The UN World Health Organization (WHO) has released new guidelines - titled 'Prevention and Treatment of HIV and Other Sexually Transmitted Infections for Sex Workers in Low- and Middle-Income Countries' - recommending, among other things, that countries should work towards decriminalizing sex work.
In the guidelines, WHO notes that violence against sex workers is a risk factor for HIV and "must be prevented and addressed in partnership with sex workers and sex worker-led organizations". WHO recommends that "health services should be made available, accessible and acceptable to sex workers based on the principles of avoidance of stigma, non-discrimination and the right to health".
"WONETHA [Women's Organization Network for Human Rights Advocacy, a Ugandan sex worker rights NGO] welcomes the recommendations that governments should work towards the decriminalization of sex work and the unjust application of non-criminal laws and regulations against sex workers, which exacerbate sex workers’ vulnerability to HIV and sexually transmitted infection," said Macklean Kyomya, director of WONETHA. "We also welcome the recommendation on HIV prevention and treatment programmes’ need to include interventions to enhance community empowerment among sex workers which are sex worker-led."
Among the recommended interventions for sex workers are: the promotion of correct and consistent condom use; offering sex workers HIV testing and counselling; offering periodic screening and treatment for sexually transmitted infections to female sex workers: initiating HIV-positive sex workers on antiretroviral treatment; and using WHO recommendations on harm reduction for sex workers who inject drugs.
Better protections needed
A recent protest by Kenyan sex workers against violence and discrimination highlights the need for better protection of this group, which remains disconnected from mainstream health services and at high risk of contracting HIV.
"It was just to show the whole country that we are not happy with the treatment we get from the society. We have rights because we are Kenyans," said James*, a male sex worker and member of the Kenya Sex Workers Alliance, which organized the protest on 17 December in the capital, Nairobi. "People castigate us during the day and embrace us in private and at night. We need recognition, and we will fight for it."
|People castigate us during the day and embrace us in private and at night. We need recognition, and we will fight for it|
The sex workers said a number of their colleagues had been killed over the last few months, with little action by the police to track down the culprits. They also called for the decriminalization of sex work, which would enable them to emerge from the shadows and enjoy the rights and privileges that other Kenyans take for granted.
"Most of the [sexual and reproductive health] services we get are from private organizations that have decided to work with sex workers, but I think the illegality of the work we do is the main reason we don't benefit from government services," said James. "People fear. And, again, you can't go to a clinic, for example, and tell a health worker there that you are sex worker. They will treat you with a lot of disdain."
Policy reform needed
In Uganda, where sex work is also illegal, sex workers are largely left out of HIV prevention policies - despite the fact that sex workers, their clients and their clients' partners account for 10 percent of all new HIV infections annually.
WONETHA’s Kyomya says that, unless the government drastically changes its policies towards sex workers, the new guidelines will have limited impact.
"Uganda should create avenues for sex workers and our clients to report crimes voluntarily, including rape or the operation of organized crime networks. Uganda has to prohibit the discrimination and abuse that we sex workers often face when seeking services for the prevention and treatment of HIV. Uganda should ensure that there is free flow of information about HIV through peer-led interventions or mass media, [that information] is not blocked by censorship," she said.
"It should provide meaningful, well-enforced penalties for police who engage in harassment or blackmail of sex workers. It should encourage and support the... collective voice of sex workers. It should ensure that there are no obstacles to advocacy and service-provision groups supporting sex workers."
*not his real name