Female Sex Workers Population Estimates in Asia-Pacific 2022

HIV and AIDS Data Hub for Asia-Pacific Review in slides Female Sex Workers Last updated: January 2022 www.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific CONTENT Population size estimates HIV prevalence and epidemiology Risk behaviors Violence Vulnerability and HIV knowledge National response 2

Population size estimates www.aidsdatahub.org

Female sex worker (FSW) population size estimates Females (15-49) As% of females (15-49) Country Estimated size Definition Afghanistan(2019) 11,237 sold sex (oral, vaginal, anal) in exchange for money, drugs, goods or services in the past 3 months 8,929,462 0.13 Australia(2012) 20,500 Self identify as having a history of sex work 5,565,870 0.37 Bangladesh(2015) 102,260 Females 10+ yrs; who sell sex and contracted by clients at hotel/street/residence/brothel during last year 43,488,027 0.24 Bhutan (2019) 597 Females 18+ yrs who have received cash payment for sex 205,442 0.29 Cambodia(2019) 54,813 Biological females, 15 to 49 years old, who sell sex in exchange of money or goods, in the last 12 months 4,458,265 1.23 China(2013) 2,520,000 Females 15-65 yrs; who have sexual intercourse with males for money(excluding transgender) 374,006,476 0.67 Females 18+ yrs; self-identified as engaging in transactional sex (i.e. the provision of sexual services in exchange for cash, goods or service) Information not available Fiji(2012) 538 224,175 0.24 India(2009) 868,000 307,922,110 0.28 Indonesia(2019) 277,624 Females aged 15 years or older who receive money or goods in exchange for anal or vaginal penetrative sex in the last 12 months 71,651,521 0.39 Japan(2013) 700,000 Information not available 26,782,348 2.61 Lao PDR(2019) 15,618 Information not available 1,923,163 0.81 Malaysia(2018) 22,000 Females reporting having been paid in cash or any kind for sex with more than 1 client within the last 3 months 8,535,616 0.26 Myanmar(2015) 66,000 Females 15-49 yrs; having been paid for sex in cash or kind in the past 12 months 14,679,563 0.45 Mongolia (2019) 6,030 Biological females, aged 15 and over, who exchanged sex for money or gift in the last 12 months 850,979 0.71 Females 16 years and above, reporting having been paid in cash or kind for sex during the last 12 months. (establishment based, home based and street based) Females who exchanges sex with others in return for money or benefits, irrespective of site of operation (e.g. street, bars, home, hotel, etc.) Female 18+ yrs who received money or goods in exchange for sexual services on a regular or occasional basis over the past six months Nepal(2016) 49,013 8,191,447 0.6 Pakistan(2016) 174,101 50,898,692 0.34 Papua New Guinea(2019) (Port Moresby, Lae, Mt. Hagen) 48,286 2,212,709 2.18 Philippines(2019) 80,400 Females, 15 years or older who has accepted payment (cash or kind) in exchange for sex in the past one month 28,058,770 0.29 Sri Lanka(2018) 30,000 Any female who is selling sex in exchange of money or goods. 5,330,332 0.56 Thailand(2016) 129,133 Females 18+ yrs who exchange money or goods for sexual services, either regularly or occasionally within the last 12 months. 17,926,178 0.72 Timor-Leste (2019) 2,018 Information not available 316,526 0.64 Viet Nam(2019) 86,000 Females who are currently selling sex 25,489,272 0.34 Source: Global AIDS Monitoring reporting, China 2013 HIV estimation, and United Nations, Department of Economic and Social Affairs, Population Division (2020). World Population Prospects 2019

HIV prevalence and epidemiology www.aidsdatahub.org

HIV and AIDS Need for focused response in HIV: Epidemic mostly affecting key populations and their partners Data Hub for Asia-Pacific Distribution of new HIV infections by population, 2020 6 12 9 2 94% of new HIV infections among key populations and their partners 18 53 Transgender women People who inject drugs Men who have sex with men Sex workers Clients of sex workers and partners of key populations Rest of population Source: Prepared by www.aidsdatahub.org based on UNAIDS special analysis, 2021

