Sex workers continue to face criminalization, violence, discrimination and other forms of human rights violations which increase their risk of acquiring HIV.
Sex workers—female, male and transgender adults who have consensual sex in exchange for money or goods, either regularly or occasionally—are among the populations that are being left behind in the HIV response. HIV prevalence among sex workers is 10 times higher than among the general population, and sex workers are poorly served by HIV services.
Many of the human rights challenges, vulnerabilities and barriers sex workers face in accessing HIV services are due to criminalisation and the restrictive laws, regulations and practices they face. Selling and/or buying sex is partially or fully criminalized in at least 39 countries. In many more countries some aspect of sex work is criminalized, and in other countries general criminal law is applied to criminalize sex work (for example, laws against loitering and vagrancy).
The threat of detention, as well as laws that allow for the use of condoms as evidence of sex work, are serious barriers to the availability and uptake of HIV prevention programmes and services. When possession of condoms is used by the police as evidence of sex work, this greatly increases the risk of HIV among this key population. Even where sex work is not criminalized, sex workers are rarely protected under the law
Furthermore, studies have shown that female sex workers are subjected to high levels of violence—in Haiti, for example, 36.6% of female sex workers report physical violence and 27.1% report sexual violence.
However, sex worker organizations are leading efforts to advance their human rights and access to HIV services in many countries. In South Africa, sex worker-led organizations worked closely with the Ministry of Health to develop the South African National Sex Worker HIV Plan 2016–2019, which calls for an enabling environment for the protection of, and access to HIV services for, sex workers. The nationwide programme enlisted peer motivators to assist in the distribution of condoms and lubricant, information on sexually transmitted infections and HIV prevention, paralegal services and health service referrals. Community empowerment services that aim to reduce violence, stigma and discrimination included sensitization training and a helpline for sex workers.
In India, sex worker organizations are working with the police and the community to reduce violence against sex workers, and to establish health and social services for themselves and their families.
There is growing evidence of the importance of addressing the structural and legal barriers that affect sex workers. Ending the AIDS epidemic as a public health threat would require translating this evidence into practice, including by ensuring that governments and all stakeholders prioritize and intensify efforts to protect the human rights of sex workers and to increase their access to HIV prevention and treatment services.
