newly infected with HIV in the US in 2006. They told us it was a disease of gay men and black people. Now they’ve done more detailed analysis: It’s not just a disease of gay men and black people. It’s increasingly a disease of gay black men.

Nearly 40,000 men got newly-infected with this completely preventable disease in the world’s wealthiest country in 2006. Three quarters of those infections were in gay men. And while blacks make up just 14% of the US population, 35% of gay men newly infected with HIV were black. Cutting the numbers the other way, two thirds of all black men newly infected were gay and another 12% were junkies, leaving just one in five black guys infected in sex with a woman. New infections were even more rare among straight white guys — 88% of all white men newly infected in 2006 were gay, and another 6% were drug injectors; just one in 16 was infected in straight sex.

Women get infected two ways — by sharing needles when they shoot up drugs, and by having sex with infected men. Straight black men are far more likely to be infected than straight white men (not least because they are far more likely to be jailed, and, in a triumph of denial over common sense, jails in America still don’t make condoms available to prisoners). Since most Americans still have sex with people of their own race, it’s no huge surprise that black women are more likely to get HIV than white women. Nearly 15 times more likely, according to CDC. (Of the 14,000+ new infections in women in 2006, 61% were among black women, and 80% of those women got infected when they were having sex, not shooting up drugs.

Some caveats about the numbers: the national estimates are based on data from 22 states; the other states, which haven’t until very recently reported new HIV cases by name, are back-filled by applying the same ratio of new infections to AIDS cases as we see in the States for which we do have data. It’s a reasonable thing to do, for want of a better option, but it assumes that the epidemic has matured in roughly the same way in all states. Here’s the problem: two of the states with missing data are two of the worst affected and least typical, California and D.C. (ok, district, not state).

I’ve used the term “black” rather than “African-American”, advisedly. In many other countries which I follow, including the UK, Canada and Ireland, a very large proportion of heterosexual infections among black people are in fact “imported” infections. They are infections in nationals of African or Caribbean countries, and are likely to have been contracted in their home country. Of course this is far less likely to be the case in the US as a whole, but imported infections may well contribute to the high levels of infection in blacks in some of the more cosmopolitan cities in the US, including New York and Washington DC. CDC does not report infections by country of birth, but I’d be curious to see the figures.

Data quibbles aside, we’re getting an ever clearer picture of the continuing spread of HIV in the United States. Both the gay community and the black community need to demand better HIV prevention services. And those services need to be sold much more aggressively to those who aren’t currently using them, especially young black men who like to have anal sex.

The conservative northern Nigerian state of Bauchi is running a lonely hearts service for HIV positives who want to get married. Authorities claim that this will reduce the spread of HIV. Predictably enough, some people are whining about this. A UNAIDS official is quoted as saying that it is dangerous, because of the likelihood of them infecting one aother with different strains of the virus.

That’s the same kind of official that tells people always to use condoms in oral sex. What are the real risks of a single super-infection? They are poorly quantified but clearly small, compared to the reward of not having to use condoms every time you have sex with your life partner. If a couple are both positive they may want to think about avoiding pregnancy, but there are other ways of doing that besides using condoms. Leave them in peace to have sex any way they want, is what I say.

One of the ironies of Bauchi’s new “sex between positives” drive is that it is a prevention initiative first devised by gay men in rich countries. We’ve even given it a name — sero-sorting — and it works well for positives though not quite so well for men who both say (and perhaps even believe) that they’re HIV negative. Ironic because Bauchi’s officials don’t exactly embrace learning from gay men. A couple of months ago they
slung a group of men in jail for being “gay”. They were identified because they were in women’s clothing.

Thailand has been much (and rightly) praised for its pragmatic approach to cutting HIV in its illegal but vast heterosexual sex trade. Of course when the tide of brothel-caught infections goes out, the rocks of ongoing infection in jails, among drug injectors and between men who have sex with one another are left exposed. And gay men have stormed into the lead in China, too.

Thailand’s relative neglect of HIV prevention among gay men has been confirmed yet again by a new paper to be published in the upcoming edition of JAIDS — the abstract is on line now. (JAIDS is one of those dinosaur journals which still makes you pay for access to the full text.) Using blood samples taken between 2006 and 2007, researchers in Bangkok used a relatively new technology to find out which infections were recent at the time people came in for their voluntary test.

