The UNAIDS Guidance Note on Sex Work and HIV

M. Seshu A. Hunter E. Reynaga F. Strack S. Mollet R. Morgan Thomas C. Overs M. Ditmore D. Allman & The Global Working Group on HIV and Sex Work Policy

In this presentation sex worker means adult male, female and transgender sex workers.

Sex work and human rights activists and public health agencies working on HIV policy and programming. The Global Working Group on HIV and Sex Work Policy

Background UNFPA became the UNAIDS co- sponsor to lead on sex work and in 2005, it conducted a series of consultations with governments, donors, NGOs and networks working with sex workers and anti-trafficking advocates. In 2007 The Joint United Nations Programme on HIV/AIDS (UNAIDS) published a Guidance Note on Sex Work and HIV that took a different approach to all previous UN policy on sex work...

The Guidance note: Focused on preventing or reducing sex work not preventing HIV and providing universal access. Offered nothing to empower sex workers or reducing vulnerability to violence, disease and discrimination. Encouraged governments and donors to shift resources away from targeted HIV care and prevention to such broad development goals as ‘girls education’ to reduce poverty and therefore sex work. Was not based in evidence. Focused on reducing demand for commercial sex rather than demand for unsafe commercial sex. Was silent on the matter of improving sex workers’ access to safe workplaces.

The ‘Willing’ and the ‘Enslaved’ Reflects false information and extremist views that conflate slavery and trafficking with sex work. This view has permeated the international response to sex work and has led to further criminalisation, police brutality, violent “raids and rescues” and deportations.

The Guidance note is silent on: Safe commercial sex (limited to condoms). Male and transgender sex workers. Violent and authoritarian anti-trafficking programming. Coerced and inadequate medical interventions ( e.g., 100% Condom Use Programme, inappropriate presumptive treatment) and barriers to accessing ART. Unethical trials of products, drugs and technologies for HIV prevention and care.

What is not addressed by the Guidance Note The impact of authoritarian, punishment based HIV prevention and mandatory testing programmes for sex workers which have been the consequence of the introduction of the 100% Condom Use Programme. The impact of false information and extremist views about slavery and trafficking that have permeated the international response to sex work and lead to further criminalisation, police brutality, violent “raids and rescues” and deportations. Ethical and human rights violations associated with trials of products and drugs for HIV prevention and care.

Sex Worker Involvement Despite GIPA principles and the Guidance Note’s own recommendation that sex workers be key partners in decisions involving their lives, sex workers’ inputs were rejected in favour of a document acceptable to organisations that are committed to the US government anti-prostitution pledge.

Sex Worker Response The NSWP and the GWG, with help from the International HIV/AIDS Alliance revised the Guidance. Only a brief formal acknowledgement was made by UNAIDS.

Campaign for a revised Guidance Note on Sex Work and HIV

Report by the NGO representative to the 20th UNAIDS PCB Additional letter from GWG to Dr. Piot Canadian HIV/AIDS Legal Network Critique Letter to UNAIDS PCB Sex worker networks publish critiques of the Guidance Note The Delhi Document, a rewritten Guidance Note delivered to UNAIDS Meeting of UNAIDS Global Reference Group on HIV/AIDS and Human Rights Video of Delhi presentation posted on internet Dr. Piot, Director of UNAIDS, responds to GWG Meeting of the 21st UNAIDS PCB OSI calls on UNAIDS to clarify status of Guidance Note Women Won’t Wait campaign to revise and reissue Note European Civil Society Forum supports efforts for UNAIDS accountability Meeting of the 22nd UNAIDS PCB

Lessons learned Few sex work policy initiatives in the history of the AIDS epidemic have elicited such a global, coordinated and rapid response as that mounted by the GWG. Utilising internet communication technologies to coordinate the contributions of sex workers, advocates, researchers and policy makers, the group was able to mobilise a broad-based coalition in support of evidence- informed and rights-based programming. Today this community-based response has grown to encompass the support of a truly involved and committed civil society.

Sex workers need a comprehensive package of services and a policy environment that reduces vulnerability and ensures access to treatment. Information for sex workers about HIV, human rights, sexual health, condoms, safe sex and accessing health services. This can be delivered via peer educators, publicity and health professionals. Information about HIV, STIs and condoms for men who buy sex and others involved in the sex industry such as sex establishment operators and staff, taxi drivers, police and local authorities. Access to “prevention commodities”. This includes condoms, lubrication, medications and contraceptives, clean water and a secure supply of food. What sex workers need…

Access to sexual and reproductive health services and medications. Freedom from abuse, discrimination, and persecution. Safe places to work and safe places to live and care for children. Psychological and social support and access to resources that enable sex workers to increase their control over their civil, personal and work lives. Opportunities that can help sex workers to reduce dependency on commercial sex and to realize their personal goals. VCT with access to social support, care and treatment for sex workers who test positive for HIV. What sex workers deserve…

The UNAIDS version of the Guidance Note abandons Jonathan Mann’s legacy of rights-based policy and programming. Abstinence-based campaigns have stigmatized sex workers. The Guidance Note merges with pre-existing fundamentalist campaigns against sex workers. Leads to HIV-prevention campaigns that have promoted blaming or scapegoating of sex workers for HIV. Inadequate attention to the access of sufficient affordable HIV-prevention commodities such as condoms, appropriate lube, etc. In conclusion…

“Twenty years of experience has shown that effective HIV prevention, treatment, care and support for sex workers is possible with their meaningful and active involvement.” Draft Reworking of the UNAIDS Guidance Note on HIV and Sex Work, September 2007