Spotlight on syphilis among sex workers

By Joyetter Feagaimaali’i-Luamanu 18 April 2018, 12:00AM

Sexually transmitted infection, Syphilis, is found to be present among sex workers in Samoa. 

This is according to the Ministry of Health’s Global Aids Monitoring report 2018 for the period between January and December 2017.

The testing was conducted during a workshop with Ministry of Health’s H.I.V. programme staff and National Health Services workshop on sexual health education and talanoa session on 4 October and 13 December, 2017. 

This is the seventh annual report to U.N.A.I.D.S. since 2010, says Director General of the M.O.H, Leausa Dr. Take Naseri.  

“This year entitled Global AIDS Monitoring (G.A.M.) Report and is evidence of Samoa’s commitment to the global response to H.I.V., A.I.D.S., S.T.I.’s, and T.B.” 

This commitment stems from the “Political Declaration on H.I.V./A.I.D.S: Intensifying Our Effort to Eliminate H.I.V. /A.I.D.S.” adopted by the United Nation member states at the high level meeting held in New York in 2011. 

In 2016, the commitments were reaffirmed when Samoa signed the new political declaration agreeing to end the H.I.V. epidemic by 2030 within the framework of the Sustainable Development Goals. 

“The Global A.I.D.S. Monitoring Report is a highly regarded report with an in-depth analysis of core indicators that provide insight into our national efforts in alleviating H.I.V./ A.I.D.S. through collective prevention initiatives and programs carried out by our various committed stakeholders and health sector partners,” said Leausa in the report.  

He pointed out that S.T.I’s pose considerable threats to morbidity and possible mortality in both adults of reproductive age and newborns.  

“The S.T.I’s can also significantly increase the risk of H.I.V. transmission if not addressed in our population. He said if S.T.I’s are not managed and prevented, they can contribute negatively to healthcare costs attributable to treatment and care, programme management and other costs that will in turn affect the Government’s overall health budget.” 

“2017 was a year of considerable achievements for all entities involved in the national response. We seek to maintain and expand these advancements as we work to eliminate H.I.V. and S.T.I’s.” 

“Samoa’s new H.I.V, A.I.D.S. and S.T.I. Policy 2017-2022 was launched in 2017 to guide the national response to combat new and ongoing challenges.” 

“Over the years, Samoa has received financial support from several international and regional partners. The Government of Samoa also contributes significantly through providing human resources and managing the logistical aspects of the National Programme for H.I.V, A.I.D.S, S.T.I’s and T.B.” 

“The ongoing support and care offered by the National Health Service for our P.L.W.H.A. and our S.T.I. and T.B. patients is greatly appreciated. Additionally the Government of Samoa through the Ministry of Health acknowledges the continuous support rendered by the U.N.D.P./ Global Fund to Fight H.I.V., Tuberculosis and Malaria and World Health Organization,” stated Leausa in the report. 

The talanoa session with the sex workers conducted by the M.O.H. employees included sexual health education and prevention training, linking sex workers to testing and treatment services, deliver condoms and lubricants, deliver dignity kits that contain toiletries and hygiene supplies to compliment condom distribution and building the trust of the sex worker community for future M.O.H. programmes. 

“The M.O.H. H.I.V. programme staff, in addition to the nurse specialist of the Communicable Disease (C.D.) Clinic, facilitated the process.” 

“Fourteen sex workers who attended the programme and received all objective services comprised 11 females and three fa’afafine’s.” 

“Three tests were reactive for H.I.V., one test was reactive for syphilis and one H.I.V. reactive case was lost to follow-up.” 

“All four were screened for H.I.V. and syphilis and that follow up appointments were booked with the nurse specialist for reactive cases at the C.D. Clinic. Confirmatory testing was conducted.” 

“All participants received a dignity kit with condoms, lubricants, sanitary pads, toothbrushes and paste, undergarments, soap, and deodorant.” 