Nine of the 11 incident infections were in men, and 60% were in gay men. Overall, the rate of new infections was equivalent to 2.7% a year. This sort of testing is imprecise at best, not least because it depends on who walks in the door asking for a test. But still, it’s worrying that such an overwhelmingly high proportion of the newly infected are among gay men. To make matters worse, the data probably exclude many of the highest-risk gay men in Bangkok, who go to gay and sex-worker friendly clinics, one improbably based in Bangkok Christian Hospital, just a sound-system’s reach from the flesh-pots of the Patpong red light district and Silom Soi 4, it’s gay equivalent.

The concentration of new infections among gay men led the researchers to conclude that these boys would be a good study population for new HIV infections in Thailand. So at least the junkies — who have long been study-population of choice for Bangkok’s talented pool of AIDS epidemiologists — may get a break for a while.

Meanwhile, over in Beijing, colleagues of mine from China CDC used a slightly different but also relatively new method to look at new HIV infections among gay men. Because the Chinese Medical Journal is not a dinosaur, you can read the full text online. They actively recruited gay men to the study; many people signed up through internet sites or because they were contacted in bars and clubs; you’d expect these guys to be at the higher end of the risk spectrum. And they are. My mates estimated new infections at 2.9% in 2005 and 3.6% in 2006. About the same as among gay men in London, in fact.

A McDonald’s in every airport, a Starbucks on every block, and a hear-no-evil, see-no-evil, speak-no evil HIV crisis in the gay community. Thailand and China look more like the US and Britain every day.

Meanwhile,

I wasn’t even going to bother to gloat about the goody-two-shoes Republican Vice-Presidential candidate’s swelling family. Plenty of others have done it for me. But the kerfuffle did get me thinking about what’s fair game in science and reporting. And that led me on an unlikely path to rape and bestiality.

Yes, Sarah Palin gutted funding for pregnant teens at just about the same time her own daughter was romping around with boyfriend but without condom. Yes, she’s a staunch supporter of the abstinence-only education which is delivering a rise in births to US teenagers. And yes, when a personal story occasions sensible reflection on a potential president’s ability to make data-free policy decisions, then I think it’s fair game for press coverage, even if it involves a family member’s sex life.

Others question that; there’s been heated discussion about what it is and isn’t fair to report.

As I was considering these issues I was reminded of a story about a bestiality and rape that was reported with great glee a couple of months back. The victim was almost certainly a minor, the rapist was 16 times her body weight. Was there a discussion about protecting the victim’s privacy? Not a bit of it. Scientists photographed the encounter, and the pictures were widely published. As here:

Lust in a cold climate

The assault involved a seal and a penguin. Different species from us, much like politicians. That’s what made it fair game for reporting.

Over at Bound Not Gagged, Jill — a seasoned reporter on penguin prostitution — assumes that the victim will soon start turning tricks (because as we know, all sex workers were set on the path to harlotry by a dark past of child abuse and incest). So say the very people who also believe that telling teens to cross their legs is an effective way to prevent pregnancy. Heigh ho.

Earn good money but hate your job? The UK charity Switch can help you out. As long as you’re a drug dealer.

Switch is a coalition of community groups based in the Western city of Bristol. The Guardian reports that the group was finding that a lot of dealers wanted out, but felt trapped because there was little else they could do that would maintain their often quite expensive lifetsyles. The publicly-funded group works largely with dealers at the bottom of the food chain, those who churn small deals for the bigger fish, as a way of funding their own drug habits. The story is a bit vague about what Switch actually offers, beyond “suggesting ways of giving [the dealer] the support and skills they need to break away from the streets.”

I’m in two minds about initiatives like this. On the one had, if people really do want out, then any help we can give them is surely a good thing (and certainly cheaper for taxpayers than many more years of cycling them in and out of jail). On the other hand, it smacks rather of those rescue missions for sex workers, which so often do more for the moral superiority of the rescuer than they do for the future of the working girl. Of course it does also open up the possibility of working with those dealers who don’t want to give up their jobs to help make drug-taking less dangerous to their clients.

For the small-time dealer, the “golden cage” probably seems a long way off in any case. While prices of petrol, heating and food soar, prices of drugs are still coming down, according to an annual survey of drug trends in the UK published today by Drugscope. The exception is heroin. The price of smack on the street has risen by 14% in the last year (to £49 a gramme, close to U$ 90), and things are bound to get worse. Just over the summer, the wholesale price has shot up by 30%, to £17,000 a kilo. (That means that dealers within the UK are current creaming off £32,000 a kilo, but I wonder how much of that filters down to the (mostly) boys that Switch are dealing with.) Even the relatively modest price rise on the streets is already affecting consumption patterns, according to Drugscope, with some heroin users switching to Valim (diazepam), which is just £1 a pill. They take it when they can’t afford the real thing, when they’re out of methadone, when they’re coming down. That’s a worry, because it increases the risk of overdose.