HIV and AIDS Data Hub for Asia-Pacific HIV prevalence among female sex workers, 2012-2020 20 HIV prevalence (%) 15.5 15 10 8.3 6.3 5 3.2 3.1 2.8 2.2 2.2 2.1 1.6 1.2 0.8 0.3 0.2 0.2 0.2 0.1 0 0 0 * Dili and Bacau; ** 3 cities (Port Moresby, Lae, and Mt. Hagen) 7 Source: Prepared by www.aidsdatahub.org based on Integrated Biological and Behavioral Surveys; HIV Sentinel Surveillance Surveys; and Global AIDS Monitoring (GAM)

HIV and AIDS Data Hub for Asia-Pacific Geographic locations where HIV prevalence among FSW is higher than national prevalence, 2015-2020 30 % 24.7 25 19.6 17.8 20 16.9 16.5 14.9 15 11.1 8.8 10 7 6.1 5.1 4.8 4.8 4.7 4.5 5 0.5 0 Philippines India PNG Indonesia Myanmar Malaysia Thailand (Indirect FSW) Thailand Viet Nam Indonesia 8 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveillance Surveys; 2) HIV Sentinel Surveillance Surveys

HIV and AIDS Data Hub for Asia-Pacific HIV prevalence trends among female sex workers in ASEAN countries, where data is available, 2000-2020 40 Cambodia (IBBS) Myanmar (IBBS) HIV prevalence (%) Cambodia * (HSS) 30 Indonesia (IBBS) (Direct FSW) Lao PDR (IBBS) 20 Myanmar (HSS) Philippines (IBBS) 10 Thailand (HSS) (Direct FSW) Thailand (HSS) (Indirect FSW) Thailand (IBBS) Non-venue based Viet Nam (HSS+) 0 9 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveillance Surveys; 2) HIV Sentinel Surveillance Surveys; 3) Global AIDS Monitoring (GAM) Reporting

HIV and AIDS Data Hub for Asia-Pacific HIV prevalence trends among female sex workers in SAARC countries, where data is available, 2000-2018 12 India (IBBS) 10 HIV prevalence (%) Bangladesh (Street-based FSW, Dhaka) India (HSS) 8 6 Nepal (Kathmandu Valley) Pakistan 4 2 Sri Lanka Afghanistan 0 10 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveillance Surveys; 2) HIV Sentinel Surveillance Surveys; and 3) Global AIDS Monitoring (GAM) reporting

HIV and AIDS Data Hub for Asia-Pacific HIV prevalence among FSW in geographical locations where rising HIV prevalence trends are observed, 2007-2017 15.2 16 HIV prevalence (%) 13.2 10.0 7.4 8.8 10 8 3.6 0 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Jakarta, Indonesia Surabaya, Indonesia Penang, Malaysia Sukkur, Pakistan 11 Source: Prepared by www.aidsdatahub.org based on Integrated Biological and Behavioral Surveillance Surveys and HIV Sentinel Surveillance Surveys

HIV and AIDS Data Hub for Asia-Pacific Sexually transmitted infections (STI) prevalence among FSW, countries where data is available, 2012-2020 50 STI prevalence (%) Syphilis Chlamydia Gonorrhoea 40 32.2 29 30 21.4 18 21.2 20 15.9 14.6 16 11.6 7.3 6.8 10 6.5 4 7.5 2.2 2.2 1.9 1.8 1.8 1.7 1.2 1.1 0 * Direct FSW **Freelance FSW 12 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveillance Surveys; 2) HIV Sentinel Surveillance Surveys; 3) Global AIDS Response Progress Reports and Global AIDS Monitoring

Risk behaviors www.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Prevention services are reaching female sex workers, but accelerated action is required to reverse the HIV epidemic Condom use at last sex and consistent condom use with clients, regional median, 2012-2020 100 % HIV testing coverage trend among FSW, regional median, 2011-2020 90% 90 condom use at last sex 80 FSW 85 70 54 60 (%) 0 50 100 50 38 40 consistent condom use 30 20 FSW 65 10 0 0 50 100 (%) 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Source: Prepared by www.aidsdatahub.org based on Behavioral Surveillance Surveys, Integrated Biological and Behavioral Surveillance Surveys, Global AIDS Monitoring (GAM)

