Even a Small Interruption in Blood Flow Affects Male Fertility

2016-08-23

Blood flow is important for the proper formation of sperm. What is known as the spermatic cord carries blood to and from the testicles. But when a varicocele forms, it can limit blood flow, affecting a man’s fertility. Medical experts still aren’t sure why this disruption occurs. But a varicocele is a blockage that prevents proper blood flow out of the testicles. Researchers believe a valve becomes faulty in a vein, inhibiting blood from moving through freely. This makes the vein dilate, which can cause damage to the testicles and affect fertility.

A varicocele often occurs in adolescence. It usually happens on the left side, but can affect sperm production in both testicles. Now, a consortium of researchers from Europe have found that even a small varicocele can affect male sperm production in a big way. 7,000 army recruits from six different countries participated in the study. Ulla Nordström Joensen, MD, PhD was its lead author. She hails from Roskilde Hospital in Denmark.

Dr. Joensen said that even the mildest interruption in blood flow had a significant impact on a man’s fertility, particularly in semen quality. This led to less sperm concentration. But for those with varicocele, motility problems are common. This is the sperm’s ability to swim energetically for long periods in order to reach its destination. Even if a man has a problem such as this, he is unlikely to recognize it himself. How to overcome the issue in men with this condition is still a point of contention, however. Surgery can fix the issue.

But 15% of men are said to have a varicocele. That is certainly too many to operate on. Of course, only those who want to have children would be interested. In this study, 7,067 men from Germany, Denmark, Estonia, Latvia, Lithuania, and Finland took part. They were all recruited between 1996 and 2010 to serve in their country’s military. Their average age was 19. 1,098 were diagnosed with varicocele, or 16% of the total. Quizzically, Dr. Joensen points out that some men with a varicocele are also fertile. It does not necessarily lead to infertility but can. If a man and his partner have been trying for up to a year without conception, it is important that the couple each seek a fertility specialist. For the hopeful father-to-be, this means an appointment with an urologist.

Men and Contraception: A Necessary Disruption of the Status Quo

2016-08-12

When men are well informed, they can become active participants in the health and well-being of their partners and children-August 11, 2016 by Monica Kerrigan and Jonathan Stack

James Ngugi is proud of his vasectomy.

The father of five lives with his wife Leah and their children in Kayole, a poor section of Nairobi, Kenya. Leah had suffered complications with each of her five pregnancies, and went on the pill after the couple’s youngest child was born. But she worried constantly about missing a dose.

Then James had a breakthrough realization.

“For too long, I assumed this problem was hers and hers alone,” he says. “But then I realized I could take on the burden myself.” James opted to get a vasectomy through Tupange, a family planning program funded by the Bill & Melinda Gates Foundation in partnership with Jhpiego and the government of Kenya. Tupange means “let’s plan” in Kiswahili, and the program is dedicated to making modern contraceptive methods available to the urban poor to improve maternal and newborn survival and empower couples and youth to plan their families and their lives.

For James and Leah, a vasectomy was the perfect choice. They were so happy with the results—and with the impact of the vasectomy on their family and their marriage—that they now work with Tupange to educate others about the benefits of voluntary male sterilization.

“I never knew how much James loved me until he had this vasectomy for me,” Leah says simply. “It is the most generous gift he has ever given me.”

James and Leah are a family planning success story. They’re also a reminder that men are a critical part of the family planning equation. Enlisting the support and involvement of men like James is essential if we want to expand the benefits of modern contraception to women and their partners all over the world.

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That’s especially important to bear in mind now, as we observe the midpoint of the global Family Planning 2020 (FP2020) movement. FP2020 was launched at the 2012 London Summit on Family Planning with an ambitious goal: to deliver modern contraception to an additional 120 million women and girls in the world’s poorest countries by the year 2020 without coercion and discrimination. Four years later, we’ve made enormous strides, reaching an additional 24.4 million women and girls and securing commitments from more than half of the 69 FP2020 focus countries. While our actions are strong, they have not caught up with our ambition yet and we risk falling short of achieving the transformational changes we promised: that women and girls, regardless of where they live, should have the same access to life-saving contraceptives.

To accelerate progress urgently, we need to continually and critically examine our strategies, review the data, and break the mold of doing business as usual. We must challenge ourselves to think creatively, disrupt the status quo positively, act on innovations and identify new partners with bold ideas to urgently expand access and use of contraceptive information, products, and quality services.

