Posted by: ndowlatshahi | 07/28/2011

IAS 2011 examines most-at-risk populations: commerical sex workers

*Please note that this blog is a summary of sessions attended at the 2011 IAS and does not represent the views of the Council.

The topic of most-at-risk populations (MARPs) was given healthy consideration at the 2011 IAS Conference on HIV Pathogenesis, Treatment and Prevention in Rome last week, particularly sex workers, injections drug users (IDU) and men who have sex with men (MSM). While there were no ground-breaking discoveries as there was on the topic of MARPs, there were definitely some interesting discussions and innovative programs to address outreach, treatment and prevention challenges among this target population.

In regards to sex workers I attended several interesting presentations, two of which involved community-level interventions, one in India and the other in Nigeria. Common challenges for brothel-based sex workers were stigma of being a sex-worker (both self-stigma and stigma of community members, particularly health care providers), limited access to condoms (which was often decided by the brothel madam or pimp), limited access to care (often due to the stigma described above and or the fear of getting kicked out of the brothel for having any illness). However, it was shown that brothel-based sex workers generally had stronger support systems than street-based sex workers who were not as easily identified and reached.

In the study from Nigeria, HIV testing behavior was examined. Factors that predicted testing were age (less testing when younger), education, being brothel-based or not, knowledge of confidentiality of test and perceived risk of HIV infection. The presenter recommended that these risk factors be taken into consideration when target intervention groups.

I also attended a workshop on sex worker interventions in which they highlighted several of the same issues. One in particular was the impact of drug and alcohol use on risk of transmission. One proposed method to combat this effect was to work with bars and have them serve ‘ladies drinks’ which are less alcoholic than the drinks for the male clients. However, the challenge still arises if once the pair leaves the bar the client has his own alcohol that he shares with the sex worker.

This workshop also presented a study from China where, as in most places, sex work is illegal. One issue raised here was the challenge of reaching those who do no self-identify as sex workers, particularly those who might be students or factory workers having transactional sex to make some money on the side; these women were much harder to reach through common interventions. The challenge was similar among those not considered to be ‘high end’ sex workers who were harder to find and might have less power to negotiate safe sex. This presentation highlighted the effectiveness of working with karaoke bars, massage parlors and truck stops as points of intervention for this hard to reach population.

A few more interesting points from the workshop: most presenters agreed that partnering with security forces, if done with solid buy-in, proved to be a great asset in program success. Furthermore, an intervention in Mexico highlighted to importance and effectiveness of reaching the male clients of the sex workers as part of the intervention, as only approaching one side of the situation would be less than complete. Lastly, I thought it was interesting the emphasis on the distinction between sex work and sex trafficking. Many often blur the line between these two scenarios and we must exercise caution as each has a different connotation and different needs, motivations and intentions. We need to insure that policies and interventions cater accordingly to the actual context of the situation and do not subject the intervention beneficiaries to undue stigma.

On the whole, these interventions seem to prove effective and have extracted many lessons learned. I look forward to hearing of more studies and updates in the coming years.


  1. ‘agreed that partnering with security forces, if done with solid buy-in, proved to be a great asset in program success.’

    NO NO NO NO NO NO NO NO. Sex workers do NOT want police doing HIV prevention with or without solid ‘buy -in’.

  2. Hi Cheryl,

    Thank you for your comment. It was frustrating for me not to have the voice and representation of actual sex workers at the conference to get a more complete picture in these discussions. Thought I understand that this was a research conference and did not necessarily intend to elicit as broad an audience beyond research – very different than the AIDS conference in Vienna last year where sex workers had a more prominent voice.

    What I had understood to be the sentiment of the presenters was not that security forces should lead HIV programs but that their buy in would better facilitate other organizations coming in for interventions and reduce crack-downs on brothels that were implementing these interventions and would ultimately protect the sex workers.

    However, I would be happy for you to share research references that demonstrates otherwise, as certainly each element of this post merits further elaboration and exploration. I know you do much research on the issue of sex workers and I welcome your experience on this topic.

  3. It’s not about sharing research . I don’t know about police from research. I know from being a sex worker and working with other sex workers for 3 decades that no sex worker; sex worker organisation or network believes the Aids industry spin about police protecting sex workers and facilitating HIV and preventiion and reducing crackdowns. Opposition to the Greater Involvement of Police and Army (GIPA for sex workers) might even be the only issue on which there is absolute concensus among sex workers.

    There were indeed sex workers voices in Vienna, albeit more via megaphone in the Global Village than in sessions with INGO ‘experts’ because most had limited registration. The challenge is to listen to and act upon what those voices were saying and ‘no cops’ was pretty close to the top of the list.

    I think all readers, need to be a bit more than ‘frustrated’ by experts at conferences agreeing how to best stop sex workers infecting others in the absence of sex workers. I suggest that in future people leave such sessions, or if you must stay to earn your living, report critically and with the views of those affected in mind.

  4. The police are often the first ones to confiscate our condoms. They arrest us in most countries when they don’t rape us!!!
    How can you imagine us partnering with them?

  5. In 2001, in front of the Parliamentary Select Committee considering the Prostitution Reform Bill, the police claimed they no longer searched for or seized condoms as evidence in prostitution related charges. In 2002, prior to the decriminalisation of prostitution in New Zealand, the police raided the house of a gay man searching for, among other things “condoms and other sex paraphernalia.” They were given orders to seize the condoms as evidence of prostitution-related charges, including brothel keeping, contrary to what they said to parliament more than a year earlier. As a sex worker, that would put his life in danger from HIV and other STI transmission. But as a gay man, how many condoms could he keep at home before his home would have been “classed” as a brothel? Sex workers do not want or need greater police involvement in their lives, especially in countries where they are treated like criminals and may be arrested for carrying condoms.

  6. (responses to recent comments posted in new blog)

  7. well…
    very nice and informational sharing here,
    i like this site…

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