12 1 Introd
duction Seeing the change taking place in participants, the bond and trust they built up with each other after a difficult start was the most rewarding of the Move Forward Project for us. 13
14 01 Chapter s Structure 1.1 Key Objectives and Activities page 12 1.2 Local Partner Organizations page 13 1.3 Project Approach page 13 Determinants of Career Development for Sex Workers page 14 1.4 Project Components page 15 Needs Assessment page 15 Desk Research page 15 Pilot Projects page 15 1.5 Project Evaluation page 16 Objectives of the Evaluation page 16 Methodology page 16 1.6 Composition of this Report page 16 1.1 Key Objectives and Activities Worldwide, sex work is often criminalized and surrounded by stigma and discrimination. This places sex workers in a marginalized position, which makes them more vulnerable to STIs and HIV and different forms of exploitation. Soa Aids Nederland considers empowerment of sex workers and sex-workerfriendly services essential in order to improve their position. Sex workers career opportunities increase when they are able to make better-informed decisions about their future and to move forward. Yet establishing programmes for sex workers to leave the sex sector is not a simple task and there is no one-size-fits-all solution. Contextual determinants like poverty, lack of alternatives, stigma, and discrimination are deep-rooted factors that hinder sex workers from altering their careers. Through the Move Forward Project, Soa Aids Nederland conducted research and set up pilot projects to explore and improve different strategies to support sex workers in taking career development opportunities. Soa Aids Nederland finds that career development projects for sex workers should aim at empowering participants with the life skills, information and support needed to make betterinformed decisions about their current and future life.
15 The key objectives of the Move Forward project were: 1. To document good practices, contextual determinants and (pre-)conditions of career development programmes for sex workers. 2. To identify the potential effects (both favourable and adverse) of the proposed career development programmes on the position of sex workers. 3. To identify needs and strengths of sex workers to enhance their empowerment through career development programmes. 4. To implement partner projects to improve career development opportunities for sex workers. Thereby focusing on the empowerment of sex workers and on improving sex-worker-friendly services in a way that career development strategies can be embedded in a good local structure. To realize these objectives the Move Forward Project consisted of four components: 1. A thorough assessment of needs and strengths of sex workers. 2. Desk research regarding good practices for career development for sex workers. 3. Partner projects on career development in all four countries with the help of strong existing partner organizations and (international) networks. 4. A final evaluation of the project results, including conclusions and recommendations for future work. The Move Forward Project was implemented in four countries: Macedonia, Uganda, Vietnam and Egypt, together with local partner organizations. The project began in September 2009 with the preparation of the first needs assessment in Macedonia and ended in May 2012 with a closing conference in Amsterdam that was attended by sex workers and staff of local organizations from all four countries. 1.2 Local Partner Organizations The improvement of the social and economic circumstances of sex workers cannot be accomplished overnight but requires long-term investment and involvement. Therefore, Soa Aids Nederland chose to enter into partnerships with local organizations that already had an established reputation in terms of working with sex workers and would continue to have one after the project ended. Exceptions included some sex workers organizations that had only started recently. However, these organizations had sufficient strengths and great potential to qualify for the Move Forward Project. In Macedonia, the Move Forward partner was the Healthy Options Project Skopje (HOPS), a local NGO that provides services for sex workers in Skopje, Strumica, Gostivar and Ohrid. In Uganda, Soa Aids Nederland worked with three organizations: WONETHA, UYDEL and War Child Holland. WONETHA is a sex workers organization based in the capital, Kampala. UYDEL, a local NGO also works in Kampala. War Child Holland works in northern Uganda, a conflict area where it focuses mainly on young women. In Vietnam, Soa Aids Nederland worked with the sex workers organization Noi Bin Yen Group and the Centre for Supporting Community Development Initiatives (SCDI) in Hanoi. In partnership with UNAIDS, the Provincial Aids Committee (PAC) in Ho Chi Minh City was supported. In Egypt, Soa Aids Nederland entered into partnership with the El Shehab Foundation for Comprehensive Development, within the Joint Programme of UNFPA. El Shehab is the only Egyptian NGO working with and for sex workers and provides different services in Cairo. 1.3 Project Approach Predominant in Soa Aids Nederland s vision is the universality of human rights, which should equally apply to sex workers. These rights include the right of access to health care, social services and legal aid; protection against discrimination; as well as the right to free choice of employment and safe working conditions. Soa Aids Nederland believes that empowerment of sex workers and sex-worker-friendly services are essential in order to improve their social, psychological and health situation. Enlarging career development opportunities using a rights-based approach is a strong means of empowerment. Sex workers should not in any way be coerced into rehabilitation programmes and forced to withdraw from sex work against their will. Another essential feature of Soa Aids Nederland s approach is the inclusion of sex workers in project development, implementation and evaluation. Far too often projects consider sex workers only as the recipients of services, not decision makers. In many cases activities are developed without exploring their effectiveness or whether they meet the needs of sex workers. In contrast, the Move Forward Project began with a thorough assessment of the needs and strengths of sex workers through individual, in-depth interviews and focus group discussions. The outcomes of this needs assessment formed the basis for the partner projects.