One area where we’ve fallen short is male engagement: getting men and boys to actively participate in frank conversations about sex, consent, contraception, and sexual and reproductive health and rights. We know that male opposition, power dynamics, lack of communication and gender equity remain serious barriers to expanding quality, access and improving the uptake and continuation of contraceptive use. Tackling these barriers head on will help drive progress forward.

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Globally, the vast majority of family planning programs are oriented towards women and girls. Programs focusing on male engagement in family planning have fewer dedicated resources, even though men are often the primary decision makers about family size, health services, and family planning methods. But if we’re going to reach our FP2020 goal—let alone our long-term goal of universal access to reproductive health—we’ll need to expand the dialogue and involve men and adolescent boys as valuable and effective partners. Programs that optimize the positive engagement of men can improve health outcomes for women, men, and their families.

Stories of progress in family planning are often stories of innovative partnerships with governments, civil society, service providers and the private sector. And one bold attempt to ratchet men’s involvement up is World Vasectomy Day, an innovative partnership designed (by men) to proactively take charge of their own health and well-being. Launched in 2013, World Vasectomy Day has quickly grown into the largest male-focused family planning event in the world. The information isn’t limited to vasectomies though; conversations also focus on preventing HIV and other STIs, male circumcision, gender equality, and the importance of men in family planning.

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The innovation of World Vasectomy Day is that it isn’t just a one-day event. It’s a larger movement aimed at encouraging men to become agents of change in their communities; to take an active role in their sexual and reproductive health throughout their lives. Men tend to be negligent of their own health, and the gender dynamic in many cultures means that men are unaccustomed to thinking about how their actions affect their partners and children. Masculinity norms also make some men unsure about family planning.

That’s why it is so critical to secure men’s engagement on this issue. When men are well informed, they can become active participants in the health and well-being of their partners and children. Their involvement can also foster joint decision-making and improve communication between partners that lead to shared decision making about family size and method choice. Men can also play a powerful role in transforming rigid gender norms, promoting women’s and girls’ empowerment and well-being, and ending gender-based discrimination and violence.

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This year the Government of Kenya is stepping up to host World Vasectomy Day on November 18. Kenya is a country that is on the forward edge of family planning, actively embracing new ways to broaden the dialogue around contraception. In 2014 Kenya showed a dramatic increase in its modern contraceptive prevalence rate for married women, which rose from 32% in 2003 to 53%, thereby exceeding its FP2020 goal.

Another important trend globally and in Kenya, is the number of women and men who have achieved their family size and want to stop childbearing. Half of married women age 15-49 and 42% of currently married men consider their families complete. The Government of Kenya is responding to this trend and is moving forward to innovate and forge strong, bold partnerships with NGOs and local communities to improve quality, access and choice.

While the gains are worthy, challenges remain in Kenya. Almost 20% of teens aged 15-19 are mothers or pregnant with their first child – numbers that have remained stagnant over five years. The modern contraceptive prevalence rates for all women including those who are unmarried, sits at 39.1%. In terms of male engagement, condoms represent only 2% of modern contraceptive use and less than 46% of married women had even heard of male sterilization.

Let’s be clear: to deliver on the promise of FP2020, we need to reach 120 million additional women and girls and their partners to promote family planning, expand access to information, services and supplies in order to accelerate contraceptive uptake and reduce discontinuation.

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We need to design programs with men and adolescent boys to address myths and misconceptions and help get them on board to become champions, users and supportive partners. Many men are like James: they see their wives suffering with fear of pregnancy or contraceptive complications, and they long to step up and relieve them of the burden. For other men it’s about their children: they want to give them the best possible chance in life, and that means making sure they can support them fully. These are positive, heroic instincts. If we are going to hold ourselves accountable to the promise we made back in 2012, we must take a closer look at men’s needs, develop an evidence base, cultivate different partnerships and gear more information towards men and adolescent boys.

When James opted for a vasectomy, he knew he was taking a risk of being one of the first men in his community to get the procedure done. And now, with only four years left on the clock to reach the FP2020 goal, the family planning community must take some risks too. That means we’re going to have to try new approaches, bring new partners to the table, listen to fresh voices and move out of our comfort zones to get things done and ignite real, lasting change.

The kind of change that involves all of us breaking down silos and building bridges – working together with men and adolescent boys so we can go further faster.