“Staff were able to build trust with this community for future programming.” 

“Sex workers want to continue with programming efforts.” 

According to the report for female sex workers in the study, most engage in sex work for economic reasons. 

“Sex work currently is illegal in Samoa. About 58 percent of the women had children and no other source of employment.” 

“Their average sexual partners in the past month were 10, with nine of those being paying clients.”

“None of the women had accessed a sexual health service within the past 12 months nor had been tested for H.I.V.” 

The report further indicates that while sex work is illegal in Samoa, yet there is no immunity for carrying condoms. 

“Homosexual acts and transvestism are no longer criminalised under the Crimes Act 2013.” 

“However the establishments of business or public spaces that promote homosexual acts are identified in the current Crimes Act.”

“There is also no legislation that specifically criminalises the transmission of H.I.V. however it can be prosecuted under the Crimes Act as ‘causing grievous bodily harm’, where areas malintent must be established.” 

“There is also no specific legislation regarding blood safety and accountability for such transmissions.” 

“Criminalisation of sex work and pervasive negative cultural attitudes towards those who engage in sex work are the most difficult challenges for health workers to reach commercial sex workers.” 

“It prevents sex workers from going to providers for fear of discrimination or legal action,” says the report. 

The report says major advances in prevention programming were made in 2017 with fa’afafine and sex workers. 

“The Ministry of Health supported Samoa Fa’afafine Association (S.F.A.) in obtaining a sub-recipient agreement with the U.N.D.P./Global Fund for support and funding.” 

“This allowed U.N.D.P./Global Fund funding, which was increased due to Ministry of Health’s satisfactory performance, to be channeled directly to S.F.A. to support their increasing efforts on health and prevention. Additionally, there was much work done in gaining the trust and rapport of the sex worker community.” 

“This population is highly stigmatised and harassed by the Police due to the illegal nature of sex work in Samoa.” 

“They are therefore very distrusting of participating in Government programmes for these reasons.” 

“The staff of the Ministry of Health H.I.V., S.T.I., and T.B. programmes met groups of sex workers in order to consult them on what programmes they need, as well as to demonstrate that the Ministry of Health is there to support them in making the best choices for their health and healthcare.” 

“After several informal meetings and discussions, the first sex worker outreach events were conducted in 2017, bringing testing, education and referral services directly to this population.”

“These efforts were well received by the sex worker community who has agreed to expand programming and outreach in 2018.” 

“Although this took an incredible amount of time, effort, and extensive work to ensure confidentiality, Ministry of Health was able to begin the process of engaging this key population group.”

Another issue pointed out from the report is that collecting data on key populations is difficult when they do not have legal status. 

“In the case of sex workers, commercial sex work is illegal making it very difficult to get research studies and interventions approved because of the cnfidentiality risk.” 

“For fa’afafine (transgender males), third gender status is not nationally recognised.” 

“Therefore data that includes that gender category is captured in programme records and cannot yet be monitored nationally in surveillance.” 

“In the case of fa’atamaloa (transgender females), this label is usually one that the community uses to identify an individual rather than a term for personal identity. Therefore, service providers are faced with the challenge of identifying these patients during clinical data collection.” 

“Without health information confidentiality and privacy legislation in place, M&E data collection poses serious risks and ethical dilemmas.” 

“Sensitive health data is legally the property of the clinician or officer that creates the record or database.” 

“This poses serious risks as there is no legal framework of accountability if such data were to be made public.” 

“Exposure of an individual’s sexual health information could result in severe social repercussions, due to the heavy stigma against H.I.V., S.T.I’s and sexual health.” 

“There is a concern that expanding data collection without legal protection methods is unethical.” 

“There is also no mechanism or infrastructure for a national electronic system of health data.” 

“This leads to duplication, loss to follow-up, unavailable health/treatment histories,” according to the health report.

By Joyetter Feagaimaali’i-Luamanu 18 April 2018, 12:00AM

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