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Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. If you have ly obtained access with your personalplease log in. There was considerable diversity in the ages, education levels, family situations and attitudes to sex work among women working mainly in the legal brothels in Victoria.

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Jump to. Female, male and transgender adults and young people who receive money or goods in exchange for sexual services, either regularly or occasionally. Sex work varies between and within countries and communities. On average, sex workers are 13 times more likely to become infected with HIV than adults in the general population. Although sex workers are one of the groups most affected by HIV, they are also one of the groups most likely to respond well to HIV prevention programmes. Proof of this can be seen in countries such as Cambodia, the Dominican Republic, India and Thailand, where reductions in national HIV prevalence have been helped by initiatives targeting sex workers and their clients.

Sex workers often share common factors, regardless of their background, that can make them vulnerable to HIV transmission. Sex workers are often stigmatised, marginalised and criminalised by the societies in which they live. In various ways, these factors contribute to their vulnerability to HIV.

Even though sex work is at least partially legal in some countries, the law rarely protects sex workers.

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Around the world, there is a severe lack of legislation and policies protecting sex workers who may be at risk of violence from both state and non-state actors such as law enforcement, partners, family members and their clients. For example, a sex worker who is raped will generally have little hope of bringing charges against their attacker.

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This lack of protection leaves sex workers open to abuse, violence and rape, creating an environment which can facilitate HIV transmission. To avoid arrest that can involve violence, rape and other trauma, many sex workers try to avoid things that may identify them as sex workers — like carrying condoms or visiting health clinics for check-ups. In addition, the stigma that sex workers face can make it hard for them to access healthcare, legal, and social services.

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They may either be afraid to seek out these services for fear of discrimination, or be prevented from accessing them — for instance, if a nurse refuses to treat them after finding out about their occupation. When I visited a VCT [voluntary counselling and testing] clinic, health personnel were not polite and immediately asked me if I was a sex worker. In general, sex workers have comparatively high s of sexual partners compared with the general population. However, this does not necessarily increase their likelihood of becoming infected with HIV if they use condoms consistently and correctly.

But elsewhere in the region, in countries with ificant HIV epidemics among sex workers condom use was low, in Pakistan, for example condom use was only at In Lesotho, for example, where HIV prevalence among female sex workers was estimated at In some cases, sex workers have no access to condoms or are not aware of their importance. For example, a study by the Open Society Foundation in Kenya, Namibia, Russia, South Africa, the United States of America USA and Zimbabwe found evidence in all six countries of police harassing and physically and sexually abusing sex workers who carry condoms, or using the threat of arrest on the grounds of condom possession to extort and exploit them.

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Sometimes, sex workers are simply powerless to negotiate safer sex. Clients may refuse to pay for sex if they have to use a condom, and use intimidation or violence to force unprotected sex. Sex workers have told us that when they ask a client to use a condom, he offers double the price to have sex without the condom. These women are trying to provide for their children and families, so they take the offer.

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The clients of sex workers act as a 'bridge population', transmitting HIV between sex workers and the general population. High HIV prevalence among the male clients of sex workers has been detected in studies globally. Sex workers who use drugs can be stigmatised in workplace venues where drug use is discouraged.

This forces them onto the street where control over condom and drug use is compromised and exposure to violence is heightened, all of which compounds their vulnerability to HIV. Because sex work and drug use are illegal in most countries, sex workers who use drugs are more vulnerable to frequent arrest, bribes, extortion and physical and sexual abuse. In turn, this discourages many sex workers who inject drugs from seeking HIV prevention and treatment.

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Researchers investigating HIV prevalence among sex workers have raised particular concerns about epidemics in Eastern Europe and Central Asiawhere there is a ificant overlap between sex work and injecting drug use. A review of female sex workers in Europe concluded that their HIV vulnerability was linked primarily to unsafe injecting, rather than sex work itself.

In Central Asia, HIV prevalence is estimated to be 20 times higher among female sex workers who inject drugs than those who do not. Migration and sex work are often linked as some migrants may turn to sex work if they cannot find an alternative means of making money. Migrant sex workers often become the targets of both police and immigration officers, especially those who cross borders both legally and illegally and do not have immigration status.

Other than facing the criminalisation of sex work, they may also face surveillance, racial profiling, arrest, detention, deportation and other restrictions on mobility imposed by criminal, immigration and trafficking laws. As well as selling sex themselves, migrants may become the clients of sex workers as a means of escaping the solitude that often accompanies migration. Sex tourism is fuelling the demand for sex workers in many countries, particularly in Asia and the Caribbean.

Sex workers and clients

In some cases, men travel to another country in order to take advantage of lenient age of consent laws, or because they know that it will be easy to find paid sex. The recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation.

Large s of trafficked people are forced into selling sex every year. Even in countries where HIV prevalence is low, trafficked people who are forced to sell sex are highly vulnerable to HIV infection because they struggle to access condoms, cannot negotiate condom use and are often subjected to violence. One study conducted among trafficked people in Mumbai brothels in India found that almost a quarter of trafficked girls and women were living with HIV.