STD Risk Increases in Women Who Use Long-term Contraceptives

2016-08-08

We usually think that in the decades before the Sexual Revolution, there were far less cases of teen pregnancy in the United States. But according to the CDC, the teen pregnancy rate in has dropped steadily in the U.S. since the 1950s. Even so, it is still far higher than most other developed countries. There are lots of reasons for this decline including better sex education, the sheer breadth of birth control options, and that protection is widely available. Some options that have gained in popularity in recent years include hormonal implants and intrauterine devices (IUDs).

Although they are very effective in preventing unwanted pregnancy, they do nothing to protect against STDs. The problem is, some couples for whatever reason, may forgo a condom, if this method of birth control is employed. The fact is, STDs have been on the rise, including some worrisome ones, like antibiotic resistant gonorrhea. The most effected population are those between ages 15 and 24. But an uptick in all demographics, including seniors, has taken place.

The 2013 national Youth Risk Behavior Survey assessed sexually active teens on condom and other contraceptive use. Researchers conducting the survey asked during their last bout of sexual intercourse what birth control method young women used. Researchers inquired about condoms, birth control pills, IUDs, and hormonal implants or injections. Another question was whether they had used a condom during their last sexual encounter. 2,300 teen girls answered the survey. 57% were Caucasian. 34% were seniors in high school. Of those who used long-term contraception, 16% said they never used condoms.

Researchers hypothesized that those using long-term contraceptive methods would be less likely to opt for or push for a condom, and more likely to contract an STD. They were right. These young women were 60% less likely to use condoms. The takeaway is no matter what your age or the stage you are at in your love life, if you are going to have sex outside a long-term, monogamous relationship, use a condom. What’s more, all sexually active adults should be tested once a year for STDs. If your time is up, be sure to go see a doctor or urologist and get screened. 

Did you know! Women can experience non-stop orgasm for 4 months!

2016-08-01

Guess what? Women can not only experience longer orgasms than men but a sexual health expert claims they can experience one for four straight months! Hard to believe? It’s true! Read to know more…

An applied practice termed as “orgasmic meditation” or OM, continually allows women to live in a continually aroused state that helps them embrace all areas of their life with sensuality and vigour.

This practice as sex instructor Nicole Daedone explains is not foreplay; it’s practised separately from sex and away from the bed and is not designed to induce orgasm, but to keep the woman on a plateau of sensation. Daedone, who is the author of ‘Slow Sex, The Art And Craft Of The Female Orgasm,’ further states that the practice of “orgasmic meditation” requires dedication.

She adds that couples should set aside 45 minutes daily, over ten days, to get any sense of OM’s benefits as according to her, an orgasm is the body’s ability to receive and respond to pleasure and although, sexual climax is often a part of orgasm, but it is not the sum total.

For “orgasmic meditation” to be a success, the woman must concentrate ‘mindfully’ on the sensations she feels, without letting her thoughts run amok, while the man’s role is to concentrate on his woman. They would be able to prolong sexual pleasure and delay climax for a much longer period with this practice.

It’s a fact! Women don’t even need to have sex to reach orgasm
Coregasms: Some researchers have found the exercise triggers sexual arousal and even climax in some women. Termed as ‘coregasms’, because of its linkage with exercises for core abdominal muscles, they could occur while biking, spinning, abdominal exercises or even rope climbing.

Thinking her way to an orgasm! A recently conducted study on the female brain during an orgasm had an interesting find. Some women claimed that they did not need to visualise a sexual or romantic fantasy to reach climax. They further stated that merely focusing on wanting an orgasm was enough and their body would respond.

Oral sex is enough: A study on the sexual behaviour of men and women in the United States discovered that while men relied on vaginal intercourse to reach orgasm, women were able to climax by participating in non-penetrative sex acts such as oral sex.

Speaking of oral sex, recent studies have revealed that indulging in it is actually beneficial to a woman’s health. Some sexual health experts are of the opinion that ingestion of semen from oral sex is quite healthy since it contains “mood-altering chemicals” elevates mood, increases affection and induces sleep. This is also why some doctors recommend that pregnant women should perform oral sex on their partners to cure the effects of morning sickness.
– With inputs from agencies

Louis’ story: Why did I blame myself after I was raped?

My name’s Louis. Louis who was the first openly gay School Captain of my Catholic high school, I was voted upon graduation ‘Most likely to be rich and famous’. I’m Louis from the large, loving family who’ve always supported me. I’m Louis who on a whim travelled on my own to Bali for my first trip overseas for a month to teach English to children in Ubud. I’m Louis who’s been asked the question “How do you smile so much, all the time?” more times than I could count.

