HIV responses should challenge the power

Demand for sex work
The Commission on AIDS in Asia reports that the HIV epidemic in Asia is
mainly driven by men who purchase sex. It is estimated that some 75 million men
in Asia purchase sex from 10 million women. From an epidemiological standpoint,
men who buy sex from women in Asia far outnumber injecting drug users and men
who have sex with men, underscoring the likely role of paid sex in the epidemic’s
future trajectory in the region. The proportion of people living with HIV in Asia
who are women increased from 19% in 2000 to 24% in 2007, with most of these
women infected through sex with husbands or boyfriends who were themselves
infected during paid sex or through injecting drugs HIV responses should challenge the power relations and division of labour between
women/girls and men/boys and promote gender equality at home, at work, in the legal,
economic and political arenas, and throughout society at large. Interventions should engage
men and boys—both to reduce women and girls’ vulnerability to HIV and to minimize
the harmful effects that societal norms about masculinity and gender often have on men
and boys themselves.88 Structural measures such as national and regional policy reform
should address the norms and factors that increase demand for paid sex, including labour
migration, mobility, and the separation of families for extended periods of time. Workplace
HIV education programmes have an important role to play in redefining gender norms
and reducing the demand for sex work. Evidence indicates that such programmes can be
successful. In Thailand, for instance, broad-based efforts to alter social norms and male
behaviours led to a significant reduction in the sexual initiation of young men through
paid sex, helping bring about a sharp decline in the rate of new HIV infections89.
Address poverty and limited economic options
Although no person should be obliged to enter into sex work as a result of insecurity,
poverty, or coercion90, the majority of people who engage in sex work have few other
economic options91. Strategies that expand educational, economic and social opportunities,
especially for women and girls, represent an urgent necessity. Economic inequality is associated
with HIV risk92, and laws and policies that empower women to own property and
access schooling reduce that risk. Programmes are needed to address harmful employment
practices and to extend access to skills, credit and jobs. The United Nations has endorsed
the concept of ‘decent work’ as a vital path out of poverty93. Decent work sums up the
aspirations of people in their working lives—for opportunity and income; rights, voice and
recognition; family stability and personal development; and fairness and gender equality.94
Governments should prioritize strategies to create local employment opportunities for
women and girls. Focused programmes should be immediately developed in areas where
recruitment into sex work is active. In devising and implementing such strategies, policymakers
and programme planners should heed evidence of the effectiveness of initiatives
that provide livelihood skills, vocational training, local job creation and microfinance
to girls and young women95. Providing women and girls with opportunities for greater
ownership and control over economic assets empowers them to make their own choices