Intimate Partner Transmission of HIV (IPT)

A Study of Cambodia, Indonesia, Lao PDR, Thailand

(part of UN Women)

Women and IPT

a focus on the transmission of HIV to women from their long-term male partners including men who: inject drugs - have sex with other men - buy sex migrate

Who is at risk?

Why is it important?
Gender equality in law (mostly) but not in practice Women lack sexual agency and decision making Gender expectations: Men sexually experienced, multiple partners Women sexually inexperienced, monogamous, no sex before marriage Low male involvement in sexual and reproductive health Focus on most at-risk populations but epidemics are changing Male clients of sex workers not considered higher risk Widespread gender-based violence Condoms synonymous with sex work only Vulnerable and hard to reach migrants Discussing sex is taboo

How can we reach women?

1. 2. HIV prevention for male IDUs, MSM, male clients (of sex workers) and their female partners Structural interventions to address the needs of vulnerable women and their high risk male partners 3. 4. Rights-based approach to health delivery Address gender inequality De-stigmatise condoms promotion for prevention of STI and other infections perspective (female condom for couples?)

What makes women vulnerable?

HIV prevention for mobile and migrant populations Research the dynamics of IPT Gender power dynamics More gender and age disaggregated data Discordant couples

HIV and women in relationships

HIV response coverage

Cambodia

100% condom use?

In Cambodia Sex workers in Cambodia report 80% condom use But 53% reported an STI symptom 100% condom-use campaign reaches: 50% of brothel workers 8% of indirect workers

No focus on low risk women who are partners of high risk males

Success in targeted interventions

Indonesia

Success but change in modes of transmission

Lao PDR

In all four countries: condom use has become stigmatized & symbolizes infidelity and mistrust in intimate relationships
In Thailand Sex workers report 94% condom use with clients Clients report 49-76% with sex workers Sex workers report 40% condom use with intimate partner

Projected new infections

Thailand

Females not now in at-risk population includes women married to clients of sex workers

Contact details Karabi Baruah PhD UNIFEM - Email: karabi.baruah@unifem.org - Website: http://unifem-eseasia.org/
Acknowledgements This poster presentation is based on research commissioned by UNIFEM conducted in Cambodia, Indonesia, Laos PDR and Thailand. The reports of the research findings: Kaybryn, J. Responding to Feminization of AIDS: Intimate Partner Transmission of HIV - Indonesia, Laos PDR and Thailand, UNIFEM East and Southeast Asia Regional Office, July 2009 Roberts, J. Preventing Spousal Transmission of HIV in Cambodia: A Rapid Assessment and Recommendations for Action, UNIFEM East and Southeast Asia Regional Office, February 2009 In-country research teams: Indonesia: Ikatan Korban Napza (IKON) Bali (Balinese Association of People Affected by Drugs); Laos PDR: Laos Womens Union; Thailand: Center for Health and Policy Studies, Mahidol University