Shahnaz Khatun (not her real name), a former sex worker now running a small clothing business in Dhaka, Bangladesh, found herself in difficulties when the country went into lockdown. Before the COVID-19 outbreak, the areas where she used to work were crowded, but now they are quiet. Ms Khatun is self-isolating in response to the government’s call, but she is unable to provide for herself and her family. “My business is now out of action due to the restrictions on movement. I have some underlying health conditions and I spent all my money on buying medicines,” she said.

As a result of the COVID-19 pandemic, sex workers in Bangladesh, like other informal sector workers, are experiencing hardship and a loss of income. With the limited support that some of them get, they can barely feed themselves and their children. Only a few of them have savings to fall back on and little access to services that could bring some relief. Conditions are more vulnerable for street-based sex workers, as most of them are homeless.

However, sex workers in Bangladesh are organizing themselves, establishing support networks to help their peers. The Bangladesh Sex Workers Network, a nongovernment organization working for the rights of sex workers, mobilized financial aid for more than 2100 sex workers across the country that was distributed through the active engagement of 26 community-based organizations. “Many sex workers have chosen this profession for the sake of their families or children, to provide them with food and a livelihood. Today, sex workers’ families are passing their days helplessly with no money in their pocket,” explains Ms Kajol, President of the Sex Workers Network of Bangladesh.

Ms Khatun received 10 000 Bangladeshi taka, equivalent to US$ 120, through the Bangladesh Sex Workers Network. “With this, I also bought food for another 30 sex workers. I am also arranging for delivery of masks, soap and food to other sex workers in my area and am teaching them about hand washing techniques, maintaining personal hygiene and social distance maintenance,” she said.

Ankhi Akhter (not her real name), who works in a brothel in Tangail, gives support for mental health issues to her peers and encourages regular communication among sex workers in order to cope with stress and to exchange thoughts. “The local governmental authority and a number of nongovernmental organizations, as well as private entities, have already helped us with food and a limited amount of money,” she said. “However, these will not be sufficient if the situation continues.”

As a result of Ms Akhter’s efforts, the Dhaka District Council Office and the Member of Parliament representing the district donated food to the brothel and distributed it among a network of 500 sex workers. The Society for Social Service, a local nongovernmental organization, offered cash payments to more than 400 sex workers and landlords postponed utility bills, such as rent, electricity and water. Most of the sex workers in the brothel received masks, soap and hand sanitizer from the brothel and volunteer organizations.

Sweety Begum (not her real name) is the leader of a community-based organization that supports street-based sex workers in Rajshahi. She relies on her husband's limited income for their living expenses and is helping other sex workers with the small amount of financial help she receives. “Street-based sex workers outside Dhaka are getting less help than those in Dhaka and they are scared to collect aid because of stigma and discrimination,” she said.

“Eleven brothels in Bangladesh have received food and some financial support from government organizations: however, this is not enough. In some areas, relief has been provided only to those who have a national identity card and, unfortunately, not all sex workers have this,” says Saima Khan, UNAIDS Country Manager for Bangladesh.

UNAIDS and the United Nations Children’s Fund have been supporting the network of sex workers to develop income-generating schemes so they can compensate for the loss of income caused by COVID-19. Also, through the network of sex workers and in collaboration with the Bangladesh Country Coordinating Mechanism, UNAIDS has supported 23 community-based organizations of sex workers to procure protective commodities such as soap and masks during the initial stages of the response to COVID-19. Advocacy with organizations to make access to aid easier for sex workers is also ongoing.

“The Sex Workers Network of Bangladesh, through collective efforts, will continue to work hand in hand, so that sex workers can fight back against any difficult situation they face together, leaving no one behind,” said Ms Kajol.

The Global Network of Sex Work Projects (NSWP) and UNAIDS recently released a joint statement calling on countries to take immediate, critical action to protect the health and rights of sex workers during the COVID-19 pandemic.

The pandemic, as with other health crises, is exposing existing inequalities and disproportionately affecting people already criminalized, marginalized and living in precarious health and economic situations, often outside social protection mechanisms.

Around the world, sex workers are being forgotten in government responses to the COVID-19 crisis. As sex workers and their clients self-isolate, sex workers are finding themselves unprotected, increasingly vulnerable and unable to provide for themselves and their families. In Ecuador, the Colectivo Flor De Azalea (the Association of Women Sex Workers) has highlighted the sudden lack of support and access to basic services that sex workers face. “Women sex workers have suffered a great impact due to the health emergency. We take to the streets with great fear and we are afraid of being violated. We do not have money for food, rent, medicine; health services are closed. There is no access to condoms—colleagues have died due to COVID-19.”

