Understanding the factors that put sex workers at risk

Understanding the factors that put sex workers at risk

A brothel in Hainan, China

It is difficult to talk about sex workers as a single ‘group’, because those involved in the sex industry come from a diverse range of backgrounds and cultures, and can differ greatly in the lives that they lead. In the same way, the levels of risk that they face in terms of HIV infection can be vastly different, depending on the country that they live in, whether they work from a brothel or ‘on the street’, and whether they have access to condoms, amongst other factors. ¹ A wealthy escort supplying services to businessmen in London, for instance, may face a very different level of risk to that of an impoverished girl who is being forced to sell sex in a red-light district in India.

Despite this diversity, sex workers often share several common factors in their lives, regardless of their background. Some of these factors can increase the risk that they will be exposed to HIV.

Multiple partners, inconsistent condom use

In general, sex workers have relatively high numbers of sexual partners. This in itself does not necessarily increase their likelihood of becoming infected with HIV – if they use condoms consistently and correctly then they will probably be protected no matter how many people they have sex with. The reality, however, is that sex workers and their clients do not always use condoms. Of 86 reporting countries, less than a third reported that 90 percent of sex workers used a condom with their last client, whilst more than half reported condom use by less than 80 percent of sex workers.² In some cases, this is because sex workers have no access to condoms, or are not aware of their importance. In other cases, sex workers are simply powerless to negotiate safer sex, even if they try to do so. Clients may refuse to pay for sex if they have to use a condom, and use intimidation or violence to enforce unprotected sex. They may also offer more money for unprotected sex – a proposal that can be hard to refuse if the sex worker in question is in desperate need of an income.

“Sex workers have told us that when they ask a client to use a condom, he offers double the price to have sex without the condom. These women are trying to provide for their children and families, so they take the offer.” Ndeye Astou Diop, Aboya (an organisation that works with HIV-positive women in Senegal)³

Social and economic factors

As well as having high rates of partner change, sex workers often share other factors in their lives, particularly in regards to their social and economic positions. Sex workers are generally stigmatised, marginalised and criminalised by the societies in which they live, and in various ways, these factors can contribute to their vulnerability to HIV.

For one thing, even though sex work is at least partially legal in many countries, sex workers are rarely protected by the law.⁴ Around the world, there is a severe lack of legislation and policies protecting sex workers from the actions of clients that can put them at risk. For example, a sex worker who is raped will generally have little hope of bringing charges against their attacker. The lack of protection in such cases leaves sex workers open to abuse, violence and rape, and in such an environment it is easier for HIV transmission to occur. ⁵ Non-governmental organisations report that almost two thirds of the countries they work in have laws which make it difficult for them to provide services to sex workers.⁶

In addition, the stigma that sex workers face can make it hard for them to access health, legal, and social services. They may either be afraid to seek out these services for fear of discrimination, or physically blocked from accessing them – for instance, if a nurse refuses to treat them after finding out about their status. Without access to these services, sex workers may face a higher risk of HIV infection, and be more likely to pass on HIV if they do become infected.

Injecting drug use

In some countries, large numbers of sex workers are also injecting drug users. Some become involved in sex work as a means of financing their drug use, while others are involved in sex work first, and then turn to drug use – perhaps to escape from the intense emotional and physical burden of their work, or because other sex workers have introduced them to it. Since needle sharing is one of the most efficient ways of passing HIV between people, sex workers who inject drugs and share needles face a particularly high risk of becoming infected with HIV. See our Needle exchange page to read more about HIV transmission through needle sharing.

Migration, mobility and people trafficking

Migration and sex work are often linked, as poor migrants who have newly arrived in an area sometimes turn to sex work because they cannot find any other way to make money. As well as selling sex themselves, migrants may also become the clients of sex workers, sometimes as a means of escaping the loneliness that often accompanies migration.

Sex tourism is fuelling the demand for sex workers in many countries, such as parts of Asia and the Caribbean

In addition to voluntary migration, people trafficking ­– whereby people, usually women and children, are forcibly moved between areas ­– is also linked to the spread of HIV in some cases. Large numbers of trafficked women and children are forced into sex work every year. Even in countries where HIV is relatively uncommon, trafficked women are still vulnerable to HIV infection, because they are rarely able to negotiate condom use, are often forced to endure multiple sex partners, and may be subjected to violent sex.⁷ One study conducted among trafficked sex workers rescued from brothels in Mumbai, India found that almost a quarter of trafficked girls and women were HIV positive.⁸ Sex trafficking also relates to a high risk of HIV infection for girls trafficked in Southeast Asia.⁹

Another way in which HIV, sex work and mobility are linked is through ‘sex tourism’, whereby clients travel between countries seeking paid sex. Sex tourism is fuelling the demand for sex workers in many countries, such as parts of Asia and the Caribbean. In some cases, men travel to another country in order to take advantage of lenient ‘age of consent’ laws, or because they know that they will find it easy to find paid sex with underage girls or boys.