Protecting Sex Workers Key to Preventing Spread of HIV

Published: September 16, 2011

By Yubing Xia
yubing.xia.oxford@gmail.com

In early August, local and national media reported that police in the city of Xiangfan, in China’s Hubei province had publicly set fire to property belonging to sex workers as part of a “crackdown” targeting sex workers operating out of rented rooms. This was not an isolated example of sex workers experiencing rights violations. In 2010, police in Dongguan, Guangdong Province paraded two barefoot, handcuffed female sex workers through the street, tied together about the waist with a rope. UNAIDS believes that such approaches to law enforcement are likely to be counter-productive, drive sex work underground and increase the spread of HIV. UNAIDS considers that all adults have the right to choose to engage in sex work, free from fear of violence or persecution. Unfortunately however, sex workers regularly experience stigma,discrimination and other rights violations, with negative consequences both for themselves and for efforts to prevent the spread of HIV.
 
Decriminalization and Law Enforcement
 
Sex work is criminalized in China, and “crackdowns” by law enforcement authorities targeting sex work are a threat regularly faced by sex workers, particularly, low-level street-based sex workers. Such punitive approaches to dealing with sex workers inevitably result in violations of dignity and rights, and thus serve to hamper effective responses. “Crackdowns lead to contradictions between the duty of the police to protect all citizens, including sex workers, and the inevitable harm and rights violations which sex workers experience as a result of them,” said Dr. Zhao Jun, an expert specializing in criminal law and sex work at Beijing Normal University. ‘In Xiangfan’s case, the police were not legally justified in destroying sex workers’ property, such as tables, beds, pillows, etc. This is a totally improper and brutal approach to law enforcement. Such activities actually harm the government’s and the police’s image.’
 
Such examples of excessive law enforcement during nationwide crackdowns have led to sex workers becoming increasingly mobile and less visible, making the implementation of HIV programs far more challenging. ‘Xiangfan’s case definitely set a negative example,’ said Mr.Cai, Executive secretary of the China Sex Worker Organization Network Forum Secretariat, ‘As more sex workers hear about this kind of thing, they become increasingly scared, and are likely to stop bringing condoms to work and stop using them with their clients.’
 
Zhao Jun noted that the police should not have burned over 1,000 condoms, as was reported by the media: ‘Unlike weapons, drugs and pornography, condoms are not illegal.’ ‘In many cases, clients are strongly unwilling to use condoms, and the sex workers are too vulnerable to refuse sex without them,’ explained Mr.Cai. UNAIDS recognises that the possession and use of condoms is essential for preventing the spread of HIV, particularly amongst those who engage in sex work. The practice of confiscating or destroying condoms is counter-productive to a successful AIDS response and should be stopped in all contexts.
 
Experience from several countries has shown that decriminalization of sex work can be an effective means of reducing the spread of HIV, protecting sex workers and promoting greater social cohesion. In countries where sex work has been decriminalized, sex workers are entitled to the same health, safety and rights as people working in other occupations. As a result, sex workers are more willing to seek access to HIV prevention, treatment and care services, with positive consequences for the AIDS response. An article published in the Australian and New Zealand Journal of Public Health revealed that while sexual services are purchased at roughly the same rate in Melbourne, Sydney and Perth, it turns out that Melbourne, where brothels can be legally licensed, had the highest brothel occupational health and safety levels while Perth, with all sex work criminalized, had the lowest. Also, sex workers in Melbourne’s licensed brothels were most likely to have access to free condoms. The researcher concludes that ‘the legal context appeared to affect the conduct of health promotion programmes targeting the sex industry. Brothel licensing and police-controlled illegal brothels can result in the unlicensed sector being isolated from peer education and support’. (Harcourt C, et al, Aust N Z J Public Health, Oct 2010)
 
Discrimination against sex work fuels HIV
 
In order to protect the health and human rights of society as a whole, and promote social wellbeing, it is essential to ensure that those most vulnerable to HIV feel safe and accepted, rather than marginalized and under threat. This is sometimes referred to as the “AIDS paradox” as only by protecting the rights of marginalized groups, and investing in services that reach them, will they be more willing to access to prevention, treatment and care services, and thereby contribute to slowing the spread of HIV within the broader community.
 
In China, the media plays an important role in shaping public opinion. Some of the language used in media reports on the crackdown was stigmatizing and one-sided. Sex work is a highly complicated social issue, and it is essential that the media treats it as such, and avoids demonizing, simplifying and attacking sex workers. Instead it is critical that efforts are made to expose the factors which make sex workers vulnerable, including poverty, human trafficking, domestic and gender-based violence, and lack of information and education.
 