“Human rights law mandates that human rights are inalienable, universal, interdependent and indivisible,” said Winnie Byanyima, Executive Director of UNAIDS. “Ensuring that this is a reality for all—especially the most vulnerable among us—is essential during this pandemic, but will also build the resilient communities we need to emerge from it.”

As sex workers report interruptions to condom supplies owing to the pandemic, sex workers living with HIV say they are losing access to essential medicines as well. In Eswatini, Voice of Our Voices report that, “for those who are on HIV treatment, it is hard to meet their visit days as there is no transport. For prevention commodities, it is hard to reach them.”

With sex work criminalized in almost every country, sex workers are also more vulnerable to punitive measures linked to the enforcement of COVID-19 regulations. Increased policing can expose sex workers to more harassment and violence, and in several countries has already led to home raids, compulsory COVID-19 testing and the arrest and threatened deportation of migrant sex workers. For those who are driven to the streets by homelessness, as has become the case for many brothel and migrant sex workers, the lack of support means little safety or means to follow through on government requirements.

The criminalization of sex work in most countries also poses particular challenges for accessing government support. In the United States of America, SWOP-Tucson (the Sex Workers Outreach Project) explained that, “many of these schemes require proof that employment has been lost or reduced as a result of COVID-19. Because sex work is criminalized, it’s not possible to provide necessary paperwork and proof of unemployment or hardship. Thus, sex workers can’t get rent/mortgage relief, utility payment abatements or unemployment checks.”

Even in countries where sex work is legalized to some degree, many sex workers are finding that the system of benefits extended to workers in the formal sector does not include them. This is the case in Germany, for example, where sex workers highlight the barriers to accessing support for anyone living outside of the system. “While the government has provided a package for (registered) freelance workers, sex workers have not been in any way addressed in particular, and there is no potential for anyone living here illegally to access money from them.”

As the global crisis deepens, sex workers are increasingly faced with the difficult choice of isolation with no income or support or working at a risk to their own health and safety. Another problem has been that the majority of affordable short-term housing opportunities have closed while sex workers struggle to pay rent or pay hotel room fees. This disappearance of short-term housing, coupled with the shuttering of workplaces, has resulted in sudden homelessness for sex workers in several countries, a situation that is especially aggravated for migrant sex workers, many of whom are also finding themselves stranded by border closures.

Despite the continued exclusion of sex worker communities from emergency public health planning groups, sex workers have begun coordinating their own responses to the crisis. Several mutual aid and emergency fundraising campaigns have been created, enabling sex workers and sex worker organizations to access and distribute funds and essential items. One such initiative was undertaken by And Soppeku, a sex worker-led organization in Senegal, which distributed food packages and hygiene kits to members in three regions (Dakar, Thies and Kaolack). Similar initiatives are being developed around the world in the absence of government action and support.

However, the self-organization of individuals and groups must not be considered a substitute for urgently needed government support. Governments are bound by international human rights law to respect, protect and fulfil human rights, without discrimination, even in times of emergency.

Sex workers and sex worker organizations are calling for equal protection under the law and access to income support and to health care. UNAIDS joins this call to action, underscoring the importance of a human rights-based approach to COVID-19 responses, centred on empowerment and community engagement.

Quotes in this article were gathered through NSWP’s COVID-19 Impact Survey, which is collecting responses from sex workers and sex worker organizations in order to monitor what governments are doing for the sex worker community at this time.

Although difficult for everyone, the COVID-19 pandemic has had severe impacts on key populations, many of whom are experiencing economic hardship and anxiety about their health and safety.

Rito Hermawan (also known as Wawan), the Advocacy Coordinator of the Network of Sex Workers of Indonesia (OPSI), explained that the places that sex workers work in Indonesia have been closed down. Since, for their own safety, sex workers are avoiding working on the streets, many have been left without an income, unable to make ends meet.

It’s been about a month since Indonesia enacted a set of preventive measures against COVID-19. With the uncertainty of when life may return to normal, OPSI is supporting the urgent needs of the sex worker community.

Many sex workers are increasingly needing mental health support to combat the stress and anxiety they are currently experiencing. In a rapid survey conducted by the Indonesian Positive Network to review the needs of people living with HIV and key populations, more than 800 out of 1000 people surveyed expressed a need to access mental health and psychosocial support.

In order to address this, OPSI uses social media to provide virtual mental health support. “Through our social media, we are able to reach sex workers and empower them with information, motivation and support. They need to know that they are not alone, even though we may not be physically close,” said Mr Wawan.