16 Soa Aids Nederland s approach is derived from the determinants of health originally developed by the World Health Organization (WHO). The WHO points out a number of factors that influence a person s health, including the individual level, the physical environment and the social and economic environment. Likewise, Soa Aids Nederland has developed determinants that influence opportunities for career development for sex workers on four levels: the individual level, the community surrounding the sex worker, the social and economic system she or he lives in and public opinion. Interventions regarding career development for sex workers often address more than one level. Determinants of Career Development for Sex Workers PUBLIC OPINION SOCIAL & ECONOMIC SYSTEM Police, legal system health institutions Family & children, friends, lovers, COMMUNITY SEX WORKER pimps, managers, Social providers other sex workers, local community education, civil society Level 1: Individual Sex Worker Interventions on this level address the individual sex worker, his or her well-being and skills. Interventions aim for example at building self-esteem, literacy skills, vocational, business and saving skills of individual sex workers. Level 2: Community A supportive environment is crucial for sex workers self-esteem and motivation. Interventions on this level involve the community surrounding the sex worker, stimulating possibilities for change. These may include activities aimed at sex workers children, but also providing support by peer educators or caregivers as well as strengthening sex workers organizations. Awareness-raising activities focusing on the local community or brothel owners also fall into this category. Level 3: Social and Economic System This level involves the broader social and economic system that a sex worker lives in. Often the formal system does not match the dynamics of sex workers lives. It is hard to access a tightly organized formal system, and many sex workers are discouraged from participating. Interventions focusing on this level aim to provide access, including access to justice, health, education and employment opportunities. Level 4: Public Opinion Public opinion is based on culture, norms, values and attitudes. Sex workers are subject to harsh discrimination and stigmatization by public opinion. Interventions on this level aim to change public opinion towards a focus on human rights for all citizens, including sex workers. Bottom-up advocacy to promote sex workers rights also falls within this level. Most of the interventions in the Move Forward Project were directed at the first and second levels, improving individual sex workers skills and well-being and creating support from their direct community. Much effort was also put into providing access to the social and economic system at the third level (access to justice, health, education and income). Some partners also aimed at influencing public opinion on the fourth level. All levels together form a holistic approach.
17 1.4 Project Components Needs Assessment The Move Forward Project started with a thorough assessment of sex workers needs, which provided vital input for the implementation of the partner projects. The needs assessment took place between November 2009 and June 2010. Individual in-depth interviews, focus group discussions and observations were conducted using a qualitative methodology. The individual interviews were semi-structured and could be described as guided conversations. A questionnaire was used as a guide, but effort was made to shape the meetings into real conversations in which the interviewee could take the lead in terms of the subjects he or she wanted to tackle most. In the focus group discussions much emphasis was laid on creating a atmosphere of trust and empowerment of the participants. In Macedonia, Egypt and Vietnam, Soa Aids Nederland and the partner organizations began the needs assessment with a kick-off week. After a field visit by Soa Aids Nederland, the local partner organizations carried on with the needs assessment, thereby validating themselves and their contacts with the sex workers involved in the interviews. Only in Uganda was the needs assessment carried out entirely by a local consultant, in close cooperation with Soa Aids Nederland and the local partner organizations. Through the assessment of needs and strengths the voices of sex workers were heard. In total Soa Aids Nederland and its partners spoke with 223 sex workers in Macedonia, Egypt, Uganda and Vietnam, 65 during individual in-depth interviews and 158 in focus group discussions. The majority of the sex workers participating in the needs assessment were female (84%), whereas 12% were men and 4% were transgender. Individual interviews Focus Group Discussions Female Male Transgender Subtotal Female Male Transgender Subtotal Total Macedonia 10 3 13 14 7 6 27 40 Uganda 13 1 1 15 62 5 67 82 Vietnam Hanoi 8 8 15 15 23 Vietnam HCMC 8 5 1 14 7 5 1 13 27 Egypt 15 15 36 36 51 Total 54 9 2 65 134 17 7 158 223 Throughout the needs assessment, sex workers played a vital role. Before starting the interview process, the questionnaire was first addressed and changed according to local circumstances and feedback from sex workers. In Hanoi, Vietnam for example, the Noi Bin Yen group ( The peaceful place ), is a fast-growing sex workers organization whose presence at all the interviews created a atmosphere of trust and made it possible to talk about issues that had never been discussed before. The fact that questions were being asked by sex workers themselves with no moral judgment attached, enabled the participants to talk freely and also to mention positive aspects of sex work and the dilemmas they deal with on a daily basis. This non-judgmental approach was also implemented in