Sex workers assess implementation of SWIT

Asia Pacific Network of Sex Workers (APNSW) held a five-day “SWIT” regional training  from 24-28th April 2017 in Bangkok, Thailand. Participants came from Papua New Guinea, Pakistan, Myanmar and China.

The Sex Workers Implementation Tool, or “SWIT,” summarises how best to put HIV and STI testing, treatment and prevention strategies for sex workers into practice. The most effective implementations are ones directed by sex workers, in ways that empower sex workers.

“It was so friendly training. Here was fun, education and lots of activities. I could not believe five days went so fast,” said one participant from China.

And a participant from Myanmar told APNSW: “We got more confidence from this training, and we understand that we are going in right track. But we also learned that we need to do more.”

During the regional training participants shared their experiences of how much the activities currently happening in their countries match the guidelines in the SWIT.

Graphic from the SWIT book showing six circles corresponding to steps in effective programming: 1) Community Empowerment 2) Addressing Violence against Sex Workers 3) Community-led services 4) Condom and lubricant programming 5) Clinical and support services 6) Programme and organisational capacity building
The key steps in implementing HIV and STI programs with sex workers.


According to participants from China, there is very little in terms of sex worker community empowerment happening in China at an official level. Most programs in China are conducted by the state, including condom distribution, awareness programs and clinical services. There are no programs addressing violence, as the government does not acknowledge the existence of violence against sex workers.

“For the problems of sex workers, it is necessary for sex workers to talk about them, they cannot be represented by other people.” – participant from China.

At the community level, a number of sex worker led groups are active in building community solidarity, networking and supporting each other. This includes using their own resources to assist sex workers in police detention. Some groups are engaged in outreach work including condom/lube programming and HIV testing, and collaboration with international partners to do research. Where possible, these groups also seek to build their own skills in organizational management.

However, China is a very large country and despite active community efforts in certain areas, the bigger picture is one of non-participation of sex workers in HIV and STI response. There is little or no involvement in clinical services, and there are no rights-based programs at all.


Community groups in Myanmar are active and strong in HIV and STI response according to participants from AMA. Most of the sex worker led organisations have funding to do their work. The Myanmar Government are positive about working together with community groups, especially through the National AIDS Program (NAP).

Participants work in small groups round a table at the APNSW Regional SWIT training, held in a hotel meeting room in Bangkok, April 2017

We got more confident and we understand that we are going in right track. We need to do more which we learn from this training.” – Myanmar participant.

AMA has many formal activities that are based on community empowerment principles, and provides a training course on community empowerment itself. Sex worker community leaders are visible and well known around the country, and they are regularly invited to share sex worker perspectives with decision makers including at national level meetings.

There are also efforts to respond to violence against sex workers in Myanmar. AMA is about to start a program to respond to violence against sex workers in four major cities. This will include practical support activities such as hotlines, health and psycho-social support, documentation of cases, legal support and advocacy around law reform. This program is in partnership with APNSW and funded by UN Trust Fund.

Community-led outreach, and condom and lubricant programming is largely implemented and managed by sex workers in Myanmar. Whether the program is run by a national or international NGO, sex worker community members are involved everywhere.

Clinical support services are the only areas where national and international organisations are still the primary service provider. Community led organisations are not yet providing much in the way of clinical services.

Some community led organisations have developed their organisational and management skills to an adequate level. And there is support from UN and donors to build capacity and skills of community based organisations.


Participants from Pakistan shared that the involvement of community groups in HIV/STI response is still at a very basic level in Pakistan. There are a few sex worker led organizations, but their voices are still not recognized at the national level. Overall, sex workers are not very involved with HIV and STI response programs.

Pakistan is far behind and we need to do many things. We thought we are doing well, but now we understand we need to do much more.” – participant from Pakistan.

There are no activities on community empowerment, no response to violence against sex workers, and sex workers are not involved in providing clinical services Some organisations are working on outreach and condom distribution programming.

As a very male-dominated country, men control most programs and activities for sex workers. Sex worker-led organizations are mostly limited to within brothel areas, as men do not want to be seen associating with brothels.

National organizations, international organizations, and some government programs engage in outreach, condom distribution and clinical services. However the involvement of sex workers in the design or implementation of these programs is very limited. There are no initiatives to develop the skills and capacity of sex worker led organisations.

Papua New Guinea (PNG)

Participants from PNG told the group Friends Frangipani is the only sex-worker led program in PNG, but currently they have no funds, no office and no activities. The main source of funding for HIV response in the country is the Global Fund (GF), however all GF activities are managed by national and international NGOs and do not involve community-based organisations.

Participant from PNG points out responses on a flipchart for each thematic area of SWIT.

“The beauty of this training was to share the experiences from different country.” – participant from PNG.

There are no specific activities on community empowerment, capacity building or human rights in PNG. Some sex workers are involved with the bigger organisations as peer outreach workers, however, they have no voice or decision making power within these programs. They only do outreach activities.

Clinical services and outreach programs are all managed by non-sex worker led organisations. The meaningful involvement of sex workers in programs that affect them is almost zero in the country.


Despite the SWIT being published in 2013, and being a WHO reference document for public health policy, it is clear many states in Asia and the Pacific have not yet engaged with these guidelines.

One reason for this is that nobody is leading strong initiatives to involve sex workers in HIV and STI response. And in practice, the strong stigma and discrimination sex workers face also contributes to policies that exclude sex workers from playing a lead role in protecting and promoting their own health and rights.