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.