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The 100% Condom Use Policy: a Sex Workers' Rights Perspective
From the
Network of Sex
Work Projects
100% Condom Use Policy (CUP) programmes that aim to reduce HIV
among female sex workers are being implemented or planned in
several countries in Asia, Latin America and Africa. As a result
of claims made about the role of 100% CUP in reducing national
HIV epidemics, UNAIDS and other key agencies promote the
programmes as a "best practice". The NSWP has a different view
of the theory and practice of 100% CUP. Our view is based on
ethical analysis and on real evidence from the field.
What is 100% CUP?
The government:
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Writes a
letter to each brothel that tells them that:
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Sex
workers must make each client use a condom. If a client
refuses to use a condom the sex worker has to refund his
money.
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Sex
workers must be identified, registered and regularly
sent to government STI clinics where their registration
card is stamped.
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If
the brothel does not comply it can be closed down.
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If
the brothel does comply it will be allowed to operate
without interference from police.
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Supplies
select IEC materials and condoms to the brothels.
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Appoints
a committee of local police, military and other local
authorities to inspect the brothels.
They check that women have their registration cards stamped,
refuse to provide unprotected sex and that IEC is available.
These programmes violate sex workers' human rights without
achieving their public health goals
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Advocates of 100% Condom Use Policy programmes claim that
registration, mandatory testing and the inspection of
brothels by police and military empowers sex workers.
One basis for this absurd claim is that the mandatory
testing component of the policy "enables" access to health
care for sex workers whose freedom to leave the brothel is
restricted by brothel owners. It is offensive to claim that
forced medical examinations aimed at reduced STI
transmission are empowering while all the other fundamental
violations of sex workers rights that are taking place in
their workplaces are so blatantly ignored.
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In some
places sex workers are taken to STI clinics under police
"escort." Governments that authorise soldiers or police to
take sex workers from brothels to clinics and then return
them may be violating national and/or international laws and
policies about trafficking in persons and controlling the
movements of prostitutes by delivering women back to
brothels in which they are indentured or otherwise abused.
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STI
treatment is not free. Cost remains the main barrier to STI
care for most sex workers and may even increase under 100%
CUP where the cost of repeated testing is passed on to the
sex worker, possibly at inflated prices.
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As with
most mandatory testing, the policy is rendered ineffective
by corruption. In most places where 100% CUP is in place
there is irrefutable evidence that sex workers can pay a
small fee to have their card stamped without being examined
in places where inspections are frequent. In many places
however inspections are haphazard due to a lack of resources
and bribes are paid directly to the local committee charged
with brothel inspection.
Mandatory STI testing violates sex workers' rights to affordable
and accessible healthcare
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These
programmes do not prevent clients who want high risk
services from purchasing them. The demand and supply of
unprotected services simply shifts and hides.
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In
direct contradiction to the policy of the Greater
Involvement of People with HIV/AIDS (GIPA) and to
contemporary notions about the value of community
participation in HIV programming, independent sex workers'
organizations have had no role in developing 100% CUP
programmes at local or international levels.
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100 %
CUP has not undergone any peer or ethical review in any
country.
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Clients
and sex workers private partners are invisible. They are not
identified and they do not receive IEC or STI care.
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Suspending enforcement of criminal law against brothels is
contrary to the principles of the rule of law. The 100% CUP
is being implemented in countries where governance is poor
and there are few safeguards against corruption or
protections for the rights of subjects. Lack of cohesion
between authorities was recently demonstrated in Phnom Penh
when brothels were raided and sex workers subject to
violence and humiliation despite the brothels having
complied with the government's 100% CUP.
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Photos
of women are sometimes displayed in brothels so that men can
identify any woman who he alleges infected him or agreed to
sex without a condom. Photos, STI and HIV results and other
identifying documents are distributed to police.
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Women
with HIV or an STI are meant to have their card removed and
be dismissed from their brothels in a process that deprives
them of income and health care. They move to less formal
sectors of the sex industry which in countries such as
Thailand and Cambodia has expanded rapidly as the brothel
sector has reduced.
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Sex
workers who are unable to read the letter from the
government are vulnerable to it being used as another
instrument of control by brothel management. There are
several reports of sex workers having been told that the
letter authorises various extra charges, worsened conditions
and even specific abuses.
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The
discourse of 100% condom use ignores the crucial role of
non-penetrative safe sex acts which don't require a condom.
No attention is paid to building comprehensive safe sex
skills, or any other kind of capacity or advocacy strategy
for sex workers.
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The
supply and quality of condoms and IEC is not guaranteed and
has in fact often been totally inadequate in many places.
Sex workers usually still have to buy condoms, either at
reasonable prices from condom social marketing companies or
at inflated prices from brothel keepers and local traders in
direct contrast to workers with rights whose employers are
required to supply health and safety equipment from their
profits.
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NGOs
that might be able to provide effective, user friendly
services are ordered to stay out of brothels participating
in 100% CUP.
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The
"evidence" for 100% CUP is based on seriously flawed
monitoring and evaluation methods. By removing permission to
work cards and excluding sex workers with HIV or an STI from
the "universe" of sex workers, the "results" are weighted
towards suggesting that STI rates among sex workers have
declined. Claims made about national impact are clearly not
credible in the absence of any data about commercial sex in
the informal sector or consideration of other prevention
programmes (which raises serious questions about the quality
of information and analysis being provided by
epidemiologists and social scientists to the institutions
that support 100% CUP).
Inspection and supervision of sex workers by police and military
is NOT empowering.
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Only
full recognition of sex workers rights can make commercial
sex safer.
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Sex
workers do not need to be coerced into using condoms.
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Sex
workers need and want empowerment for full labour and human
rights.
Original Link:
http://www.nswp.org/safety/100percent.html
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