HIV and AIDS Data Hub for Asia-Pacific Proportion of female sex workers who reported condom use with their most recent client, 2015-2020 96 % 100 95 91 90 89 89 89 85 85 90 84 84 82 80 74 67 70 60 50 50 37 40 30 20 10 0 * Kathmandu; ** Port Moresby Source: Prepared by www.aidsdatahub.org based on Behavioral Surveillance surveys; Integrated Biological and Behavioral Surveillance Surveys and Global AIDS Monitoring

HIV and AIDS Data Hub for Asia-Pacific Need for a greater focus: a considerable proportion of surveyed sex workers are under 25 years of age Proportion of surveyed sex workers who are under 25 years of age where data is available 100 % * Female Entertainment workers, ** Direct FSW 80 60 83 40 65 57 50 42 20 37 34 30 29 27 24 18 17 8 0 Lao PDR (2014) Timor-Leste (Dili, 2016- 17 PNG (2016-17) Cambodia (2016) * Fiji Philippines (2018) Viet Nam (2016) Nepal (2017) Myanmar (2015) Pakistan (2016) Indonesia (2015) ** Malaysia (2017) India (2019-20) Sri Lanka (2017-18) (2012) Unmet HIV and health service needs of young sex workers: programs often do not reach young sex workers (no age disaggregated data) Legal policy barriers (i.e., condom policy not favoring unmarried young people, parental consent, existing gender inequality, etc.) Need for clarity on policy and programmatic approach for reaching under-18 young people who sell and buy sex Need to ensure broader opportunities health, education and security Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveillance Surveys; 2) HIV Sentinel Surveillance Surveys; 3) Behavioral Surveillance Surveys

HIV and AIDS Data Hub for Asia-Pacific Average duration of selling sex among female sex workers, countries where data is available, 2013-2018 25 Average duration of 19.1 20 sex work (years) 15 10 7.8 6 6 6 5.5 5 3.2 3 2 1.7 1.5 0 *Median duration of sex work 17 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveillance Surveys; 2) Behavioral Surveillance Surveys

HIV and AIDS Data Hub for Asia-Pacific Average number of clients reported among female sex workers, 2011-2018 40 in the last week in the last month 34 Averge number of clients 30 24 24 20 20 16 15 14 12 11 7 10 5 4 4 4 4 4 3 0 *median number ** median number of regular clients 18 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveillance Surveys; 2) Behavioral Surveillance Surveys

HIV and AIDS Data Hub for Asia-Pacific Proportion of female sex workers who reported consistent condom use with their clients, 2012-2018 100 % last month 80 last 3 months 60 last 6 months 94 88 86 81 40 75 66 64 64 last year 47 20 38 35 33 29 29 No defined period 0 * Dili; ** Colombo; *** Yangon; # Port Moresby; ## 22 Highway Districts 19 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveillance Surveys; 2) Behavioral Surveillance Surveys

HIV and AIDS Data Hub for Asia-Pacific Overlapping risk behaviors: Proportion of female sex workers who reported injecting drugs, 2014-2019 0 2 4 6 8 10 12 14 % 5 Philippines * (Cebu city, 2015) 0.6 Nepal (Kathmandu, 2017) Injected drugs in last 6 month 1.3 Cambodia (2016) 2.3 Nepal (Pokahara, 2016) Injected drugs in the last 12 months 3.2 Lao PDR (2014) 3.8 India (2019-20) 5.9 Pakistan(2016) Ever injected drugs 10.2 Pakistan(Street-based,2016) 10.4 Pakistan(Hyderabad,2016) 2 Viet Nam (2015) 3 Sri Lanka (Colombo, 2017-18) 12 Viet Nam (Hanoi, 2015) *freelance FSW 20 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveillance Surveys; 2) Behavioral Surveillance Surveys

Violence www.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Proportion of female sex workers who experienced physical violence, 2012-2017 last 3 months last 12 months ever % 56 60 52 47 50 45 40 37 40 32 28 26 30 20 10 7 10 0 Kathmandu Chandigarh Madhya Pradesh Odisha Mandalay Yangon Mt. Hagen Port Moresby Cambodia (2016) Nepal (2017)* Fiji (2012) India (2014-15) Myanmar (2015) PNG (2016) Pakistan (2016) * Female entertainment workers, **Street-based FSW Source: Prepared by www.aidsdatahub.org based on Behavioral Surveillance Surveys; and Integrated Biological and Behavioral Surveillance Surveys

