- Because sex work is illegal and/or stigmatized in many settings around the world, sex workers are often marginalized. Their marginalization puts them at risk of violence in multiple ways: they may work alone, in unfamiliar areas, and without the protection of the police; they may be unable to develop supportive networks that could help them avoid dangerous clients or dangerous settings; and they may seek out the protection of gangs or others operating outside the law, leading to further risk of exploitation and abuse. Sex workers may also not be aware of their rights and may be less likely to consider an act violence if it does not necessitate hospitalization, decreasing their likelihood of reporting violence which in turn limits their ability to prevent future violence (International HIV/AIDS Alliance, 2008; WHO, 2005b).
- Even when sex workers do seek out assistance, they may be met with further abuse. Within the health sector, for example, when health professionals are not adequately trained, they may reflect the stigma in the surrounding culture through judgmental or abusive treatment. Health services may subject sex workers to disapproval, refusal to treat their health problems, mandatory HIV testing, exposure of their HIV status and threats to report them to the authorities. Sex workers who have been raped or beaten may be blamed, or have their concerns dismissed (Montgomery, R., 1999 & Amin, A., 2004, cited in World Health Organization, 2005b).
- The minimum standard to which any health service should be held is to do no harm. Therefore, it is essential for health services to train staff to treat sex workers with the same respect and compassion that they would treat any other person, and to not report them to authorities. However, their vulnerability to sexual violence means that it is essential to go beyond that minimum standard, to provide sex workers with supportive and rights-based counselling, voluntary testing for HIV, and referrals to legal assistance if available. In addition to providing the full array of violence-related services described in Build institutional capacity to address violence against women and girls in hospitals, health clinics, and other primary and secondary health facilities, health facilities should also be prepared to:
- Provide sex workers with information on their rights and that violence is a violation of rights.
- Provide sex workers with information on where they can safely go for help on violence issues.
- Provide safe places to disclose violence with ensured confidentiality and privacy.
- Provide health services near sex workers’ places of work, such as clinic within the hotels frequented by sex workers.
- Promote sex worker organizations that can advocate for quality of care medical treatment for sex workers.
- Train service providers by sex workers on how to provide care in a non-stigmatizing way
Sources: WHO and Global Coalition on Women and AIDS, UNAIDS, 2005b; UNAIDS, 2009.
- Violence against sex workers is one of the factors driving the HIV epidemic in many countries, because violence against women and girls is linked to their inability to insist on use of condoms, thus consequent inability to protect themselves as well as their clients. HIV programs have an important role to play in addressing violence. The International HIV/AIDS Alliance has documented some ways in which HIV/AIDS services can help to address violence against sex workers by enlisting the participation of sex workers in the training of providers and development of protocols:
- HIV/AIDS projects can assist sex workers to conduct training for health service providers, in order to show them how they should address and treat sex workers in a non-abusive and non-stigmatising way. Sex workers can work with health services to develop guidelines that promote safety, confidentiality, and non-discriminatory care and support (International HIV/AIDS Alliance, 2008).
Example: In 2003, the Bill & Melinda Gates Foundation launched Avahan, an initiative to reduce the spread of AIDS in India. Avahan specifically supports programs that serve groups that are most vulnerable to HIV infection, including sex workers and their clients and partners. Through their interventions for work sex workers, Avahan has aimed to reduce the incidence of HIV among sex workers and their partners, reaching 59,000 sex workers since 2004. These interventions have included instituting a system whereby health workers are sensitized to provide appropriate health care to sex workers and sex worker peer educators are oriented to help each other and contact providers and police when subjected to violence or coercion. Within 12 months of introducing this system, the project responded to all reported crises within 20 minutes, benefitting 6,507 sex workers, leading to improved condom negotiation. Prior to this project, the previous response time was 8 hours and a response rate of only 80% of reported cases (Gaikwad and Kumar, 2008).
Example: Médecins sans Frontières (MSF) faced a particular challenge in its work with migrant sex workers in Svay Pak, Cambodia. From MSF’s perspective, providing only clinical services was not enough to ensure the effectiveness of their efforts to combat HIV/AIDS. It was important to find ways of addressing some of the broader issues affecting sex workers’ vulnerability and risk, in a way that did not threaten the brothel owners or other powerful groups such as the police. However, they were working in an area where sex workers faced serious restrictions, with their movements being controlled by brothel owners and the police. The owners of the brothels were generally suspicious of the activities of any organizations that tried to work with the sex workers, although they were keen to allow sex workers to attend clinical services. MSF therefore worked with sex workers to set up a drop-in centre just above the clinic. The centre provided an informal safe space which sex workers could attend at the same time as they made visits to the clinic. In time, the centre began to organize regular group activities including structured discussions about well-being, about common needs of the community and ways of acting upon them. Gradually, it became possible to organize discussions on sensitive issues such as violence and how to avoid it, although facilitators were very careful to allow these discussions to emerge in their own time, rather than forcing the issue. (Busza, J., Hom-Em, X., Ly, S., Un, S., 2001. “Petals and thorns: the dilemmas of PLA and debt bondage”, PLA Notes, 40.
Source: excerpted from International HIV/AIDS Alliance, 2008. “Sex Work, Violence and HIV”, pg. 20.
Sex Work, Violence and HIV. A Guide for Programmes with Sex Workers (International HIV/AIDS Alliance. 2008). Available in English. Also see AIDS Alliance website.
UNAIDS Guidance Note on HIV and Sex Work (Joint United Nations Programme on HIV/AIDS, 2009). Available in English.
The Global Network of Sex Work Projects (NSWP). See the website and see “Violence, Repression and Other Health Threats,” (Wolffers, I. 2001) in Issue 4: Risk and Violence of Research for Sex Work. Available in English.