I’m Louis, a victim of rape.

Soon I’ll have my final checkup back at the clinic, giving one third and final verification that I don’t have HIV. I have to say at 20 that’s not a sentence I ever thought I would have to say or write or even think, none of this is really. There’s been a lot of that though so far, a lot that I hadn’t previously fathomed would ever become a part of my story.

I’ll never forget walking out of the sexual health clinic past the waiting room and seeing at least six solemn faces of mostly young, clearly homosexual men and suddenly witnessing the reality of a side of our community that I was always aware of but never thought applied to me.

I’ll never forget sitting on a park bench the next day and calling my mother. It was getting dark, I was looking at the traffic lights and the cars passing through them nearby when I tried but couldn’t bring myself to actually say the words out loud.

I’ll never forget hearing her say to me: “You were raped.”

I’ll never forget the look on my sister-in-law’s face when two weeks later she was picking me up from the kitchen floor when I was crying uncontrollably. I don’t remember beginning to cry, I just remember washing dishes and the next moment there she was with her arms around me sitting on the tiles.

I’ll never forget the first night I spent alone in the house after it had happened and the quiet sense of terror that I ignored until sunrise, but that no matter how much Gwen Stefani I played I inevitably couldn’t escape.

I’ll never forget feeling like a piece of me had been taken. That I had become less complete than I was before.

The words “You didn’t deserve this” are ones that I’ve now come to know quite well, and honestly while with everything I know and everything I’ve learned through this experience tells me that these words are of course truth, these are still words I struggle with.

Ultimately I’m a very lucky human being, I’ve lived a life of opportunity, have travelled and have people who I love ready to support me, as I would for them all around me. I made a series of decisions the night it happened that lead me to the single most traumatic event of my entire life. A series of decisions that really aren’t that uncommon for a lot of people my age, but a series of decisions that ultimately I’ve paid for.

Again though, I continue to be lucky, if there’s anything that I’ve come to realise through all of this it’s that one night of seemingly standard, alcohol-infused behaviour could ultimately be the difference between life and death. I am still alive, I’m now physically unharmed and I’ve been able to go on with my life. There are many people who sadly haven’t had this luxury, have been or continue to be violently assaulted and have had a lot more taken from them than their dignity.

So before I write anything more, I want to be clear that I am grateful to be here and don’t for a second forget that this all could have been much, much worse.

For me it’s all a very familiar tale, picked a guy up in a bar, went back to his without really knowing where I was and things became progressively darker from there. What could have been a funny one night stand story just happened to end up being an ongoing source of many sleepless nights. The details themselves are still quite painful and on a lot of levels extremely humiliating to share but essentially I was in the wrong place with the wrong person, in the wrong state of mind and the word ‘no’ was repeatedly ignored until all 170 centimetres, 62 kilograms of me was left without a choice and I was overpowered.

48 hours later I was sitting across from a nurse who has now reserved a place in my memory as one of the most incredible, personable and funny people I’ve ever met, with tears running down my face I said words that have haunted me since the moment they crept into my mind and out of my mouth,

“I hate that I let myself become a stereotype. I’m just another statistic.”

This is a concept I’ve had to come to terms with before this point. I’m a relatively slim built, feminine gay man who’s been dying his hair since he was 14 and cried far more than any person should when I saw Lana Del Rey live for the first time in concert. I have always said if I could be more masculine then believe me I would have figured out how to do so effectively a long time ago but the reality is I could walk into a room and fifty metres away I have no doubt a blind man could lean over to the guy next to him and say, “I know which team he bats for.”

I’ve always been an advocate for being proud of who you are, stereotype or not, but it was sitting in that sterilised room that screamed of a hospital scene in Days of our Lives, with a stack of papers piled in front of me that had my name and the words ‘SEXUAL ASSAULT CASE’ right next to each other that I felt ashamed. I felt like I was every cautionary tale from that spurts from the hateful mouth of every bigot you see in modern day media. I felt like I had let my community down, that through my own choices I had contributed to archaic imagery that has so damaged the LGBT community of promiscuity, a dancefloor and liquor.

