Sex Work is an HIV Issue

Criminalization, stigmatization and marginalization of the sex trade increase the risks of HIV, Hep C and STI transmission for sex workers, partners and clients. In one of the most rigorous, global studies on the subject, decriminalization of the sex trade could cut the rate of transmission by 33-46% over the next ten years. Advocacy for decriminalization and de-stigmatization of the sex trade should be at the forefront of health advocates’ agendas to meaningfully address the spread to HIV and promote care of those who are HIV positive.

There are many ways in which those who trade sex experience institutional marginalization, including lack of access to comprehensive healthcare or affordable housing. This briefly touches on four specific areas where public health advocates and sex worker rights organizations can collaborate, but it is by no means exhaustive.

Policing: Access to Condoms

One policing practice which hinders efforts to address the spread of HIV is the use of condoms and other safer sex supplies as evidence of prostitution and related crimes. This practice has had dire consequences on populations already put at high risk of HIV transmission because of other structural determinants. In New York City, reports of confiscation and condom destruction were widespread, impacting communities of sex workers and those profiled as such. This led communities to assume that there was a legal maximum number of condoms one could carry and caused many to fear carrying condoms at all. This meant that sex workers were forced to decide between taking enough condoms to see clients that evening or fear arrest and incarceration. Further, outreach workers were frequently harassed, making condom distribution more difficult. For a population at higher risk for HIV transmission, confiscation and creating criminal fear around safer sex supplies is an affront to the basic principles of public health.

Stigma and Lack of Training: Sex Workers’ Barriers to Services

Stigma of those in the sex trade has been well documented around the globe, impacting everything from sex workers’ interpersonal experiences to reasoning for criminalizing the sex trade. Service providers are not immune from this widespread experience. Sex workers often report stigma and mistreatment from service providers as a significant barrier to accessing services, including medical care. Shaming around participating in the sex work, fear of outing to other practitioners, forced counseling, or denial of care bar sex workers from accessing services or from disclosing participation. Many cite previous discrimination or experiences of discrimination told to them by friends as determining factors for not bringing up sex work or giving false information to hide their participation. Stigma also prevents sex workers from participating in service development and implementation of services, including HIV services, despite peer-based education models being lauded.

PERSIST, a community-based health program conducted a series of focus groups with sex workers to find out their experiences, needs and desires around accessing health care. Read more here.

Funding and Policy: Anti-Prostitution Loyalty Oath

In both HIV and anti-trafficking funding, the US federal government specifically says that no funding “may be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution,” referred to as the Anti-Prostitution Pledge. This Bush-era stipulation has crippled HIV funding internationally for organizations that follow best practices for HIV outreach and service provision and engage with communities of sex workers. While a law suit struck down the language for part of the pledge, it is still being haphazardly applied in both HIV and anti-trafficking funding domestically and internationally. This pledge has impacted the work of organizations across the globe, leading them to scale back their work preventing the spread of HIV. Further, it has promoted the work of groups who publicly disavow sex work, adding to the stigmatization and discrimination which hinders outreach efforts and can prevent sex workers from seeking services and treatment, putting sex workers, their families, and client at risk.

Click here for more information on the Anti-Prostitution Pledge.

Criminalization: HIV Modernization

Public health advocates have long decried the impact of laws which create or increase criminal penalties for those who are HIV positive. Sex workers are overwhelmingly impacted by HIV specific provisions, specifically mandatory felony upgrades for being HIV positive when arrested for prostitution charges and mandatory HIV testing upon arrest. For sex workers who are HIV positive, a prostitution arrest can turn a misdemeanor into a felony with often a multi-year sentence. Mandatory testing practices, which are often arbitrarily enforced, can mean that an individual’s HIV status can become part of their criminal record, available to judges and prosecutors, or even read in open court. A recent study looking at California looked at those criminalized under HIV specific laws found that 96% of those convictions were related to sex work. Recent HIV modernisation efforts, such as the most recent success in Colorado, have recognized this fact and fought hard to incorporate these issues faced by sex workers.

HIV Criminalization Beyond Non-Disclosure: Advocacy Toolkits on Intersections with Sex Work and Syringe Use, The Center for HIV Law and Policy and National LGBTQ Task Force (2017)

These are just a few ways in which the issue of sex workers rights is essential to addressing HIV in the United States. Public health advocates must engage with communities who trade sex to improve services and address the institutional factors which make sex workers vulnerable to transmission. In advocacy, these collaborations can prove a valuable resource to moving forward the efforts of marginalized communities to make change which can have a tangible impact on the lives of those put at risk for HIV.

Recommendations

Advocate for decriminalization of the sex trade through deprioritization of prostitution-related arrests or removing laws which criminalize the sex trade.

Ban the use of condoms and other sexual health devices as evidence in prostitution-related crimes by police departments through legislative efforts, police procedural reform, or asking District Attorneys to refuse to consider these as evidence in prosecutions.

In states which require mandatory testing for prostitution-related crimes, do not participate in mandatory HIV testing procedures. In states which had statutory upgrades which make participation in the sex trade while HIV positive a felony, refuse to testify in cases for the prosecution on an individual’s HIV status.