workers and their clients with HIV prevention

laws, policies, discriminatory practices, and stigmatizing social attitudes
drive sex work underground, impeding efforts to reach sex workers and their clients with
HIV prevention, treatment, care and support programmes. Sex workers frequently have
insufficient access to adequate health services; male and female condoms and water-based
lubricants; post-exposure prophylaxis following unprotected sex and rape; management
of sexually transmitted infections, drug treatment and other harm reduction services19;
protection from violence and abusive work conditions; and social and legal support.
Inadequate service access is often compounded by abuse from law enforcement officers.
Documented and undocumented migrants working in sex work often face particularly
severe access barriers as a result of linguistic challenges, exclusion from the services that are
available locally, and minimal contact with support networks. Even where HIV information
and services are accessible to sex workers, such services often fail to comply with human
rights standards20 and insufficiently engage clients, the controllers and managers of sex work
or take account of the local social and cultural context.
Similarly, in many countries, official policies principally focus on reducing or punishing
the suppliers while ignoring the consistent demand for paid sex.21 The demand for sex
work may be affected by social and cultural norms and individual circumstances, including
work-related mobility and spousal separation; social isolation and loneliness; access to
disposable income22; and attitudes based on harmful gender norms, including a desire for
sexual dominance and sense of entitlement, which may manifest in sexual and economic
exploitation and violence against sex workers. When addressing HIV in the context of
sex work, policies and programmes should not only focus on the needs of sex workers
themselves but also address factors that contribute to the demand for paid sex.