In those moments I felt ashamed and disgusted in myself not only because of what, at the time, I felt like I had invited to happen to me, but because I have always advocated that I want to live a life that is mine, my own choices, my own dreams. This meant that if I was happy but my characteristics or way of speaking were considered stereotypical without my trying to then so be it, but it had never been my intention to live in a way where I allowed myself to become a stereotype that continued to feed into negative and generalised misconceptions. I was raised by people who are open-minded and loving and good, I had a blessed childhood full of memories that still put me in tears of laughter, even now in early adulthood as my parents are divorced they are respectful and genuinely good to one another and all my siblings and I love my stepfather.

Sitting in that hospital, I felt like none of that mattered anymore because I was just another statistic. Everything I had ever worked for as Louis, as an individual, all the aspects of my life that had nothing to do with my sexuality were all suddenly moot because I had let myself become another number that lobby groups could use in their studies or promiscuity and sexual abuse amongst gay men.

Basically I felt like I had let myself down, I had let my family down and I had let my community down.

Today, months later, in the late hours of a particularly dark day of mine wherein I struggled yet again with my sense of self-worth to the point where I even went as far as questioning those closest to me as to why and how they could love me I want to say for myself, and potentially to others if this ever gets read:

I was wrong. Wrong to feel like I let the community down. Wrong to blame myself.

It was my mother’s words this evening that are the latest to resonate with me, I was crying and blaming myself again for my share in the whole affair and she said to me:

“Are you kidding me? If this was one of your sisters would you tell her it was her fault? Would you let others tell her that?”

And she’s right. No matter what the circumstances were leading to it, no matter the choices made by her, if anyone did to any of my sisters what was done to me I would never for a second tell them it was their fault, because if you say no, whether it’s verbal, or it’s with your actions, black and white, plain and simple:

It is not your fault.

This then got me thinking about how I would respond if one of my friends, or a partner told me this had happened to them, how I would then respond, and then comparing how all of these people have reacted when I’ve shared with them my story.

In my fear of being another statistic that casts a negative shadow over the LGBT community I completely forget what really I should have been focusing on to help get me through and that is what our community is built on.

Love.

The ongoing battle for rights within the LGBT community, especially in Australia is still being fought and still prevalent within society because we are a people that fight together, fight for one another, we support each other’s rights to love and to live as freely and openly as anyone else. It’s a community that celebrates difference and diversity and embraces all of those who embrace the cause of open mindedness and freedom. Every person I know who is a part of our community or in support of our community that I’ve spoken to about my incident has met me with support, with understanding, without judgement, even in moments I’ve felt that I deserved it.

I am more than a statistic, and if you’re reading this and you’ve been through anything like I have then I want you to know that you are more than a statistic too.

I’m not done healing yet, there is definitely still work to be done. I’m seeking counselling because I feel as though I’m ready to really talk about it and face what I need to, to build a positive future. I’m writing this, not because I’m looking for attention, or because I think I have unheard of insight into the issue but because I think that sharing about such an issue is maybe an important step within all those dealing with something like this to know that it is OK to share within our community and that you will be met with more love and acceptance than judgement.

I’m not a finished story and that’s exactly why I wanted to write this, because sometimes it’s not about reflecting on something when it’s a part of your past, but instead it’s about living it and sharing it as best you can while it’s happening.

You are still you. You’re more than your choices, and you’re definitely, completely, certainly more than someone else’s. We as members of the LGBT community are fighting as a collective but we are still individuals with varying hardships and specific circumstances that we may battle with on our own but know that when it comes to sexual assault you don’t have to battle alone.

There is support, there is care, there are people you can speak to, people who will listen.

There are people who exist who disgustingly and unfortunately will take what they want in life without considering the consequences or ongoing ramifications of their actions, but these are not the only people in the world, not by a long shot, and these are not the people who anyone should let define their sense of self-worth.

I am still Louis. The Louis who spent most of today crying, but also the Louis who is taking another volunteer trip to South East Asia early next year to teach more English. I’m still Louis who gets emotionally involved in Agatha Christie novels and still doesn’t quite get the hype with Game of Thrones (sorry).

I’m Louis with work to be done, with some love in myself still yet to be rediscovered but I am still me.

Not a statistic, not a stereotype, I’m a part of a community where love and acceptance is the foundation and reminding ourselves of this is important.

I am a victim but I am so much more: I am me.