HIV and AIDS Data Hub for Asia-Pacific Proportion of female sex workers who reported being forced to have sex in the last year, 2014-2017 100 % 80 53 60 51 49 45 41 38 40 28 28 26 17 15 13 20 0 Yangon Mt. Hagen Dili Madhya Pradesh Pakistan (all FSW) Mandalay Baucau Kothikhana-based Kathmandu valley 22 Terai districts Port Moresby India India (2014-15) Myanmar (2015) Nepal (2015-16) Pakistan (2016)* PNG (2016-17) Timor-Leste (2016-17) *ever beaten or forced to have sex Source: Prepared by www.aidsdatahub.org based on Behavioral Surveillance Surveys; and Integrated Biological and Behavioral Surveillance Surveys

Vulnerability and HIV knowledge www.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Proportion of female sex workers with comprehensive HIV knowledge, 2011-2019 100 % 80 66 64 55 60 48 41 37 35 40 32 27 27 15 20 11 0 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveillance Surveys; 2) Behavioral Surveillance Survey.

HIV expenditure www.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Key populations account for 98% of new HIV infections in Asia and the Pacific countries but less than half was spent for key populations HIV prevention programme Proportion of prevention spending among key populations in Asia and the Pacific region 250 Million US$ 210 200 40% 150 of total prevention spending 23% 10% 7% 100 84 49 50 21 14 - Total prevention spending Key populations prevention spending (20 countries) Spending on people who inject drugs (14 countries) Spending on men who have sex with men (19 countries) Spending on sex workers and clients (18 countries) 20 countries: Afghanistan, Bangladesh, Cambodia, India, Indonesia, Kiribati, Lao PDR, Malaysia, Myanmar, Nepal, Palau, Pakistan, Philippines, Samoa, Solomon Island, Sri Lanka, Thailand, Vanuatu, and Vietnam 27 Source: Prepared by www.aidsdatahub.org based on Global AIDS Response Progress and Global AIDS Monitoring (GAM) reporting

HIV and AIDS Data Hub for Asia-Pacific Prevention spending on key populations is heavily dependent on international financing sources Prevention spending by financing source, 2012 - 2017 100% 60% 82% 80% 73% 75% 50% 25% 40% 18% 20% 27% 0% Total prevention Prevention for MSM Prevention for sex workers Prevention for PWID % Domestic % International Note: Regional aggregate based on available data from 12 countries - Afghanistan, Bangladesh, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Nepal, Pakistan, Philippines, Thailand, Viet Nam - between 2012 and 2017 28 Prepared by www.aidsdatahub.org based on Global AIDS Monitoring Reporting, NASA reports

National response www.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific HIV testing coverage trend among female sex workers, regional median, 2011-2020 % 100 90% 90 80 70 54 60 50 38 40 30 20 10 0 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Source: Prepared by www.aidsdatahub.org based on Behavioral Surveillance Surveys, Integrated Biological and Behavioral Surveillance Surveys, Global AIDS Monitoring

HIV and AIDS Data Hub for Asia-Pacific HIV testing coverage among female sex workers, 2012-2020 % 100 90 80 72 69 69 67 66 70 61 57 55 60 54 46 50 41 39 39 35 40 30 30 25 30 20 6 10 0 * Kathmandu; ** Port Moresby data # Programme data ## Denominator used for calculating HIV testing coverage is total sample size of survey Data is not strictly comparable across countries since methods and sampling varied. In addition, many surveys were conducted in a few urban areas and it might not necessarily reflect prevailing conditions at the national level. Source: Prepared by www.aidsdatahub.org based on Behavioral Surveillance Surveys, Integrated Biological and Behavioral Surveillance Surveys, Global AIDS Monitoring (GAM) Reporting

HIV and AIDS Data Hub for Asia-Pacific Proportion of FSW reached with HIV prevention programmes in the last 12 months, 2015-2020 100 Prevention coverage (%) 88 80 87 82 Definition of reach: In the past three months, MSM reported receiving two or more of the prevention interventions listed below - Given condoms and lubricants Received counselling on condom use and safe sex Tested for sexually transmitted infections 72 60 63 61 54 50 40 40 40 37 20 27 18 15 13 0 * Programme data Source: Prepared by www.aidsdatahub.org based on Behavioral Surveillance Surveys, Integrated Biological and Behavioral Surveillance Surveys, Global AIDS Monitoring (GAM) Reporting

