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WHO, UNAIDS, NSWP Release Guidelines to Reduce Sex Workers' HIV Burden

A report released by the World Health Organization (WHO) and collaborating organizations earlier this month proposes guidelines for public health and legal systems to reduce the vulnerability of sex workers to HIV and other sexually transmitted infections (STIs). Sex worker advocates generally favored the recommendations, but raised concerns about presumptive antibiotic treatment.

The reported, Prevention and Treatment of HIV and Other Sexually Transmitted Infections for Sex Workers in Low- and Middle-income countries, aims to offer a framework for public health officials, non-governmental organizations, health policy-makers, and health workers for how to create effective programming in their countries.  

The document, which details best practices and technical recommendations, was developed by a partnership of WHO, the United Nations Population Fund (UNFPA), UNAIDS, and the Global Network of Sex Work Projects (NSWP).

Principal among the recommendations is decriminalization of sex work. Decriminalization, the report claims, will reduce stigma, decrease violence, and lessen barriers to accessing health care. One example of how criminalization hinders HIV prevention efforts is "condoms as evidence" -- the practice of law enforcement officials using safer sex supplies as evidence for an arrest in prostitution cases -- leading sex workers to avoid carrying condoms out of fear of harassment or detainment by police.

The report also strongly advocates for community empowerment and peer-led models of public health programming. "Programs exclusively targeting the individual risk of sex workers or their clients are likely to have a limited impact," according to the report. "Environmental-structural interventions, such as community empowerment…may enable sex workers to have greater control over their working conditions and thereby control their risk of acquiring infection."

Sex worker groups have come forward to praise the endorsement of decriminalization and the recognition that an intrinsic piece of creating effective health programs is a willingness to work hand-in-hand with sex workers. NSWP issued a press release stating, "[We] particularly welcome the recommendations that governments should work towards the decriminalization of sex work and elimination of the unjust application of non-criminal laws and regulations against sex workers."

WONETHA -- a Uganda sex workers' rights organization -- also commended the document, stating that their government needs drastic changes to its current policies; currently more than a third (37%) of female sex workers in sub-Saharan Africa are HIV positive. WONETHA director Macklean Kyomya added that in addition to the current recommendations, Uganda needs "... avenues for sex workers and our clients to report crimes voluntarily, including rape or the operation of organized crime networks; to prohibit the discrimination and abuse that we sex workers often face when seeking services for the prevention and treatment of HIV; (and the) free flow of information about HIV through peer-led interventions or mass media."

Not all of the response has been favorable, however, and one of the technical recommendations is being called into question. Among with the suggestions for implementing increased condom promotion and HIV/STI screening is a call for voluntary Periodic Presumptive Treatment (PPT) as a short-term emergency measure in environments where STI prevalence is above 15%. PPT refers to distribution of antibiotics without testing whether an individual sex worker actually has an STI.

Cheryl Overs, the founder of NSWP, asserts that given the lack of information about long-term effects of antibiotic use and the risk of drug resistance, PPT "falls short of sex workers' right to quality sexual and reproductive health care because it effectively offers either medicine without diagnosis or nothing. On ethical grounds alone it should only be used in emergencies or individual cases, and never as part of an ongoing program."

The report did not discuss how PEPFAR's "anti-prostitution pledge" -- a U.S. rule requiring that organizations seeking international HIV/AIDS funding must oppose the legalization of sex work -- affects low- and middle-income countries' ability to institute the new guidelines.  

WHO is currently planning framework to evaluate the impact of this report and a revision of the guidelines is planned for 2016.  

12/27/12

Reference

World Health Organization, UNFPA, UNAIDS, Network of Sex Work Projects. Prevention and Treatment of HIV and Other Sexually Transmitted Infections for Sex Workers in Low- and Middle-income Countries. December 2012.

Other Sources

Network of Sex Work Projects. NSWP Welcomes New WHO Recommendations on Prevention and Treatment of HIV/STIs for Sex Workers. Press release. December 12, 2012.

Africa Sex Workers Welcome WHO Recommendations. Identity Kenya: the Kenya Gender and Sexual Minorities News Service. December 18th, 2012.