Special dermatologic needs for men who have sex with men

2016-07-29

Inside the world of male sex workers

The well-dressed father of two earns good money. He speaks English and works for an international NGO that combats HIV/AIDS. He used to be a sex worker, a man who has sex with other men, and then became a government informer, reporting back to the police on other sex workers who were then arrested. He resorted to drink and drugs because of his shame and isolation. And now he wants to talk about it.

The root cause of all his problems, says Ko Kyaw Zayyar Swe, 38, is poverty. He was forced out of school at 15 because his soldier father could not afford the tuition fees. He worked as a waiter at a Chinese restaurant, but the owner cut his already low wages after giving him a dumpling for lunch instead of money. He quit.

Because he never made it to 10th standard, he could not find a good job, and money was always short. When he married at the age of 17, making ends meet became almost impossible.

“I was working in a shop in Bogyoke Market. One day, two foreigners I’d seen before in the market bought me jeans and shirts. Nobody had ever given me anything before,” he said.

The men invited him for drinks, then brought him back to their hotel room and asked for sex.

“I was shocked. But I needed money urgently for my family so I agreed to do it,” he said.

More contacts were made, and more money came in. He became a regular sex worker, offering services for gay men. Since foreigners paid much better than local men, Ko Kyaw Zayyar Swe decided to learn English.

He came to know many other male sex-workers like himself, working around Bogyoke and Theingyi Zay markets and Sule Pagoda Road, and even further afield.

In 2003 he was arrested under a law banning “inappropriate” sex, along with a friend and two foreigners, and spent two-and-a-half years in Insein Prison. The law is also used against transgender people.

This was the first time his parents and his wife became aware of his secret life.

When he was released, the Ministry of Home Affairs asked him to turn informer against the male prostitutes of Yangon. As his friends went to prison, he got paid. “I received K10,000 a day for some years. That was a lot of money. I didn’t want to destroy other people’s lives because I knew what it was like to be in that position. In the end, I stopped informing and went back to being a sex worker myself,” he said.

All the other sex workers did what they did because they were poor, he said, and saw no other way out. “We didn’t dream of this profession. But with no education and no work but odd jobs, how can you support a family? We didn’t want to be rich. We just wanted enough to get by for a family life.”

Conditions for sex workers changed with the advance of the internet. Now they don’t have to hang around on the street, but make contact online through dedicated websites. At one time, you could see up to 50 sex workers around the markets at night, chatting to customers. There is a thriving market for male sex-workers among gay men, with more male than female customers.

Though the money is the best they have ever made, male sex-workers feel disgusted, lonely and depressed. They feel nobody stands up for their rights, and everybody looks down on them.

“This way of life makes us angry. We can’t share our feelings with family or friends. It’s a big problem for society too,” said Ko Kyaw Zayyar Swe.

Many drink to forget, he said, and then go on to take drugs.

One day, a man from Bangladesh involved in promoting health awareness for male sex-workers asked him to take a part-time job at his NGO, which was gathering information about prostitution and developing training programs for public health professionals.

Ko Kyaw Zayyar Swe said sex workers needed both physical and mental support, as well as job opportunities, to be provided by the government, NGOs and INGOs.

“I never even knew how to use a condom with customers. Luckily, I didn’t get HIV. Knowledge is very important and we need that,” he said, adding that courses in leadership skills, empowerment and capacity building would also help to raise self-confidence.

Dr Aung Myo Min, director of Equality Myanmar Human Rights Group, said male sex workers were hard to reach because they isolated themselves. Too much isolation, he warned, could turn them into drug addicts, or even susceptible to becoming terrorists.

“They are ashamed of what they do. They only do it for the money. Even within the group, there are problems of competition for customers,” he said.

They are not even particularly high-profile. Most of the small counselling groups set up by NGOs in Myanmar for HIV and health awareness cater to female and transgender prostitutes because most of them suffer exploitation, discrimination and even torture. Male sex-workers are seen as being in the profession mainly for the money.

“Even their customers can find them difficult to deal with because of their lack of self-esteem and feelings of indignity. There has to be a way of allowing them to change their profession,” said Dr Aung Myo Min.

A doctor who provides health support for people living with HIV and AIDS said male sex-workers are particularly difficult to contact. “Both sex-workers and customers have to be aware of sexual health issues. Now there are many drop-in centres, including day-care centres for HIV-positive patients, where they can express their feelings and receive support,” said the doctor.

According to 2013 figures from the UN agency UNAIDS, there are an estimated 70,000 sex workers in Myanmar. About 8 percent of them are living with HIV.