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HIV/AIDS and Sex Workers: Implications for Policy Carol Jenkins Alternate Visions Bangkok September 15, 2005
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HIV/AIDS and Sex Workers: Implications for Policy “..communities, like individuals, cannot respond to the challenges of HIV unless they can express the basic right to be involved in decisions that affect them.” -- Jonathan Mann
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What Is Sex Work? The term “sex work” was coined by Carol Leigh (aka Scarlot Harlot) in 1979 “Provision of sexual services or performances by one person (prostitute or sex worker) for which a second person (client or observer) provides money or other markers of economic value” Priscilla Alexander, Sex Work and Health: A Question of Safety in the Workplace in JAMWA vol 53, no. 2.
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Commercial Sex Trade Commercial sex is central to many of the the HIV epidemics of the region Big business, organized, protected But sex workers usually the easiest group to work with, respond quickly to respect
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Females Biologically more susceptible than male partners Stigma, external and internalized At high risk of violence and sexual coercion Little social power, education
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Males Large numbers sexually active with both males and females Highly stigmatized Greater likelihood of risk-taking as part of masculinity
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And Transgenders Transgenders occupy an important role in sexual transmission in many countries Nearly always have higher HIV levels than any other group of sex workers Gender-benders, cultural challenge
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Summary of Key Issues Where epidemic driven by sex trade, large impact possible. Few countries cover more than 20% of SWs. Few programs reach all types of sex workers. Personal partners, clients, part-timers, suburban and rural SWs often missed. Condom use can rise very high if clients also addressed. Sustainable if group norms change but vigilance is required. Violence, rape, police harassment undermine effectiveness Improving social capital, social inclusion has impact on condom use. Best set of components Peer outreach Build social group Quality STI treatment Condom (M/F/Lub) sales
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Components of Effective HIV Prevention
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Peer Outreach Requires training, supervision Requires payment Training : technical knowledge, communication skills, safer sex, gender & society, working safety, legal rights, counseling skills, fitness, health, & beauty, M&E HIV support group
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Exposed vs non-exposed: % MSW using condoms by type of exposure to intervention All effects p=.000
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Exposed vs non-exposed: % MSW showing condoms and seeking STD treatment last time by type of exposure to intervention
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Exposed vs non-exposed: Sex with personal partners: % MSW having all last anal sex with condoms and any last oral sex with condoms p=.000
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Dhaka Street Sex Workers-syphilis, condom use and STD treatment - 1999-2004
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Violence against Sex Workers-Bangladesh -2004
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Prevalence of gang rape among sex workers in Phnom Penh, Cambodia (n=1003)-2004
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Conditions at last gang rape among sex workers in Phnom Penh, Cambodia
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Drug Use at last gang rape among sex workers in Phnom Penh, Cambodia
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HIV Prevalence among injecting drug users and sex workers - Kathmandu
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Who Makes Policy? Governments, politicians? Protectors, NGOs? Self-help groups of marginalized people?
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