UN Integrated Regional Information System - November 3, 2008

"I don't want to do this kind of work, I want to finish school," she told IRIN/PlusNews. "But I feel I don't have anyone; my family can't help me." Even if she had finished school, things may not have turned out differently for Marie Jessy, who lives in the poorest country in the Western Hemisphere.

More than 60 percent of Haitians live in poverty on less than US$2 a day, and the unemployment rate is over 30 percent. In the past year they have been struggling to cope with crippling increases in the prices of food and transport, while remittances from family members living overseas have been shrinking; both consequences of global economic trends.

The four consecutive tropical storms that hit the Caribbean island nation in August and September wiped out much of the country's agricultural sector and cut roads to many cities, pushing living costs even higher.

The resulting food crisis already threatens many HIV-positive people who can no longer afford adequate nutrition, but it may also increase the number of new infections as more desperate young women resort to sex work to survive.

According to the 2008 UNAIDS Epidemic Update, overall HIV prevalence in Haiti has halved in recent years to the current rate of 2.2 percent, but the number of young Haitians having sex before the age of 15 has increased, while condom use among women who had more than one sexual partner in the last 12 months has decreased.

"Women are particularly vulnerable," noted Steeve Laguerre of Catholic Relief Services, an international non-governmental organisation (NGO) that provides food and other support to people infected and affected by HIV. "We have a lot of cross-generational sex between young girls and older men who can provide for them."

Marie Jessy is off the streets now and living with her 32-year-old boyfriend. "People ask me if he's not my father or older brother, but that doesn't bother me because I need his help," she said.

The reasons women enter into such relationships were nearly always the same, said Fritz Moise, executive director of the Foundation for Reproductive Health and Family Education (FOSREF), a local NGO that runs drop-in centres for young people and sex workers: "Poverty, misery, and many of them have a child to support."

FOSREF runs 29 centres around the country: 16 assist youth, while 11 assist sex workers, but according to Moise, there is an increasing overlap between the two.

"The sex business starts at [the age of] 15 or 16. They go to the youth centres, but they won't admit they're sex workers," he said. "They're the most at risk because the clients are mostly older, married men who think it's safer to have unprotected sex with a young girl."

The FOSREF centres, called "Lakay" (Creole for our home), offer counselling and testing for HIV, treatment of other sexually transmitted infections (STIs), and vocational training that aims to give the women an alternative to sex work.

"Our job is easy, because in most places any job will pay more than what they make," said Moise, who estimated that most sex workers in Port-au-Prince's downtown area earned less than US$1 per client, and slightly more in Petionville, an affluent suburb in the hills above the city.

Seven years ago, the rate of HIV infection among sex workers in some parts of the capital was as high as 30 percent, but testing figures from FOSREF's centres now indicate a prevalence of about 6 percent.

Many have died and some have moved out of prostitution, but Moise also attributed the decline to FOSREF's aggressive promotion of condoms. To participate in the vocational training programmes and benefit from other services the centres offer, the sex workers must commit to a "100 percent condom policy", which is strictly enforced.

"We use mystery clients who offer extra money to have sex without condoms," he explained. "If she agrees, she loses access to all opportunities through the programme."

The policy may seem harsh, but Moise insisted it was effective, although there was no way of ensuring that the women used condoms with their regular boyfriends.

Adele*, 23, got into sex work after she finished school and could find no other way to support herself. Before coming to the FOSREF centre in Carrefour, an impoverished neighbourhood in Port-au-Prince, she knew about condoms but had used them infrequently. Now she always uses them, even with her boyfriend. "I have to protect myself because I don't know if he protects himself," she said.

Most people living in Carrefour are unemployed and "living in very precarious conditions", according to Rose Anne Auguste, who runs a community-based organisation that supports HIV-positive women in the area.

Many of the women depend on male sexual partners for financial support and protection from the sexual violence that is rife in the city's slums. "If there was socio-economic security for the woman, it wouldn't be necessary for her to find a boyfriend," said Auguste. "They have one boyfriend, but the men have several girlfriends at a time."

Marie Jessy talks wistfully of returning to school, but her hopes for a future that doesn't involve sex work seem to be more strongly tied to finding "someone special".

"Most guys outside aren't good," she said, picking at some scabs on her arm, the legacy of a recent fight with another girl who attacked her with a broken bottle. "I want someone who will help me."

*Not their real names

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