promoting health and human rights |
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promoting health and human rights |
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Introduction to the issues
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IntroductionCommercial sex takes place in many kinds of ways and involves many different types of people, many of whom are in no way stereotypical. People from various backgrounds and classes sell sex and they do so for a broad range of reasons. These reasons often change over time. Some people sell sex as a full-time occupation, while others sell sex only occasionally. Although some people are willing sex workers and others are pressured to sell sex, it is not helpful to see sex work as either voluntary or forced. In fact, between the educated and resourceful woman who chooses commercial sex from a broad range of possibilities and the poor, uneducated woman who is physically forced to do it, there is a whole continuum of situations. For example some people suffer pressure from familiars, but have the possibility to stop sex working if they wish. Others see sex work as a bearable occupation, rather than an ideal one, which is how many, or even most, people feel about their jobs. Commercial sex involves several actors apart from the sex worker and the client. These people are owners, managers and staff of commercial sex and entertainment establishments, partners and families of sex workers, support staff such as maids, cleaners, receptionists and security. Taxi drivers, tourist guides and hotel staff that bring clients and sex workers together are also included in the sex industry, as are vendors who sell products in places where sex services are marketed. The motivations of sex workers, clients and all other actors involved in this industry vary immensely. The roles played by them are not static either and vary from person to person, situation to situation and place to place. It is crucial to understand the multiple realities within sex work. Analysis that neglects the varied aspects of sex work is worthless. Sex is one of the primary ways that HIV is transmitted. This means that sex workers, who usually have sex with more people and more frequently than other people, are at greater risk for HIV. This booklet is intended to assist organisations working in HIV and AIDS to include sex workers and provide information needed by sex workers to protect themselves and their partners.
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1. Sex work in contextWho are sex workers?
Commercial sex is an ancient and widespread phenomenon. Women, men and transgenders sell sex all over the world and have done so forever. It is more useful to think about sex work as the sale of services and time rather than selling one's body. There are plenty of reasons why people sell sex, the main reason being that people need to "make ends meet". Few people to whom all other options are open choose sex work. Most people choose sex work out of a limited range of choices. For some, sex work brings autonomy from oppressive families or husbands or occupations. For others, sex work offers an escape from poverty or a way to secure material stability and privacy. For a very few it is the fulfilment of a fantasy or of a natural talent. For others it may simply be a question of chance. Not all or even most people who face pressure, poverty and very limited options become sex workers. Even those whose lives in sex work are characterised by inescapable debt can leave, unless physically restrained. However, they may suffer worse consequences than other people who owe money. These consequences may include violence against them and their families. Who are clients?Lon is a fifty-five year old man who works in the market. He pays for sex but always wants to spend more time than he can pay for. He likes to see sex workers who are much younger than he is. Abbid is Rupul's bubu. He spends two nights a week with her. When he drives his truck to other parts of India he sleeps with other girls but he only sees Rupul when he is in Chennai. Pablo is a forty-year old family man with two children. He picks up young men on the street and pays them for sex and he does not think of himself as gay. One of the most popular questions about sex work is "Why do people sell sex?" The obvious answer is "Because people buy sex". The sex industry is subject to the same economic rules as any other business or industry — demand drives supply. However, the factors that create demand for commercial sex reflect multiple realities. Clients seek sex workers for a variety of reasons. Some clients seek sexual services because they want to have sexual relations without emotional ties, or because they like the thrill of anonymous sex. Some like illicit or forbidden, because they want to perform sexual acts that their sexual partner does not approve of or cannot perform, or to fulfil sexual fantasies. Some look for the illusion of being loved by someone, others to prove their masculinity or power over someone else. Many clients seek sex workers to learn about sex, while others look for someone to talk to and keep them company. On the other hand, some perceive a commercial sexual transaction as the purchase of a body to which they can do whatever they like. Some think that by purchasing a sexual service, they also purchase the sex worker's right to say no. As in all else, the reality is as multiple as human nature. Third PartiesMany other people are involved in commercial sex in addition to the sex workers and clients. These include business owners, bar tenders, cleaners, taxi drivers, maids, receptionists, touts, security staff, local vendors and many others. The people with whom sex workers share their private lives may also have a role in influencing the environment in which sex workers live and work. Note that the term "pimp" is not used in this document. It is unhelpful because it collapses too many of the "third parties" described above into one [stigmatised] category. This reduces the opportunity to understand the important and different influences that these actors may have. Most sex workers rely on the support of third parties in their work. Many third parties are crucial to the protection and safety of sex workers and to the