I have always had an interest in the country of Madagascar, maybe for the serene scenery or maybe because of the people and the culture. Because of this, it only made sense for me to pick Madagascar as the country I want to write about for my final blog post. The issue I will be focusing my attention on in this paper is the issue of women’s health and sex work in Madagascar. More specifically, I want to look at the issue from epidemiological approach and come to some conclusions about what we can do to aid in getting women the help they need health wise as well as what we can to do help decrease the amount of sex workers in the first place.
Madagascar is a small island country off the coast of Eastern Africa. It is “almost four times the size of Georgia; slightly less than twice the size of Arizona”, according to the The World Factbook and the CIA (The World) . In July of 2017, there was estimated to have been a little over 25,000,000 people living on the island (The World). Of these 25,000,000 inhabitants, it is estimated that in 2014 about 167,443 were sex workers (Madagascar 2016). Now, that may not seem like a lot of people, but it is a way bigger number than what it should be.
Women get into sex work for a multitude of reasons. One of which may be that their family is in need of financial help so the burden falls on them to make money and sex work is a quick fix (The Horror). Another reason may be that the women know what men want and choose to exploit themselves for monetary gain (Stoebenau 2009). The most disturbing option is that these women are forced into it whether it be when they were children or even as adults to make money for someone like a pimp. Pimping out women for money is not legal in Madagascar, but it does happen (Stoebenau 2009). Despite the reason these women are going into the sex working field, the fact that they are is having long lasting health effects for not only them but the people around them. Because there are women that work in the field of sex work, there are diseases that spread such as HIV and AIDS. Another diseases that is spread is syphilis. According to the UNAIDS website, in 2016 about 5.5 % of women had HIV and 12% of women had syphilis contracted through sex work (Madagascar). This is not surprising due to the lack of condom use on the women’s part, which is only quoted at 62.8% (Madagascar).
Looking at the issue from an epidemiological point of view, we would ask ourselves, at the population level, what can we do to get rid of the issue (Lecture 1.2)? In the 2017 Trafficking in Persons Report, this is what is said about the government in Madagascar as it pertains to the issue of sex work: “The Government of Madagascar does not fully meet the minimum standards for the elimination of trafficking; however, it is making significant efforts to do so. The government demonstrated significant efforts during the reporting period by expanding the child protection network and by working at the regional level to combat child sex trafficking “(Madagascar: OFFICE). We all know Madagascar is not one of the richest countries in the world so the government may not have the money nor the resources to do much about the sex trafficking and sex taking place in its country. But the community can do something. In the 2017 Trafficking in Persons Report, it is mentioned that something that would help aid in the issue of sex work is to “develop formal procedures for, and provide training to officials on, proactive measures to identify victims, investigate cases, and refer victims to appropriate services” (Madagascar: OFFICE). Another thing they mentioned we can do is “increase efforts to raise public awareness of labor trafficking, including of adults subjected to forced labor” (Madagascar: OFFICE). These are not necessarily things the population can control because it is more up to the government, but what we can do is make people more aware of the issues. Such issues being the spread of diseases such as HIV and syphilis.
In one of the articles we read for this class during week 5, the author Donald Joralemon talks about how significant epidemics come with substantial knowledge associated with what causes the disease (PDF: 1.1). He also talks about there being links between epidemics and social factors (PDF: 1.1). I think in terms of us trying to decrease the amount of diseases spreading and also aid in helping keep women safe and healthy, we not only need to educate people on the issue, but we also need to be aware of some factors effecting the issue. One of those issues is poverty. Poverty is big in Madagascar and because people need money to get food, and essentially survive, going into sex work is one of those things that seems to make sense for a lot of women because it is easy money. To get a better idea of just how bad the poverty in this country is, we can look at the writing from the article in the UK HuffingtonPost. “Poverty is everywhere. It’s evident as soon as you set foot out of the airport. I’m in Madagascar. Little kids in filthy clothing run to you to beg for a few coins as you struggle to lift your bag into the taxi. As you exit the airport in Antananarivo mud lined streets are filled with small makeshift stalls and women desperately trying to sell something. Gangs of young men in torn clothing roam the streets, the homeless lie on the sides of the road and small children, no older than 4 years old are left alone to beg for money. The poverty is startling” (The Horror). The Huffington Post article talks heavily about poverty playing such a big role in the sex work field. This article also talks about even though there is not a way to end poverty, we can do something about the sex work and trafficking going on and that is to teach then men in our lives to have a greater respect for women and it is never okay to take advantage of vulnerable women and children (The Horror).
Another issue that leads to sex work and ultimately the issue of spreading diseases is the use of condoms when engaging in sexual behaviors with strangers. In a study done by Audrey Pettifor and her staff where they test the use of condoms among sex workers in Madagascar, we see that “more than 40% of participants (192 total sex workers studied) reported never using a condom with their main partner, compared to 0.5% who never used male condoms with clients” (Audrey). Also in this study, it was found that “more than half of the women (52.6%) reported having no or little control over condom use with their main partners compared to 40.2% with clients” (Audrey). This demonstrates a huge issue right there. In order to be better protected from diseases such as HIV, AIDS, and syphilis, one has to use protection. In order for us to keep sex workers healthy, we need to be making sure condoms and other forms of protection against STIs are being implicated. When sex workers get into the car with their clients, they do know know their client’s past. They do not know who they have had sex with nor do they know if they are clean of any diseases. In order to keep sex workers safe, we need to make sure diseases are not getting spread because of people being careless. We also need to worry about women’s health in the aspect of them going to the doctors and getting the medical attention they need to make sure their lifestyle is not endangering their health.