A video teaching meditation and breathing techniques was recently launched to help sex workers cope with stress and to improve their general well-being. OPSI is also highlighting innovative work, such as making masks for sex workers during the COVID-19 pandemic. For those who need one-on-one support, OPSI has also established a counselling hotline.

In addition to supporting the sex worker community in Indonesia, OPSI is also exploring ways for outreach efforts to be continued despite the current conditions. The essential work of outreach workers should not come to an abrupt halt because of COVID-19, but it will need to move to a virtual form.

With technical assistance from the United Nations Population Fund Indonesia, OPSI developed a module on virtual outreach. The module outlines how outreach workers can adapt their work online, such as by using WhatsApp. The outreach workers are provided with lists of HIV counselling and testing services that are still open in 88 districts in Indonesia, which they can use to refer sex workers.

Sex workers, like others, are facing incredible hardships during the COVID-19 pandemic, whether it be struggles with their mental health, difficulty in continuing their work and loss of income. The role of networks and organizations of sex workers like OPSI is incredibly important in ensuring that the needs of sex workers are supported at this vital time.

GENEVA, 8 April 2020—The COVID-19 pandemic, as with other health crises, exposes existing inequalities and disproportionately affects people already criminalized, marginalized and living in financially precarious situations, often outside social protection mechanisms.

During these difficult times, the Global Network of Sex Work Projects (NSWP) and UNAIDS wish to draw attention to the particular hardships and concerns facing sex workers globally, and are calling on countries to ensure the respect, protection and fulfilment of sex workers’ human rights. 

As a result of the COVID-19 pandemic, sex workers all over the world are experiencing hardship, a total loss of income and increased discrimination and harassment. The criminalization of various aspects of sex work in the majority of countries serves to magnify the already precarious situation of sex workers in the informal economy. As sex workers and their clients self-isolate, sex workers are left unprotected, increasingly vulnerable and unable to provide for themselves and their families.

Sex worker-led organizations from all regions are reporting a lack of access to national social protection schemes and exclusion from emergency social protection measures being put in place for other workers, particularly where sex work is criminalized. Whenever and wherever possible, sex workers are responsibly self-isolating in response to governments’ calls. However, when they are excluded from COVID-19 social protection responses, sex workers are faced with putting their safety, their health and their lives at increased risk just to survive.

NSWP and UNAIDS are furthermore concerned at reports of punitive crackdowns against sex workers, resulting in the raiding of homes, compulsory COVID-19 testing, arrest and threatened deportation of migrant sex workers.

UNAIDS calls on countries to take immediate, critical action, grounded in human rights principles, to protect the health and rights of sex workers. Measures should include:

• Access to national social protection schemes for sex workers, including income support schemes.
• An immediate firewall between health services and immigration authorities in order to ensure that migrant sex workers can access health services.
• Emergency financial support for sex workers facing destitution, particularly migrants who are unable to access residency-based financial support.
• An immediate end to evictions and access to appropriate emergency housing for homeless sex workers.
• Stopping raids on sex workers’ homes and sex work premises and ensuring that all measures to protect public health are proportionate.
• An immediate halt to arrests and prosecutions for sex work-related activity, moving away from punitive measures and criminalization towards reaching and serving those most in need.
• An immediate end to the use of criminal law to enforce COVID-19-related restrictions, including forced COVID-19 testing and related prosecutions.
• Automatic extensions on visas due to expire as travel restrictions tighten. Immigration detention systems must support detainees in safe accommodation.
• The engagement of sex worker communities in responses—the meaningful involvement of sex worker-led organizations in emergency public health planning groups.

UNAIDS, as ever, stands ready to support countries in the implementation of the above recommendations.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

There are around 45 000 people living with HIV in Papua New Guinea, with marginalized groups, such as sex workers and other women who exchange sex for money, goods and protection, gay men and other men who have sex with men and transgender women, most affected. However, less than half of the people who belong to those vulnerable groups have ever taken a test to know their HIV status.

In November 2018, UNAIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria and other partners implemented a new outreach programme in the capital, Port Moresby, to try to reduce the impact of HIV among those groups of people by mapping the HIV epidemic and expanding HIV treatment and prevention services. Under the project, several outreach teams were created to promote and increase the uptake of testing and prevention services and to link people to HIV prevention and care services, if necessary.

By April 2019, the outreach teams had contacted 5000 people and tested 3000 of them for HIV, offering advice and support so that each person understood their test result.

“I like that we go to new places where people have never been offered an HIV test,” said a member of one of the outreach teams. “My motivation is meeting the young girls and taking care of them—making sure they take their medication.”

The outreach workers sometimes face harassment while conducting their work and change out of their official uniforms and into their own clothes so that people feel more comfortable talking to them. But the outreach workers find the work deeply rewarding.

