A girl wearing a sign that reads "HIV/AIDS" growls and waves her arms menacingly as she tries to break into a circle of girls and boys who laugh as they duck and - weave to keep her out. Opposite, a boy sporting a "Syphilis" sign attempts to push through, but the giggling protectors thwart his efforts. "Herpes" takes on the challenge, but "Chlamydia" is intent on winning. Fast-paced and uproarious struggling eventually results in a victory – "Gonorrhoea" jubilantly plunges into the circle as the players cheerfully disband.

These young service workers are participating in their second of three days of reproductive and sexual health training in the Laos capital of Vientiane. In their jeans, fashionable tops and sneakers or sandals, they look like typical high school students. At night they transform; donning makeup and sophisticated clothing for their work serving drinks and entertaining customers in bars and nightclubs around the city. Today's training is part of a CARE project that is teaching service workers how to prevent unwanted pregnancy and sexually transmitted diseases and infections, and how to improve their confidence and negotiation skills in potentially violent and unsafe situations.

Phim speaks openly about her experiences, gained while working for six months in a city hotel nightclub. "One customer left me stranded at a remote guesthouse. I had no way of getting back," the 24-year-old remembers. "I was angry and upset and I cried." Phim, now a housekeeper, is participating today as a peer educator, drawing on her knowledge to help other young people working in the service industry. Peer educators, along with staff from CARE, the Lao Youth Union and local government, are arming the young workers with skills to minimise the risks inherent in the work they do. Through games and more formal education, they learn how to protect their health and safety. Skills like confidence, the ability to negotiate safe sex, and recognising dangerous situations are given as much emphasis as knowing how sexually transmitted infections and diseases are transmitted and prevented. Most service workers in Vientiane are young women or girls, sometimes as young as 14, who come from provinces of Laos. Today's 35 participants are aged between 15 and 25 years old. "Most don't come to the city with the intention of becoming sex workers," says CARE's Project Manager Dr Senkham Boutdara. "In their villages there's an assumption that there are many opportunities in the city to find work and earn money." An industry has grown up around this assumption. Potential employers pay truck drivers between 10,000 and 20,000 kip ($1.30 and $2.50) for each girl they transport from a village to Vientiane for work. However, the girls don't realise until they arrive that certain paperwork is required and they are often left to fend for themselves while this is being arranged.

"The society in bars, nightclubs and restaurants is very stressful and violent."

"Most girls can't afford accommodation, so those with friends stay with them while others struggle to find a roof over their heads," says Dr Boutdara. "Even once the employers have organised paperwork, the girls don't earn enough to pay their rent or meet their family commitments. Often they find themselves in a position where they have no alternative but to supplement their income by selling sex." Sex work is profitable, Dr Boutdara explains, particularly when compared to the other limited options an unskilled girl has to choose from, such as serving drinks. On any given night in a club or a bar, a girl can earn around 20,000 to 50,000 kip ($2.50 to $6.35) for an evening serving drinks to a customer. If she then has sex with him, it is common to augment that amount by between 200,000 and 400,000 kip ($25.35 and $50.70). Phim explains how she took the job at the nightclub to help her father pay back a bank loan of 17 million kip ($2100) for his farm in the southern province of Savannakhet. This is common, says Dr Boutdara. Often families have financial expectations of their daughters. They are obligated to send money back to their village to help put their brothers or sisters through school or pay off their family's debts," he says. As well as the training days, CARE's project also has an outreach component. In the dressing rooms of around 24 venues each month, girls chat, change clothes and apply makeup while peer educators present sexual and reproductive health information. Over drinks and snacks, the peer educators discuss and demonstrate methods of contraception and circulate photographs of symptoms of sexually transmitted diseases. Sometimes the workers are involved in focus group discussions, in which they discuss work and health issues in more detail and work through how they dealt with similar issues. This sort of outreach activity is also carried out in the girls" homes.

Phim has been a peer educator in the Chanthabouli district of Vientiane since the beginning of the CARE project, which also covers Saysetha, Sikhotabong and Sisattanak districts. Like the other peer educators, she distributes cards containing her contact information to bar and nightclub staff. The young workers feel comfortable contacting her for support or assistance, and she is also able to provide basic counselling and/or refer them to appropriate services, such as Vientiane Youth Centre for clinical and counselling services, or to hospital, as required. "The society in bars, nightclubs and restaurants is very stressful and violent," Phim says. "There are often problems with the guests, it's difficult to earn money, and even more difficult to leave. I feel the need to give other girls information that will help them to work in this sort of environment." Dr Senkham says that Phim's efforts to help her peers are proving extremely successful. "Phim is well respected, as she's very open and honest with the girls. They pay attention to her," he says. Dr Senkham explains that such help is desperately needed. "The reality is terrible for some girls. Recently the friend of a 14-year-old girl came to CARE's training and asked for help for her friend, who had been haemorrhaging for three weeks after her first sexual experience.

Despite all our efforts, the girl was too scared to come to a clinic, and went home to her village without treatment," he says. "Fortunately, she was able to receive some support and health-related advice from the peer educator who visited her, but sadly that was the best we could do." Despite such sad situations, Dr Senkham says the project's success has far exceeded his expectations. Since it began in October 2003, more than 2160 service workers in over 100 locations have received reproductive and sexual health information, 880 more than the target. "Many girls are also visiting appropriate medical services after being referred by peer educators." "We now plan to expand the project to include vocational training, so that the girls have other job alternatives. At the moment there are very limited career options to offer them, but with scholarships and training in how to run a small business and speak English these options will widen," he says. "One of the most rewarding things is seeing young girls realise the value of their health and the future, over money and the immediate gain that it may bring," Dr Senkham says. "Most of them would like to marry and have children, and they realise they can start to take control of their future by making safer choices now."

From Care Australia Annual Report 2005, p. 10-12.