the other countries. As a result, a simple interview often turned into an empowering intervention that contributed to the self-esteem of those involved. Desk Research For the desk research, a two-pronged approach was used. A literature review was conducted into previous projects aimed to improve sex workers social and health position. The findings of this review were used to support the empirical data from the Move Forward Project. Interviews with 14 experts were conducted as an additional source of information about the sex sector and the dynamics that surround support strategies for sex workers. Some experts represented organizations implementing career development programmes themselves and were valuable sources for further documents and good practices. Together, the literature and interviews led to the phrasing of key elements for success of career development programmes for sex workers. Pilot Projects In all four countries, the Move Forward partner organizations implemented rights-based projects to support the career development of sex workers. The partner projects started in 2010 and the implementation period ranged from 12 to 18 months. All projects aimed at further investigating the possibilities and methodologies for improving sex workers career opportunities, health and safety. The projects had an exploratory character, informed by the needs assessment with the aim of building sustainable programmes.
18 Although all pilot projects were set up based on the approach described above, they also differed in some ways. Some differences related to the region where the project was implemented. What works in Africa does not necessarily work in Asia. Other differences were due to the diversity of partner organizations involved. For example, the sex workers organization Noi Binh Yen in Hanoi, Vietnam, has a significantly different approach towards the issue of career development of sex workers than the provincial governmental organization PAC in Ho Chi Minh City, Vietnam. These differences also reflect the activities implemented by both organizations. Furthermore, in some countries, like Macedonia for example, there is already a social infrastructure that sex workers can use up to a certain degree, whereas in other countries, such as Uganda, this infrastructure is totally absent. This too influenced the nature and scope of the pilot projects. 1.5 Project Evaluation The last component of the Move Forward Project consisted of the evaluation of the project results. The evaluation aimed to highlight the achievements of the project as well as the obstacles that had to be tackled and which, in some cases, still remain. A separate report has been published on the results of the Needs Assessment and the Desk Research, when the partner projects were in the first phase of implementation. In this final report, the main outcomes of the desk study and the needs assessment are lightly touched on again, supplemented by the evaluation of the partner projects and the Move Forward Project as a whole. Objectives of the Evaluation The key objectives of the evaluation can be described as follows: To determine the extent to which project results have been achieved and to identify the key processes and activities contributing to achieving these results. To assess the effects and impact of the activities in relation to the project s results and objectives. To identify lessons learned, including challenges, successes and unexpected outcomes or consequences of the activities. To draw conclusions and make recommendations for future initiatives. Methodology The methodology used to evaluate the results of the pilot projects and the Move Forward Project as a whole were mostly qualitative in nature, with the use of quantitative data where possible. It consisted of the following: Development of questionnaires to be used during interviews with representatives of partner organizations and individual sex workers who participated in the pilot projects; Interviews with representatives of the partner organizations, both at executive and ground level; Analysis of the main documents related to the project, such as the terms of reference, project proposals, interim and final reports, reports of Soa Aids Nederland to the Dutch Ministry of Foreign Affairs and information derived from the needs assessment and desk research into good practices of career development of sex workers. Due to limited time and resources, an extensive survey of individual sex workers who participated in the pilot projects was not possible. Nor was it possible to hold interviews with other stakeholders participating in the partner projects. This report is not a blueprint with a list of dos en don ts for organizations that wish to set up similar projects in other countries. For this, the partner projects were too uniquely developed for each country and by each partner organization. Nevertheless valuable conclusions and recommendations can be drawn for future projects on career development for sex workers, both for the Move Forward partner organizations and possible new initiatives in other countries. 1.6 Composition of this report Chapter 2 presents the results of the desk research, including an overview of key elements for successful projects on career development for sex workers. Chapters 3 to 6 present the results of the partner projects in Macedonia, Uganda, Vietnam and Egypt, giving voice to sex workers and the organizations supporting them. Chapter 7 provides sets out the lessons learned from the Move Forward Project. It provides an overview of what turned out to be the most critical issues when setting up career development initiatives for sex workers, as well as a summary of recommendations for future projects. 1 Soa Aids Nederland, 2010
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