National HIV/STI Surveillance System for Commercial Sex Workers in Bolivia

Fisher - Research in Bolivia - CLACS at NYUI have been in Cochabamba for just over 6 weeks now. There is a lot to recap, so I’ll try to be succinct. First, it has been difficult to be here doing two very time-consuming and mentally-challenging activities: taking an intensive Quechua course (every morning from 8-12:30) and conducting my master’s research on the National HIV/STI surveillance system for commercial sex workers. To just give a little background on my project, in Bolivia, sex work is regulated. I had read that it was legal, however after my research thus far, I have learned that it isn’t really legal or illegal, in fact there really isn’t anything about it in the penal code. What is true though is that it is regulated, and the police cannot arrest sex workers if they are registered. There are various mechanisms to regulate it; one is that the municipal governments process “locales” or brothels that have applied for registration. Apparently this process involves a lot of paperwork and probably quite a bit of money, so there are also “clandestine locales” which are not regulated officially and are subject to fines if they are discovered. The other aspect of the regulation is the HIV/STI surveillance system for sex workers. Basically this is an epidemiologic surveillance system run by the Ministry of Health. The workers who have chosen to register (there are also clandestine workers) must go for “control” where they receive various kinds of examinations, tests, and treatments (the kinds of examinations and tests, as well as the frequency with which they must go for control varies greatly and is affected by many factors).

As I arrived in Bolivia, my main research objectives were to map out the system, trying to really understand how the whole regulatory apparatus worked. After a few slow weeks in the beginning (meeting with people who didn’t know anything about it but could give me some contacts), I finally gained access through SEDES (Servicio Departamental de Servicio) in Cochabamba to speak with the Director of Epidemiology, the Coordinator of the HIV/STI surveillance system, and the gynecologist who sees all of the registered sex workers for their “control” every 15 days at CDVIR (Centro Departamental de Vigilancia y Referencia).

The interviews were extremely informative, and really cleared up some of my questions. Through them, I have really been able to fill in a lot of the holes in my understanding of the surveillance system and how it functions. I was also able to set up a meeting with the President of the national union of sex workers, ONAEM (Organizacion de Activistas por la Emancipacion de la Mujer). This meeting was also extremely helpful as the union has been influential in fighting for the rights of the sex workers and for changing the surveillance system in drastic ways. I learned in this meeting that although the system is nationwide, each department has its own ways of implementing the “control” aspect of it.

For example, in Cochabamba, the union has been very successful at changing both the appearance and the regulation of the carnet de sanidad (it is a booklet that registered sex workers must carry with them at all times that contains stamps inside that ensure that the worker is disease-free). Here in Cochabamba the carnet doesn’t contain a photo or the worker’s real name. Also, it can only be asked for by workers with the surveillance system, which means that the police, locale owners, or clients cannot request it or have the sex workers arrested for not having it. They have even won a free box of condoms every month (144 condoms). Even though there are still many abuses and much discrimination against the sex workers in Cochabamba, these changes to the system have been significant. In fact, the coverage of the surveillance system is nearly complete here and the prevalence of STIs is nearly zero, mostly because in the opinion of many of the sex workers, the benefits of registering outweigh the cost (free exams-although they have yet to achieve free comprehensive care, free treatments, and a free box of condoms every month).

Unfortunately, in most other departments of the country this move towards decriminalization has not happened. Apparently things are much worse in Santa Cruz and several other departments. I just wish I had more time to really do a comprehensive nationwide research project. Fortunately I will have a week in La Paz coming up in order to get some data for that Department and hopefully compare a bit. More on that coming up!

Posted by Rebecca Fisher – MA Candidate at CLACS at NYU

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