Health and HIV

For the last 25 years the focus of attention on sex workers health has been HIV. However transgender, female and male sex workers and their families are frequently affected by a range of issues that directly and indirectly affect their wellbeing and impact on public health. 

Sex workers in developing countries are disproportionately affected by illnesses and conditions caused by social exclusion, poverty and gender based violence. Lack of access to  sexual and reproductive health services mean that sex workers of all genders are vulnerable to STIs and women are at greater risk of unwanted pregnancies and unsafe abortion. 

Although the potential for commercial sex to play important roles in expanding HIV epidemics is well recognised, HIV and AIDS-related prevention, treatment and care for sex workers remains inadequate and the specific dynamics of commercial sex in HIV epidemics remains controversial. The same is true of the efficacy and ethics of disease control measures as they apply to sex workers. In recent years controversies have been created by the United States HIV policy which has encouraged the criminalization of sex work in developing countries through conditions of its funding allocations and by the UN which encourages prevention of sex work via poverty reduction. 

Paulo Longo Research Initiative research projects will examine the impact of the architecture of international and national public health interventions and policy. We will map and critique the evolution of established evidence and ‘best practice’ in respect of the health of sex workers and their clients and investigate issues in health policy and programming that affect sex workers. These might include HIV testing policy, new HIV prevention technologies such as microbicides, integration of sexual and reproductive health and HIV services, delivery of sexual and reproductive health services and harm reduction strategies for drug users.

Resources

  • Sex Work, Violence and HIV: A Guide for Programmes with Sex Workers - 2007

    This programming guide, by Matt Greenall for the International HIV/AIDS Alliance, is primarily for organisations implementing HIV/AIDS projects with sex workers and for organisations providing funding and technical support to these projects. It aims to help organisations understand and assess the importance of taking violence into account, and to help design and carry out activities to prevent and deal with violence against sex workers. (summary taken from the report)

  • Size matters: the number of prostitutes and the global HIV/AIDS pandemic - 2007

    Article by Talbott, J. R. in PLoS ONE 2(6): e543.doi: 10.1371/journal.pone.0000543. He argues that cross country regression data does not support the theory that male circumcision is the key to slowing the AIDS epidemic. Rather, it is the number of infected prostitutes in a country that is highly significant in explaining HIV prevalence levels across countries.

  • The first community-based sexually transmitted disease/HIV intervention trial for female sex workers in China - 2007

    An article in AIDS 2007, 21, (suppl 8): S89–S94.

    Objectives: This study was the first community-based intervention to test feasibility and effectiveness of an intervention targeting sex workers in China.

    Design: Prospective, community-based, pre/post-intervention trial.

  • The necessary contradictions of 'community-led' health promotion: a case study of HIV prevention in an Indian red light district - 2007
    An article by Cornish F, Ghosh R in Social Science and Medicine Jan;64(2):496-507.
  • Trials and Tribulations of HIV Prevention Research - 2007

    A news story, from PlusNews, that explores why South African women have volunteered in their thousands to participate in clinical trials for microbicides. It also explains why they might drop out of the study before its completion.

  • Working from a rights-based approach to health service delivery to sex workers - 2007

    This article, in Exchange on HIV/AIDS, Sexuality and Gender, focuses on the relationship between HIV and sex workers’ rights. It outlines the elements of a rights-based approach to sex work and includes information on how the criminalisation of sex work and stigma and discrimination increase vulnerability. It suggests that the key elements of a rights based approach are that it:

  • Clients of sex workers in different regions of the world: Hard to count - 2006
    An article by Carael M, Slaymaker E, Lyerla R and Sarkar S in Sexually Transmitted Infections, 2006; 82:iii26-iii33. This article explored the proportion of the male population in different regions who reported having unprotected sex with female sex workers as well as the number and characteristics of their other sexual partners.
  • Estimates of the number of female sex workers in different regions of the world - 2006

    Article by Vandepitte J, Lyerla R, Dallabetta G,Crabbé F, Alary M, and Buvé A in Sex Transm Infect. 2006 June; 82(Suppl 3: iii18–iii25. This research attempted to estimate the number of women in the world that sell sex by collating information from published and unpublished literature, as well as from field investigators involved in research or interventions targeted at female sex workers. The proportion of women in adult female populations was calculated including by were extrapolating subnational estimates to national estimates.

  • HIV and Sexually Transmitted Infection Prevention Among Sex Workers in Eastern Europe and Central Asia - 2006

    This study, by UNAIDS, describes the experiences of, and challenges faced by, five nongovernmental organizations in eastern Europe and central Asia, which developed effective practices and implemented promising HIV and sexually transmitted infection prevention programmes for sex workers and their clients. The programmes' key objectives were to decrease sex workers' vulnerability by improving their overall well being and supporting their empowerment. It is hoped their experiences will be helpful in initiating and moving forward similar projects in low-resource settings.

  • Sex Work and Research Ethics - 2006

    STELLA is a Canadian sex worker group that has developed its own code of research ethics for clinical trials on new HIV-prevention and treatment technologies or sero-prevalence studies.

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