Barriers to HIV prevention amongst sex workers

Barriers to HIV prevention amongst sex workers

There is overwhelming evidence of the benefits that HIV prevention campaigns aimed at sex workers can bring. However, in many cases laws and policies are actively stopping HIV prevention campaigns from helping sex workers protect themselves from HIV. The number of countries reporting the existence of laws, policies and regulations which hinder sex worker's access to HIV prevention, treatment and care has increased from 41 percent in 2006 to 67 percent in 2010.¹⁷

Sex work is still seen as morally corrupt or criminal in many places, and those involved are often neglected or ignored by wider society. In 2010, the need to protect high risk groups from stigma and discrimination was acknowledged by the majority of reporting countries (62% had laws protecting high risk groups from stigma and discrimination).¹⁸ However, whether protection laws are enforced remains an area of concern.

Demonstration for sex workers in Paris

An example is the U.S. government’s policy of refusing overseas aid to any HIV prevention program that does not ‘explicitly oppose’ the practice of sex work. Since many of those working with sex workers rightly feel that they cannot effectively help this population while simultaneously sending out the message that sex work is morally wrong, they are not usually eligible for U.S. money. This has led to HIV prevention campaigns aimed at sex workers missing out on money that could otherwise have saved lives. It has also led to tense relations with authorities that are seeking to reach out to sex workers. In Brazil, the National AIDS Council refused $40 million in aid from the U.S. government to fight AIDS in 2005, because it would have required them to agree with the American sex worker policy. ¹⁹

The U.S. ‘prostitution loyalty oath’ has been criticised by many other groups and individuals involved in the global fight against AIDS, including Dr. Dennis Broun, the UNAIDS India country co-ordinator:

"[The U.S. sex work policy] will not solve the problem. There has and always will be prostitution. We have to choose methods of AIDS control that have proven efficacy." ²⁰

There are many more cases around the world where laws and policies have stopped HIV prevention campaigns from reaching sex workers. Another example comes from Goa, India, where the state government chose to demolish the red-light district of Baina in 2004, in an attempt to ‘rehabilitate’ sex workers. They did so despite pleas from non-governmental organisations that had worked in the area for over a decade to prevent HIV amongst sex workers. As a result of the demolition, it became nearly impossible to continue these campaigns, condom distribution fell, and the newly homeless and destitute sex workers became even more vulnerable to HIV. ²¹

Since the introduction of an 'anti-human trafficking' law in Cambodia in 2008, violent crackdowns against sex workers in Cambodian brothels have increased.²² Police violence has pushed sex workers into other settings such as karaoke bars, 'beer gardens' or the street where it is difficult to access them with HIV prevention education. As condom use is far lower among sex workers and their clients outside brothels²³ organisations working with sex workers have expressed concern that the crackdowns are a major setback to the government's successful '100% condom' enforcement programme. The programme had been credited with reducing HIV prevalence among brothel based sex workers from 44% in 1998 to 12.7% in 2006.²⁴

Crackdowns on sex workers in China are also common. In April 2010 sex workers held a rare protest following police raids on brothels, demanding an end to anti-prostitution laws.²⁵

It is understandable that authorities may want to discourage sex work, and that some people find the notion of an individual exchanging sex for money to be objectionable. However, it needs to be understood that sex work is not always a choice, and that even when it is, the reasons behind this choice are often complex. Limiting sex workers’ access to services that could help them simply worsens the situation.