“I have lost friends to AIDS, so that keeps me doing this work,” said another of the outreach workers. “It makes me work extra hard not to see someone else lost to this disease.”

The outreach teams are led by members of marginalized groups, an essential part of establishing community trust and engagement. In addition, leaders offer coaching, support and advice to field workers on a daily basis in order to ensure that their activities are as effective as possible.

The outreach programme is saving lives. Another of the outreach workers recalled his work with a transgender person, who he persuaded to try medication after testing positive for HIV.  

“He told me that because he is transgender, he will only talk to a friend and that when he saw me, he knew I was a friend. Later, he brought in his companion to take a test.”

“This is a model of what can be achieved when we put our trust in community-led HIV services and programmes,” said Winnie Byanyima, UNAIDS Executive Director, in discussion with the outreach workers during her visit to Papua New Guinea with the United Nations Deputy Secretary-General, Amina Mohammed. “These outreach workers are heroes and they are saving lives.”

The outreach programme is also cost-effective and is projected to save hundreds of thousands of dollars over the next two years.

Oral pre-exposure prophylaxis (PrEP) has shown considerable impact in reducing new HIV infections when provided as an additional HIV prevention choice to gay men and other men who have sex with men, transgender people and sex workers.

PrEP is now being rolled out in sub-Saharan Africa for serodiscordant couples and adolescent girls and young women who are at higher risk of HIV infection. Uptake is high when community-level stigma and misconceptions are addressed, when women and girls are provided with accurate and relevant messaging about PrEP and when PrEP is framed as an empowering prevention method and a positive life choice.

However, further global expansion of PrEP requires countries to address regulatory issues and other barriers that are stopping people who want to use PrEP from doing so.

GENEVA, 2 December 2019—UNAIDS applauds the decision by the parliament of Australia’s Northern Territory to decriminalize sex work. The Sex Industry Bill 2019 enhances the safety of sex workers and their clients by applying public health legislation to operators of sex service businesses and by allowing sex workers to work together. The legislation explicitly prohibits the exploitation of sex workers, supports their access to justice and outlaws any involvement of children.

“I commend this decision by Australia’s Northern Territory, which upholds the human rights of sex workers and means that they can operate within existing laws and regulations, including laws relating to employment, occupational health and safety, workers’ rights and discrimination,” said the UNAIDS Executive Director, Winnie Byanyima. “The decriminalization of sex work reduces the risk of HIV transmission for both sex workers and their clients.”

Globally, sex workers are 21 times more likely to acquire HIV than the general adult population. A 2014 study published in the Lancet indicated that the decriminalization of sex work is the single intervention that would have the greatest impact on the course of the HIV epidemic over 10 years, with reductions in new HIV infections among sex workers and their clients estimated at between 33% and 46%.

“This is a huge achievement built on the advocacy of sex workers and their supporters over many years and the result of best practice collaboration between the government and sex workers,” said the Chief Executive Officer of Scarlet Alliance, the Australian Sex Workers’ Association, Jules Kim. “Decriminalization means that sex workers in the Northern Territory are able to access justice in the event of a crime without fear of being arrested. We will also be able to implement occupational health and safety strategies and prioritize the health and safety of all those involved in sex work.”

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Despite the availability of a widening array of effective HIV prevention tools and methods—and a massive scale-up of antiretroviral therapy in recent years—there has been insufficient progress in reducing global new HIV infections, which have fallen by only 16% since 2010.

The United Nations General Assembly’s 2016 Political Declaration on Ending AIDS calls on countries to ensure that 90% of those at risk of HIV infection are reached by comprehensive prevention services by 2020. However, sex workers―and other key populations―often haven’t been accessing the prevention services they need. Country data reported to UNAIDS within the last three years show a widely varying coverage of combination HIV prevention services.

With female sex workers having a 21 times higher relative risk of HIV acquisition compared to the general population, access to suitable HIV prevention options is vital.

The global distribution of new HIV infections in 2018 crossed a threshold: the majority of global new infections were among key populations and their sexual partners.

This change is a result of the strong progress in settings with high HIV prevalence in eastern and southern Africa, combined with a mixture of progress and setbacks in lower prevalence regions.

Key populations make up a small proportion of the general population, but they are at extremely high risk of acquiring HIV infection. Available data suggest that the risk of HIV acquisition among gay men and other men who have sex with men was 22 times higher in 2018 than it was among all adult men. Similarly, the risk of acquiring HIV for people who inject drugs was 22 times higher than for people who do not inject drugs, 21 times higher for sex workers than adults aged 15–49 years and 12 times higher for transgender women than adults aged 15–49 years.