Whatever we do on the streets, we could certainly be doing more for drug users (and perhaps pushers) when they are in jail. I was interested to note yesterday (again in The Guardian that the drugs charity RAPT has joined a consortium bidding to run two jails in the UK. Read the rest of this post…

New York likes to think of itself as ahead of the rest of the US on many fronts. It certainly is on the HIV front.

In most of the world, we’ve got precious little idea how many people get infected with HIV each year. Generally, we report HIV prevalence — the number of people who have HIV right now. Some of those people will have been infected last month, some will have been infected 10 years ago. It doesn’t tell us much about what’s happening right now. What we really want is information on HIV incidence — the number of people who got infected in the last year. Recently the US has been trying out new technologies that can distinguish between an old and a new infection. That tells us what proportion of the people tested this year were infected this year; then we have to add in a guesstimate for how many people were infected this year but didn’t get tested. CDC last month published national estimates of incidence for 2006. Now New York City has published its own estimates.

And yes, New York is ahead of the curve. Whites in the city are four times more likely to be newly infected with HIV than they are nationally, Hispanics three times more likely and blacks twice as likely. Overall, half of all new infections are among men who have sex with one another. In fact among white New Yorkers, nine out of 10 new infections are among men, most of them gay. Seven out of 10 of the blacks who got HIV in New York in 2006 were men, and over half of them picked up HIV in anal sex with another man. So much for the “feminising epidemic”.

Blacks of the “post-AIDS generation” — men under 30 who probably became sexually active after effective HIV drugs became the norm in 1996 — seemed particularly hard hit. Read the rest of this post…

Jamie Clayton, by James Morgan

The New York Observer has crowned Jamie Clayton the second most beautiful woman in New York. (It doesn’t tell us who the most beautiful woman is.) The always engaging Broadsheet deems this a triumph for transgenders, since Jamie was born a boy.

Quite understandably, Jamie relates her “education sentimenale” to her past with a penis.

She’s noticed a funny thing since making her transformation. Because of her looks—she calls herself a “top-shelf” transsexual—she gets hit on by all sorts, not just tranny-chasers.

She has a type—she likes confident, sexy, creative guys. But she’s found that these men, more so even than the men she dated pre-op, are frequently unable to live up to the swaggering open-mindedness they claim to possess.

“If I have a connection with someone, I’d like to think that they’d be able to respect that connection enough and respect themselves enough to not care about my past—that they would want to see what happens between us,” she said. “But I have had plenty of instances where guys don’t even give it a chance, or maybe they do give it a bit of a chance, and then they sort of drop off the face of the earth because it freaks them out.”

I would humbly submit that Jamie’s transition has been far more successful than perhaps she recognises. Let’s run that again, without the references to her anatomical history:

Because of her looks, she gets hit on by all sorts.

She has a type—she likes confident, sexy, creative guys. But she’s found that these men are frequently unable to live up to the swaggering open-mindedness they claim to possess.

“If I have a connection with someone, I’d like to think that they’d be able to respect that connection enough and respect themselves enough to not care about my past—that they would want to see what happens between us,” she said. “But I have had plenty of instances where guys don’t even give it a chance, or maybe they do give it a bit of a chance, and then they sort of drop off the face of the earth.”

Doesn’t that read like a universal lament of single women in New York City, regardless of what our pasts conceal?

I suppose I ought to write an outraged post about Glasgow’s daft decision to try to wipe out prostitution. Not least because other countries such as New Zealand that have decriminalised prostitution have found that conditions for many sex workers are improving, with no increase in the sex trade. On top of that, no HIV was found (pdf) among over 340 sex workers at sexual health services in New Zealand.

There are examples closer to home, too. Scotland’s own capital, Edinburgh, has been doing well at controlling HIV among sex workers by providing services to women working in saunas (though some health service bosses are reported to think they can stop paying for these services because there are so few working women are getting infected with HIV. Soon, they’ll stop funding clean water sources because there’s so little cholera these days…) So yes, I should write a long, cross post about Glasgow.

But instead I’m going to post a wildly off-topic (but still dump-related) recording (mp3) from a call centre. If this doesn’t make you laugh, read another blog…

Thanks to Peter Saxton for the New Zealand data and the stunning Cerissa Nyen for the laughs.