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Anti-Prostitution Oath Video: Taking the Pledge

NSWP Page on Health and Safety

Safety, Security and the Well-being of Sex Workers: A Report Submitted to the House of Commons Subcommittee on Solicitation Laws (outside link to pdf)

Sex Worker Harm Reduction Initiative Project Directory
From OSI
Published in June 2001, the directory is a comprehensive listing of IHRD's sex worker initiative grantees, IHRD partner organizations and Technical Advisors, and additional contacts for funding, training, and technical assistance. The directory provides descriptions of grantees' work in harm reduction and sex work and offers background information on this IHRD initiative.

The 100% Condom Use Policy: a Sex Workers' Rights Perspective
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.

HIV in India — The Challenges Ahead (.pdf)
Robert Steinbrook, M.D.
On April 1, 2007, India will launch a new phase of its National AIDS Control Program (NACP). Its goals include reducing the number of new human immunodeficiency virus (HIV) infections — currently, an estimated 98.5 to 99.5% of India's 1.1 billion people remain uninfected — improving treatment, and providing therapy to more people.

Mandatory Health Testing

Women at Risk: Issues in the Primary Prevention of AIDS, in"Female Sex Workers: Scapegoats in the AIDS Epidemic," Cohen Judith B. & Priscilla Alexander (1995), in A O'Leary & LS Jemmott (eds.),  New York: Plenum Publishing Corporation.

Protection of sex workers by Goodyear and Cusick
Decriminalisation could restore public health priorities and human rights

Violence and Exposure to HIV Among Sex Workers in Phnom Penh, Cambodia — By Carol Jenkins, the Cambodian Prostitutes' Union, Women's Network for Unity and Candice Sainsbury. Produced for review by the United States Agency for International Development, March 2006. Courtesy NSWP

Sex Workers and Violence Against Women: Utopic Visions or Battle of the Sexes? — By Laura M^a Agustín. Development, Society for International Development, Vol. 44, No. 3, September 2001.
"…uncovers some of the myths around sex workers and the men engaging their services within the context of building a movement to end 'violence against women'. She argues that totalizing all experiences of prostitution with a view to punishment and criminalization does not work and advocates a much more visionary and pluralistic approach." Courtesy Walnet

This article by Population Services International (PSI) charts the significant decrease in HIV prevalence in Cambodia between 1998 and 2002, and outlines the key role that targeted condom promotion has played in this decline. Specifically, PSIs social marketing of condoms is discussed, including a variety of strategies used to target both high and low risk groups. Whilst overall HIV prevalence has dropped, the decrease has been greatest among brothel-based commercial sex workers (CSWs) and other high risk groups. Condom use has also increased dramatically among these groups, however remains low outside brothels, particularly in marital and "sweetheart" relationships.

The article concludes that these changes are largely attributable to the Cambodian government’s 100% condom use policy in the sex industry, combined with PSIs strategic social marketing of condoms. Whilst the changes do not signal the end of the epidemic in Cambodia, they do demonstrate the significant and wide-reaching impact that well-targeted condom promotion can have on HIV prevalence. Given this impact, the article recommends that social marketing as a means of HIV prevention be scaled up in both low and high prevalence countries.

This report presents research conducted in Kazakhstan in 2002 to demonstrate that officials routinely harass and discriminate against injection drug users and sex workers, compounding their already marginalised status and reinforcing their reluctance to use AIDS-related health services, including needle exchange

The paper argues that while on the one hand, some state health facilities have attempted to reach out to drug users and other high-risk groups by offering prevention and care services, other state actors, in particular law enforcement agents, dissuade persons at risk from taking advantage of these services through repressive practices. Other vulnerable persons, including men who have sex with men, and those already living with AIDS, are similarly deeply stigmatised and marginalised

The paper makes recommendations to the government of Kazakhstan on HIV/AIDS, international human rights conventions and on law enforcement conduct. It also makes recommendations to the National AIDS Program, U.N. agencies and other multilateral and bilateral donors, the European Union and Member States, the United States, the European Bank for Reconstruction and Development.

