The first workshop of its kind to bring together sex workers’ associations from around the world together with the United Nations, took place in Geneva this week. Around 35 representatives from 16 countries from the UN, governments, sex work networks, and sex worker organisations took part.
It is one of a series of workshops focusing on groups which are particularly vulnerable to HIV. In the Declaration of Commitment on HIV/AIDS, adopted unanimously at the UN Special Session on HIV/AIDS in June 2001, governments agreed to make groups at higher risk a priority in the AIDS response.
Sex workers across the globe have been one of the groups most affected by HIV, and they have been mobilised and empowered to become leading advocates and educators on HIV prevention and care, according to Aurorita Mendoza, Prevention and Vulnerability Adviser at the Joint United Nations Programme on HIV/AIDS (UNAIDS). "Over the years, we have witnessed sex workers become one of the biggest mobilisers in the AIDS response, both on the care and prevention front. Despite this, they still face many stumbling blocks, including stigma and discrimination, and laws which criminalize them, and prevent them from receiving needed information and services,"
The workshop, a consultation on sex work and HIV/AIDS, hoped to identify strategies for the UN and sex worker communities to work together to prevent the spread and mitigate the impact of HIV/AIDS among sex workers. Representatives of sex work networks and organisations discussed effective ways of mobilising sex workers and preventing the spread of HIV/AIDS among them.
Many factors increase sex workers' vulnerability to HIV. While sex work is a global phenomenon, it is also frequently illegal and, therefore, clandestine. Sex workers are often victims of stigma and discrimination, exploitation and violence, and have limited access to health services.
Sex work is also a significant social and economic sector in many countries. According to the International Labour Organization's (ILO) estimates, the sex work industry accounted for more than 2% of gross domestic product in four South-East Asian countries in the late 1990s.
In countries where heterosexual intercourse is the main mode of HIV transmission, HIV epidemics tend to be concentrated initially among sex workers and their clients before becoming established in the wider population. "Experiences in many countries show that when HIV infection rates among sex workers rise, it is an indication that HIV rates in the wider population are very likely to increase unless effective prevention efforts are introduced," said Ms Mendoza.
Experiences in the field indicate that sex workers are among those most likely to respond positively to HIV prevention programmes. Some countries have succeeded in reducing HIV prevalence among sex workers, such as Bangladesh, Benin, Cambodia, Dominican Republic, and Thailand, primarily due to policies supporting condom use with clients and to initiatives directly involving sex workers in condom promotion.
One of the keys to successful HIV prevention among sex workers is to involve them directly in the development and implementation of care and prevention programmes, according to Mahbooba Mahmood, Project Coordinator of Naripokkho, a sex work organization in Bangladesh. "Building the capacity of sex workers to take the lead in programmes that respect human and citizen rights has proven to be one of the most successful strategies in preventing the spread of HIV. It promotes solidarity, enables them to reach more of their peers and share their knowledge on health matters. They no longer need to rely on outsiders, thus giving them increased control over their own health," she said.
Experts agree that much can be done to address factors that force men and women to use sex work, whether formal or informal, as a means of survival, protect the sex workers, and assist them in leaving sex work, if they so wish. "The ultimate challenge is for governments to make access to HIV prevention and care available to sex worker communities, implement policy and legal frameworks that do not discriminate against sex workers, set up programmes that empower young women, and work towards eliminating violence against women," said Lin Lean Lim, Manager of the ILO's Gender Promotion Programme.