AMSA Conference : Part 3
More from the AMSA Conference from Lily Gutnik-Rhona 
Hundreds of more medical students arrived in Houston, Texas for the official first day of the AMSA convention. Reunions were made as well as new relationships formed among medical students and speakers throughout this busy day. The keynote speakers were Houston locals, Mayor Bill White and Director of Emergency Medical Services Dr. David Persse. They shared their heart-wrenching personal tales of trial, endurance, and lessons learned when they were faced with aiding in the aftermath of Hurricane Katrina. Later on in the evening, Dr. Evangeline Franklin, a New Orleans native and the current New Orleans Director of Director of Clinical services and Employee Health shared her poignant experience with Hurricane Katrina at the Women Leaders in Medicine Award and Reception.
Moving on from the environmental disaster in the Southern U.S. to a social disaster in Southeast Asia, Zafar Mithavayani uncovered the taboo subject of Thailand sex workers.
Mr. Mithavayani presented his findings as the four stages of sacrifice. The first stage involves young girls being sold as commercial sex workers. This is particularly seen among very poor families who have no other means of making money. These girls are coerced via various tactics. For instance, some are simply convinced that they are the only hope and option for their families. Moreover, since women are considered of much lower social status then men, they don’t have the power to stop the decision. While other times, current sex workers visit these families glamorizing their careers. The second stage conveys that once these girls enter the sex workforce, they are often abused and raped. In the third stage, these women get in contact with HIV via customers. At this point, if the brothel owner discovers a HIV infected worker, the decision is made that this worker is no longer needed. This leads to stage four, where the woman returns to her village (if she is from Thailand) or she is shot (if she is a foreign worker i.e. Burmese women) or she may go on to start her own brothel.
Due to the strong spiritual and religious beliefs of this region, unfortunately many women, especially at stage 3 or 4, believe that it is karma and become class conscience. In other words, they feel as though they belong in the low social class that they were often forced into. Clearly, the adverse effects of this industry are not limited to medical disease but also have severe psychological and emotional repercussions. Furthermore, these sex workers don’t’ have access to proper healthcare. If they do receive any “medical” care, it is in the form of “witch doctors,” religious leaders and not licensed health care providers.
This concept of staging in the Thailand sex industry leads HIV/AIDS to be viewed as social disease with a devastating social outcome. One approach advocated for prevention is to intervene early on in the four stages. For example, one proposed intervention is to educate parents and assist them in providing alternate means of making money, such as growing corn to be sold for profit. Another project involved the distribution of cards inscribed with “Please use condoms, it protects both you and me.” This idea is aimed at preventing stage three.
To learn more about these issue, check out Zafar Mithavayani’s book “The four stages of sacrifice: Brothel and Bar Commercial Sex Workers, HIV, and Abuse.“ Lily Gutnik: gutnikl@bgu.ac.il