However, many emphasise that the relationship between sex work and human trafficking should not be overplayed as it can lead to false or exaggerated anti-sex work arguments and harmful action by authorities, ultimately undermining HIV prevention for sex workers. In fact, evidence suggests that fewer people enter into sex work through trafficking than enter consensually.

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For example, it is estimated that one in five people in the sex trade in Andrah Pradesh, India and one in 10 in Thailand have been trafficked. Despite this, policies that conflate sex work and trafficking have dominated approaches to sex work over the past decade. As a result, many countries- including Thailand, Cambodia, and Vietnam - implemented punitive measures targeting the sex industry. Many sex workers were forced into unsafe work environments, undermining their access to healthcare and increasing their vulnerability to violence, abuse and, ultimately, HIV.

Although the USA revoked the clause inits legacy continues, and more must be done to ensure that anti-trafficking efforts target those who commit trafficking, rather than punishing consenting adults engaged in sex work.

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While there is near-universal agreement between countries on the need to prevent people under the age of 18 from selling sex, there is little agreement on how to meet the needs of the ificant s of young people who are involved in selling sex. Data on young people who sell sex is extremely limited, although evidence suggests that a ificant proportion of sex workers begin selling sex while adolescents.

Research shows that adolescents under 18 who sell sex are highly vulnerable to HIV and other sexually transmitted infections STIshave higher levels of HIV and STIs than older sex workers and have limited access to services such as HIV testing, prevention and treatment. Young sex workers face many of the same barriers to HIV prevention as their older counterparts including the inability to negotiate condom use and legal barriers to HIV and sexual health services, which are amplified by their age.

In Kazakhstan, the law states that a person under 18 cannot be tested for HIV without [an] accompanying parent or guardian. As a rule, parents do not know that their daughter sells sex; therefore, girls are afraid of disclosure and do not get tested for HIV or STIs. Furthermore, young people who sell sex are often excluded from much of the research on sex work and HIV. Access to HIV prevention services for sex workers in still too low.

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Sex work is diverse and occurs in various contexts around the world. Although some sex workers sell sex through brothels or other venues, others might work independently and solicit clients directly in public places or online. Effective HIV prevention packages for sex workers are those that for the contexts in which they work and the particular risks they face. UNAIDS also emphasises the importance of combining HIV prevention strategies for sex workers, including integrating condom distribution with other HIV services and increasing links between HIV services and other sexual and reproductive health services such as family planning services, gynaecological services and maternal health.

Despite this, in just 3. The vast majority of this funding was supplied by international donors. The Avahan programme has been working with key affected populations in six southern India states since Pre-exposure prophylaxis PrEP whereby someone at higher risk of HIV takes antiretrovirals before possible exposure to HIV in order to decrease their likelihood of contracting the virus, is another area of prevention that could reduce HIV transmission rates among sex workers.

Within 12 months, more than 16, young people who sell sex had been reached with peer education sessions, with around 5, referred to clinics of whom more than 1, took up services, the most common of which was voluntary HTC. In Guatemala, a sexual health clinic that offered targeted HTC and follow-up services over a six-month period witnessed a four-fold decrease in HIV among sex workers. HIV prevalence among sex workers in Chile and El Salvador has also fallen ificantly following the targeting of sex workers with similar prevention programmes.

Inthe UNAIDS Key Population Atlas found female sex workers only had similar levels of access to treatment as other women in three out of 12 countries reporting data. Sex worker-led, community-based services that address legal and social barriers can have a real and lasting impact on the lives of sex workers, including by reducing their vulnerability to HIV. In Kenya, for example, the Bar Hostess Empowerment Programme has trained local sex workers as paralegals, which included learning about local and national laws and educating other sex workers about their rights.

Sex workers and clients

This has resulted in a strong sex worker network that is increasingly benefitting from community-led services. In Thailand, the Service Workers in Group SWING is a partnership between sex workers and the police formed inwhich aims to foster law enforcement practices that protect rights, and supports effective HIV programming.

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SWING sensitises young police cadets by giving them the opportunity to interact with sex workers in a neutral setting. Positive changes have already been noted in Bangkok constabularies, with fewer reported arrests and incidents of harassment.

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This includes outreach strategies and workshops targeted at key community leaders, law enforcement officers and state-level religious authorities who frequently arrest or fine sex workers. The PT Foundation has also developed a leaflet to inform sex workers of their rights should they get arrested.

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This [sex worker rights leaflet] has been very helpful…when the authorities come I tell them I know my rights. As soon as we start talking about rights they just move away. It amplifies the voices of these organisations in order to advocate for rights-based services, freedom from abuse and discrimination, freedom from punitive laws, policies and practices, and self-determination for sex workers.

The Survival Advocacy Network SANa transgender and female sex worker network founded by and for sex workers in Fiji, which trains healthcare providers to enable sex workers to access healthcare without fear of stigma or discrimination. Can you support us and protect our future? In many cases, laws and policies are actively stopping HIV prevention campaigns for sex workers.

Sex work is viewed as morally corrupt or criminal in many places, and those involved are often neglected and marginalised by wider society. However, the enforcement of these laws remains an area of concern. In China, widespread violations of sex worker rights have been documented.

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