One thing that sucks is that Madagascar is such a poor country. The government need more money in order to fund more health care facilities and more health care facilities need to be established so these women in the sex work field feel safe enough and secure enough to seek help for their own well being. In an article that talks about Madagascar’s health challenges, we see that access to health care is hard to come by (Barmania). “Many people find it difficult to access health care despite it being free of charge; 40% of the population live in areas far from health centres”(Barmania). There just needs to be better access to health care. We cannot go on like this. In an article about sex for survival, it is said that “about one in seven residents of Madagascar’s main port city of Toamasina are sex workers” (Sex for Survival). “In less than 20 years, the number of registered sex workers in the city of about 200,000 residents has climbed from 17,000 in 1993 to 29,000 in 2012. The increase has been driven by rising poverty levels as well as the city’s proximity to the recently opened Ambatovy nickel mine. Prostitution has become a normal phenomenon in Madagascar… Now sex has become a product, a means to survive” (Sex for Survival). “Sex work is legal in Madagascar, and although HIV/AIDS prevalence is low compared to other southern African countries – with about 0.2 percent of people between the ages of 15 and 49 living with the virus, according to UNAIDS – the incidence of sexually transmitted infections (STIs) like syphilis is well above regional norms. According to government figures, 4 percent of pregnant women are infected with syphilis, as are 12 percent of female sex workers” (Sex for Survival).
What is being done? “In recent years, commune governments have established an identity card system for sex workers, providing them with specialized health care and legal protections. The cards are only distributed to those who apply for them and only if they are over the age of 18″(Sex for Survival). But what about those who cannot apply for the cards? What about the children forced into sex work by pimp? Or the children who do it because they are providing for their family? Or even the women who do it to provide for children they cannot afford to take care of?
Even though we cannot end the epidemic of HIV, AIDS, and other diseases such as syphilis, we can do other things such as make women aware of the risks they are taking in not using a condom with their clients. We can educate the general public of the health issues arising from the rise in sex work in the area. We can make health care facilities more readily accessible so women are able to take care of their health. We can also get more involved in the government side of things and help implement polities to keep women safe. Vaccinations are always an option. While Madagascar is still a very poor country and may not be able to afford a ton of vaccinations for some of the diseases readily able to be caught, we can at least vaccinate some women so that there is a safeguard in place for them in their field of work.
There are a multitude of ways we can help women stay safer and healthier in the field of sex work. All we need to do is come together and educate. Educate the men about safe sex practices and treating women with respect. Educate women on how to demand respect as well as how to demand the use of a condom when engaging in sexual activities. We can educate the public as to where the nearest health facility is so they can keep themselves safe. And I would say the last thing we can do is to keep ourselves safe. As women, we should be making sure we are keeping up on our health and making sure we do not have any diseases. Like the lecture on the first week of class talked about – we need to be asking answering the following question: how can humans intervene in the outbreak of this disease, especially on the population level? Some of the suggestions about how to get rid of the issue of women’s health in the sex work field are at an individual level, but they all lead to the bigger picture – the population level. Everyone has a part to play in keeping the community safe and once you keep yourself safe and healthy, you can join in the community and help keep the women in the sex work field healthy!
Audrey Pettifor, et al. “Perceived Control over Condom Use among Sex Workers in Madagascar: a Cohort Study.” BMC Women’s Health, BioMed Central, 28 Jan. 2010, bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-10-4.
Barmania, Sima. “Madagascar’s Health Challenges.” The Lancet, vol. 386, no. 9995, 22 Aug. 2015, pp. 729–730., www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61526-4/fulltext.
Lecture: 1.2. Introducing Theory 1: Epidemiological Theory
“Madagascar: OFFICE TO MONITOR AND COMBAT TRAFFICKING IN PERSONS.” U.S. Department of State, U.S. Department of State, www.state.gov/j/tip/rls/tiprpt/countries/2017/271233.htm.
“Madagascar 2016 Country factsheet”. UNAIDS.
PDF: 1.1. Joralemon, Donald. Chapters 3 and 4 – “Recognizing Biological, Social, and Cultural Interconnections” and “Expanding the Vision of Medical Anthropology” In Exploring Medical Anthropology (Pages 30-56)
“Sex for Survival.” IRIN, 1 Dec. 2015, www.irinnews.org/report/96193/madagascar-sex-survival.
Stoebenau, K. (2009). Symbolic capital and health: The case of womens sex work in Antananarivo, Madagascar. Social Science & Medicine, 68(11), 2045-2052. doi:10.1016/j.socscimed.2009.03.018
The Horror of Sex Tourism in Madagascar”. HuffPost UK. 28 June 2016.
“The World Factbook: MADAGASCAR.” Central Intelligence Agency, Central Intelligence Agency, 7 Aug. 2018, www.cia.gov/library/publications/the-world-factbook/geos/ma.html.