HIV and AIDS Data Hub for Asia-Pacific Proportion of FSW who avoided HIV testing services for fear of stigma Versus HIV testing coverage, countries where data is available, 2018-2019 % avoided HIV testing (Target = <10%) HIV testing coverage (Target = 90%) Mongolia (2019) Sri Lanka (2018) Source: Prepared by www.aidsdatahub.org based on Integrated Behavioral and Surveillance Surveys and Global AIDS Monitoring (GAM)

HIV and AIDS Data Hub for Asia-Pacific Punitive laws hindering the HIV response in South Asia, latest available data, 2014-2019 Sex work in private is illegal Soliciting for sex work illegal Sex work regulated and/or permitted in some locations The law or policy provides an enabling environment for HIV responses Afghanistan Punitive law or policy; there is no enabling law or policy; the law or policy does not provide an enabling environment for HIV responses Bangladesh Bhutan Partially enabling; enabling but subject to significant limitations; some aspects of the law or policy are punitive India Maldives Nepal Information is unavailable or unclear Pakistan Sri Lanka 34 Sources: Prepared by www.aidsdatahub.org based on UNAIDS and UNDP. (2021). Legal and policy trends. Impacting people living with HIV and key populations in Asia and the Pacific, 2014-2019.

HIV and AIDS Data Hub for Asia-Pacific Punitive laws hindering the HIV response in South-East Asia, latest available data, 2014-2019 Sex work in private is illegal work illegal regulated and/or permitted in some locations Brunei Soliciting for sex Sex work The law or policy provides an enabling environment for HIV responses Cambodia Punitive law or policy; there is no enabling law or policy; the law or policy does not provide an enabling environment for HIV responses Indonesia Lao PDR Malaysia Partially enabling; enabling but subject to significant limitations; some aspects of the law or policy are punitive Myanmar Philippines Singapore Information is unavailable or unclear Thailand Timor-Leste Viet Nam Sources: Prepared by www.aidsdatahub.org based on UNAIDS and UNDP. (2021). Legal and policy trends. Impacting people living with HIV and key populations in Asia and the Pacific, 2014-2019. 35

HIV and AIDS Data Hub for Asia-Pacific Punitive laws hindering the HIV response in East Asia, latest available data, 2014-2019 Sex work in private is illegal Soliciting for sex work illegal Sex work regulated and/or permitted in some locations The law or policy provides an enabling environment for HIV responses China Punitive law or policy; there is no enabling law or policy; the law or policy does not provide an enabling environment for HIV responses Japan Partially enabling; enabling but subject to significant limitations; some aspects of the law or policy are punitive Mongolia DPR Korea Information is unavailable or unclear Republic of Korea 36 Sources: Prepared by www.aidsdatahub.org based on UNAIDS and UNDP. (2021). Legal and policy trends. Impacting people living with HIV and key populations in Asia and the Pacific, 2014-2019.

HIV and AIDS Data Hub for Asia-Pacific Punitive laws hindering the HIV response in the Pacific, latest available data, 2014-2019 Sex work in private is illegal work illegal regulated and/or permitted in some locations Fiji Soliciting for sex Sex work The law or policy provides an enabling environment for HIV responses Kiribati Punitive law or policy; there is no enabling law or policy; the law or policy does not provide an enabling environment for HIV responses Marshall Islands FSM* Nauru Partially enabling; enabling but subject to significant limitations; some aspects of the law or policy are punitive PNG Samoa Solomon Islands Information is unavailable or unclear Tonga Tuvalu Vanuatu * Micronesia (Federated States of ) 37 Sources: Prepared by www.aidsdatahub.org based on UNAIDS and UNDP. (2021). Legal and policy trends. Impacting people living with HIV and key populations in Asia and the Pacific, 2014-2019.

HIV and AIDS Data Hub for Asia-Pacific THANK YOU slides compiled by www.aidsdatahub.org Data shown in this slide set are comprehensive to the extent they are available from country reports. Please inform us if you know of sources where more recent data can be used. Please acknowledge www.aidsdatahub.org if slides are lifted directly from this site 38