1. Human rights violations against sex workers: Burden and effect on HIV Decker MR, Crago A-L, Chu SKH, Sherman SG, Seshu MS, Buthelezi K, Dhaliwal M, Beyrer C HIV and Sex Workers, Paper 4

2. Comprehensive review – Prevalence of human rights violations – Quantitative estimates of impact on HIV risk, infection, treatment and care – Analyzed legal environments according to evidence of human rights violations and HIV burdens Searched scholarly databases for keywords and terms related to sex work and human rights violations. Priorities: primary data, published 2009-2014 Reviewed over 800 studies What did we do?

4. Violations by State-Actors: Police Condoms confiscated, destroyed or used as evidence of a crime by police (7- 80%) -Associated with unprotected sex. Confiscation of sterile injection equipment -Associated with prevalent HIV and police-perpetrated sexual violence. Extortion by police (12-100%) -Associated with inconsistent condom use and STI symptoms -Prompted taking on riskier clients

5. Police-perpetrated physical & sexual violence Physical Violence by Police (5- 100%) Sexual Violence by Police (7-89%) …he pulled out a police badge and said “C’mon, you want me to take you in or screw you?” I was scared, and allowed him to screw me – FSW, Serbia (Rhodes et al., 2008) Twice I was locked in police station, there 12 police officers beat me. They dragged me to the toilet and forcefully had sexual intercourse with me without using condom. – Meti [transgender] sex worker, Nepal (Wilson et al., 2011)

6. Police violence significantly associated with: other experiences of violence prevalent STI/HIV Police sexual violence significantly associated with: accepting more money for unprotected sex, inconsistent condom use, STI symptoms and STI/HIV infection. HIV Implications of Police Violence

7. Systemic Impunity & Violations by Non-State Actors High level of homicide Significant levels of violence reported by non-state actors including perpetrators posing as clients, clients, spouses/intimate partners and third parties. 39-100% consider they cannot report abuse to police Physical and sexual violence from non-state actors fueled by perpetrators’ recognition of sex workers’ barriers to seeking justice.

8. Violence by clients or perpetrators posing as clients associated with STI/HIV Violence by non-state actors is a barrier to accessing health services HIV Implications of Violence by Non-State Actors

9. Arrest (4-75%) Even when lawfully applied, punitive laws impede sex workers’ human right to protect their safety and health: Arrest (4-75%) Experiences of arrest and imprisonment are associated with unprotected sex, STI/HIV symptoms or infection in 4 studies on 4 continents. Where measured, experience of police raids were associated with experience of violence. Human Rights and HIV Implications of Raids and Arrest

10. Arrest (4-75%) Criminalization of sex workers OR of their clients is linked to displacement to isolated and dangerous areas. Where measured, police displacement correlated with violence and pressure not to use condoms. Human Rights and HIV Implications of Police Displacement

11. Discrimination or denial of health services or ART based on being a sex worker. Widespread mandatory or forced HIV testing regimes for sex workers Unlawful detention, sometimes lasting years. Documented conditions of forced labour, violence. Denial of access to prevention tools, medical care, ART and antenatal care in police detention, prison or “rehabilitation” centers. Human Rights Violations Within Health & Detention Systems

12. Criminalization Most severe and systematic rights violations in the literature occurred under systems of full or partial criminalization. Gives cover for widespread abuse and institutionalizes discrimination Even when lawfully applied, punitive laws impede health and safety Criminalization of clients and third parties (ie “the Swedish approach”) creates many of the same harms to sex workers of full criminalization.

13. Legalization Sex work is legal under specified conditions – Highly restrictive, often discriminatory, enforced with criminal law – Often mandatory registration and health exams – Often specifically criminalizes HIV-positive sex workers – Many, if not most, operate outside the system Violence and access to justice remain major issues Goal containment and control not human rights

14. Decriminalization Human rights promotion is a core goal New Zealand’s 2003 Prostitution Reform Act – Increased protections against violence – Increased power to refuse a client – Increase power to report violence – Increased access to services Challenges remain – While diminished, instances of violence persist as does reluctance to report abuse to police

15. Legal Reform Decriminalization… safeguards the rights of sex workers. The failure of legal recognition of the sex- work sector results in infringements of the right to health

16. Ending the conflation of sex work with trafficking Anti-prostitution loyalty oath (APLO) Sex work and trafficking are distinct, yet often conflated in policy and practice Anti-trafficking policy has escalated criminalization of sex work Conflating sex work with trafficking fails both in realizing their rights Global policy climate: a need to end discriminatory policy.

17. Dismantling impunity Criminalization of sex work Abusive police practices: brutality, sexual violence, extortion Attitudes that sex workers cannot be raped Refusal to take reports or investigate violence against sex workers

18. Dismantling impunity Criminalization of sex work Abusive police practices: brutality, sexual violence, extortion Attitudes that sex workers cannot be raped Refusal to take reports or investigate violence against sex workers LEGAL REFORM Social transformation REFORM to practice

19. The path forward