Recommendations to the government of Kazakhstan on HIV/AIDS include:

• implement fully and as soon as possible the decision announced by the government in July 2002 to rescind the policy of mandatory testing of all persons in government detention. Review the proposed replacement policy on voluntary testing against the United Nations International Guidelines on HIV/AIDS and Human Rights, with particular attention to safeguarding the provision of voluntary and confidential HIV testing and minimising the use of mandatory HIV testing by the state
• discontinue the registration of HIV-positive persons by government offices and any other practice that violates an individual's right to confidentiality about HIV status
• discontinue the practice of isolation of HIV-positive prisoners
• discontinue the practice of confiscating official identification papers of detainees, drug users and persons living with HIV/AIDS
• amend Article 14(2) of the Constitution of the Republic of Kazakhstan on non-discrimination or issue a policy or official edict to interpret the article to ensure that no person can be discriminated against based on HIV status or sexual orientation. Similarly, specify that all persons regardless of HIV status should enjoy equality before the law, as noted in Article 14(1)
• ensure the prompt review of HIV/AIDS legislation and regulations being undertaken by the government and the use of international standards
• establish humane treatment services for narcotics addiction
• at AIDS centres, skin and venereal disease hospitals and other health facilities, establish health services for persons at risk of and living with HIV/AIDS according to the standards of the U.N. International Guidelines on HIV/AIDS and Human Rights, with particular attention to confidentiality of HIV testing and non-mandatory HIV testing with appropriate counselling. Eliminate all practices by government authorities at these centres and facilities that violate the right to confidentiality of HIV testing and to non-mandatory HIV testing

This note, published by the World Bank, examines a donor-supported scheme in Nicaragua, which involved giving vouchers for sexual health services to commercial sex workers and their partners and clients. The highest rates of voucher redemption were among the poorest women and among groups with the highest initial rates of sexually transmitted infections (STIs). The programme reduced the prevalence of gonorrhea in the female sex worker population by about 5 per cent per year, and the prevalence of syphilis by 10 per cent per year. Women who attended follow-up consultations also stayed free of STIs for longer.

The cost of the scheme was low compared to consultations in public facilities. However, the note argues that reducing costs further by charging the beneficiaries is unrealistic and would exclude the poorest, who also have the greatest health needs. As it is, the costs to the beneficiaries in transport and lost income are significant, and for some constitute a reason not to use their voucher. The note concludes that the scheme provided access to, and increased the use of, high-quality, tailored sexual health services in a non-stigmatising manner for commercial sex workers and their regular sexual contacts. It also reduced the risk of STIs, including HIV, among the general population.

This article from the Journal of Sex Research reports high levels of awareness about HIV prevention methods among women sex workers in southern China. It shows the women are using a range of contraceptive practices, and different methods to prevent HIV and other sexually transmitted infections (STI). This indicates that there will be high levels of willingness to use vaginal microbicides and female condoms when these become available. However, promoting the use of these new female-initiated prevention methods will have to take account of the specific context of sex work, and also differences in knowledge and use of prevention methods according to age and ethnicity.

The study shows that the women were knowledgeable about the male condom, and the majority tried to insist on their partners using them. However, they also found negotiating condom use difficult and frequently had to resort to other, less reliable, methods. Promoting the use of microbicides will involve discouraging some of these other methods as their use would counteract the effects of the microbicide products. The article recommends using a range of culturally sensitive means to promote knowledge about new HIV prevention methods, including translating information into local languages and using oral communication. The research indicates that peer-delivered and site-based interventions are particularly effective in this context.

The prevalence of HIV in Nigeria is high and rising. Sex workers have a high risk of contracting and spreading the disease and are often the target of public health interventions aiming to increasing condom use. What factors influence the use of condoms by sex workers?

Thailand's sex industry is of core importance for the country's serious HIV problem. There is a strong male tradition of using commercial sex workers (CSW) before and during marriage. What are the psychosocial factors that affect the use of condoms by CSW? How can interventions increase the rate of condom use?

Patterns of risk behaviour and condom use among commercial sex workers (CSWs) have been heavily investigated in recent years. But what is known about the social context of these women's lives? What factors prevent them from having safer sex? Researchers from Population Services International investigate the lives of CSWs in Lusaka, Zambia.

This publication, from the Monitoring the AIDS Pandemic (MAP) Network, reviews the situation of men who have sex with men (MSM) in Asia. The report summarises the key findings about the epidemiology of HIV and AIDS among Asian MSM and discusses the programmatic implications of these findings. Key findings show that in 2003, 17 per cent of MSM in Bangkok, Thailand were HIV positive. By 2000, 15 per cent of MSM in Phnom Penh, Cambodia tested positive for HIV. The prevalence of HIV among transgender sex workers in Jakarta, Indonesia increased from 6 per cent in 1997 to 22 per cent in 2002. While these findings represent the most at risk segment of the MSM population, they give cause for alarm in Asian countries that continue to neglect MSM prevention, care, support and treatment.

The report highlights four areas that programme managers addressing male-male sex need to consider. These include increasing condom use in male-male sex, and introducing prevention methods to those engaging in high-risk activities, such as men and transgendered people who sell sex to men. Managers also need to consider issues of drug use and men who have sex with men and women. [adapted from author]