Three Pillars of an Effective, Evidence-Informed Response to HIV and Sex Work

Three Pillars of an Effective, Evidence-Informed
Response to HIV and Sex Work
UNAIDS will base its efforts to address HIV and sex work on three essential pillars.
Pillar 1: Assure universal access to comprehensive HIV prevention, treatment, care and support.
Pillar 2: Build supportive environments, strengthen partnerships and expand choices.
Pillar 3: Reduce vulnerability and address structural issues.
Each pillar is essential, and the three are mutually interdependent and should be coordinated
and implemented simultaneously. Each pillar permits and envisions short-term
measures and results, as well as longer-range structural measures that take longer to produce
effects। These need to be pursued in combination and with equal urgency.
Assure Universal Access to Comprehensive HIV
Prevention, Treatment, Care and Support
31 Monitoring the AIDS Pandemic Network (2004) AIDS in Asia: Face the facts. http://www.mapnetwork.org/docs/
MAPAIDSinAsia2004.pdf , UNAIDS (2006). Report on the Global AIDS Epidemic.
32 Rekart ML (2005) Sex-work harm reduction, The Lancet. Vol 366 No.9503 PP:2123-2134.
33 Overs C (2002) Sex Workers: Part of the Solution. An Analysis of HIV prevention programming to prevent HIV
transmission during commercial sex in developing countries.
Comprehensive, accessible, acceptable, sustainable, high-quality, user-friendly HIV
prevention, treatment, care and support must be urgently scaled up and adapted to
different local contexts and individual needs. Essential actions include:
actions to address structural barriers, including policies, legislation, and customary
practices that prevent access and utilisation of appropriate HIV prevention, treatment,
and care and support;
policies and programmes to ensure freedom from violence, abuse, and discrimination;
information for sex workers and their clients and others involved in the sex industry;
reliable and affordable access to commodities, including high-quality male and female
condoms, water-based lubricants, and contraceptives, and other requirements for
health, such as food, sanitation and clean water;
access to voluntary HIV testing and counselling, with treatment, effective social
support and care and for sex workers who test positive for HIV;
Consistent with the aim of universal access to HIV prevention, treatment, care and
support—formally endorsed in the 2006 Political Declaration on HIV/AIDS—
comprehensive, evidence-informed programmes for sex workers and their clients should
urgently be scaled up. Meeting the needs of key populations at higher risk of exposure to
HIV, such as sex workers and their clients, has also been shown to be highly cost effective31.
Sex workers have amply demonstrated their willingness and ability to be active partners
in such efforts32; where health and social services are provided and sex workers are actively
engaged in efforts to provide universal access to HIV prevention, treatment, care and
support, HIV incidence declines.33
States should...take measures necessary to ensure for all persons, on a sustained and equal basis, the
availability and accessibility of quality goods, services and information on HIV/AIDS prevention,
treatment, care and support, including antiretroviral and other safe and effective medicines, diagnostics
and related technologies for preventative, curative and palliative care of HIV and related opportunistic
infections and conditions. States should take such measures at both the domestic and international
levels, with particular attention to vulnerable individuals and populations.