Mr.Cai suggests that the media should seek to understand and treat sex workers as human beings: ‘The media should not portray sex workers as nothing more than tools for spreading sexually transmitted infections and HIV.’ Zhao Jun echoed this view: ‘The perspective of law enforcement authorities is not the only perspective; the media can report on the work of community-based organisations, for example their outreach activities, peer education work and other important areas of work. No matter how ambiguous moral standards have become in China, at least the law should serve as a standard. Burning citizens’ private property during a crackdown is definitely illegal and should not be given positive coverage in the media.’
 
It is important to realize that a broad range of perspectives also exists among the general public. Reacting to the Dongguan incident, where sex workers were paraded publicly through the streets, many Chinese netizens expressed strong opposition to this inhumane act. Commenting on Sina.com, one netizen characterized the actions as ‘bullying the weak.’ Netizens using the Sohu portal said that ‘female sex workers are human beings’ and noted that ‘the police’s illegal law enforcement not only violated their dignity, but also violated the law’.
 
In summary, discrimination against sex work, especially lower paid street-based sex workers,  only fuels the HIV epidemic. Ideological discrimination pushes sex workers falling into huge disgrace so that they feel too shameful to seek for HIV-related help on the one hand. Institutionalized discrimination, such as punitive laws and policies, scares most-at-risk populations away from effective HIV intervention on the other.
 
CBO contributions to HIV programmes among key affected populations
 
Community-based organizations (CBOs) have a central role to play in developing and implementing HIV programmes for sex workers and their clients. However, obstacles such as lack of funding, personnel and support from local government limit their contribution.
 
Ye Haiyan, Director of the China Feminist Workshop and an ardent advocate for sex worker rights, stressed that grassroots NGOs can more easily gain access to sex workers and develop an accurate understanding of their lives and needs than the government is able to do, as well as a fuller picture of how HIV-related laws and policies are really being implemented on the ground. ‘Our work, including research and outreach, is closely related to sex workers’ livelihoods. This means we are able to play a strong role in planning HIV interventions and appropriately spending every penny of funding,’ said Ye Haiyan. ‘It is getting more and more difficult to get funding, and CDCs at all levels really need to support grassroots organizations’ participation more.’
 
Mr.Cai also expressed his concerns about the future development of grassroots CBOs that advocate for sex workers: ‘It is not enough to just train community leaders; we also need qualified personnel, or it will be impossible to reach more sex workers. More peer educators are needed everywhere – they play an irreplaceable role.’
 
Ya Haiyan agreed with Mr.Cai’s assessment: ‘Grassroots NGOs actually reduce the burden on government by doing peer education and advocacy, so that the government can focus on how to create a supportive environment for communities, instead of handling endless protests.’ In late June, at the 2nd International Workshop on HIV Prevention in Sex Work in Beijing held by UNFPA with support from WHO and UNAIDS, a CBO representative from India also said ‘We are not the problem. We are part of the solution.’ These words reflected the core belief of many CBOs working in China.
 
Empowering sex workers key to achieve China’s HIV commitments
 
Good news is that the Chinese government has already realized CBOs’ value and made serious commitments. In July, China’s Vice Premier Li Keqiang stressed his commitment to facilitating CBOs’ greater participation by allowing them to register as a first step. ‘The government will provide powerful support to these organizations,’ Li told UNAIDS Executive Director Michel Sidibé.
 
Li’s attitude reflects the bold and specific commitments China made at the UN High Level Meeting on AIDS held in New York in June this year. These included the commitment to halve sexual transmission of HIV by 2015. This is an important goal and one that China is well placed to succeed.
 
To translate this goal into reality, specifically in the context of sex work, China needs to engage legislative bodies, government and police authorities at all levels, the media and communities in a dialogue based around the understanding that protecting the rights of sex workers leads to concrete public health and social benefits. In particular, sex workers themselves should be empowered to directly and substantively participate in the planning and implementation of HIV programmes that address the vulnerabilities that put them at increased risk of HIV, creating a more sex worker-friendly environment and reducing the risks posed to the whole of society by a growing HIV epidemic. CBOs also need to be given a greater role in the AIDS response at all levels, and government should leverage the competitive advantages of CBOs to promote increased demand for prevention and testing services among sex workers.

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