provision of sex work itself. However, some third parties can and do exploit sex workers. A good brothel owner is one who provides good working conditions and pay, just like any other good employers. There is nothing inherently exploitative about commercial sex, but its status and sex workers' lack of civil and industrial rights offer few mechanisms to limit the behaviour of bad employers. Relationships vary greatly between sex workers, their employers and other third parties, including even those defined as "traffickers". Slavery is at one end of the continuum and very good business arrangements are at the other. Sex workers' personal relationships with family, friends, lovers and husbands also vary greatly. Some sex workers are forced to enter or remain in the industry by people with whom they have personal relationships, and others enjoy supportive relationships that can have a crucial role in their well-being and safety . Sex workers' private sexual partners also affect sex workers' health. In places where most commercial sex is protected or non-penetrative, high STI rates among sex workers have been attributed to their private sexual partners. Local gangs and criminal groups often play a part of the sex industry. This can but does not necessarily lead to exploitation. They may provide protection from police and violence and provide other services that sex workers value. Stereotypes, simple labels and moralistic analyses can obscure the multiple realities within sex work. PoliceThe relationship between sex workers and police is varied. In some cases, police harass, abuse and bribe sex workers. Police can be the main source of violence towards sex workers. Some police officers extort money from sex workers in exchange for not arresting them. Police are also a major client group, and therefore engage in all types of client-sex worker relations. On the other hand, in many cases the police have an understanding of commercial sex and protect sex workers from criminal elements. Sometimes the police tolerate sex workers or commercial sex establishments in return for some information from sex workers about local criminals. In some places, condoms are used by police as evidence of sex work. Police therefore use condoms as justification for abuse of sex workers. Police activity sometimes interferes with projects that offer services and supplies to sex workers. These actions severely discourage condom use by sex workers and pose a serious health risk. How does the sex industry operate and why?Where the clients areCommercial sex occurs in a broad range of settings. Venues are limited only by human imagination, opportunities and technology. Sex industries, sometimes enormous, have been recorded for thousands of years along transport routes, around mines and even moving with entire armies. Mobile phones and the internet have changed the shape of the sex industry, even in some resource poor settings. Cheaper transport and geopolitical changes have created specific new routes of migration and increased the mobility of sex workers themselves. There are also more opportunities for businessmen who travel alone and tourists to buy sex. What the authorities say and doIn many places, the main activities related to sex work, such as soliciting and operating a place of prostitution, are either illegal or treated as if they are illegal. The enforcement and application of these laws, policies and quasi policies plays a major role in determining how the sex industry operates. This affects sex workers' health and safety. When overt brothels are closed down, former brothel workers relocate to the street and/or very hidden and more exploitative brothels. Traditional "cover-ups" for commercial sex venues are often associated with recreation, such as karaoke bars and cinemas, or services such as hairdressing, street vending, massage or domestic service. These may be tolerated according to the whims of local authorities. Changes in societal attitudes also affect the extent to which identities and activities must be hidden. The sex industry is not simple and monolithic. Many factors combine to shape the sex industry in different places. There are multiple realities within the sex industry. Forms of sex workThere are many types of sex work. Once again, diversity is the rule. Some sex workers look for quick transactions while others look for long-term clients. In some cases, sex work and domestic work are combined. There are reports of women who work as both maids and sex workers in the Middle East, as homes offer a good cover for illicit activities. Police do not usually enter homes and outsiders never enter without being invited. Similarly, sailors and truck drivers in some African locations typically hire a woman's services for a few days. Services include washing clothes, cooking, general domestic tasks and sexual services. In this scenario, sex is not a central part of the agreement. There are specialised types of sex work. Some sex workers offer specialised services such as sado-masochism, domination and submission. These specialised services rely on role-playing and the fulfilment of fantasies and fetishes. They do not necessarily involve any sort of penetrative sex. Some sex workers specialise in providing sexual services to people with disabilities. They are called surrogates and their work is a mix of sex work and sex therapy. These services involve specialised knowledge of safe practices and techniques. Some people practice sex work in an indirect form. They may be entertainment workers (strip-tease dancers, belly dancers, go-go dancers, karaoke singers) who may engage in sexual transactions occasionally. Such transactions do not necessarily involve purely sex or penetrative sex. There is a whole range of sexual activities that differ greatly from straightforward sex. WorkplacesDifferent sex work venues include streets, brothels, bars, saunas, massage parlours and other settings. Male sex workers also operate in resorts, gay bars and clubs, cinemas, car parks and cruising areas for gay men like parks, swimming pools, and public toilets. Sex workers' safety in the workplace is determined by a variety of factors. These include quality of lighting, the presence of support staff or other sex workers, clean facilities, access to water, safe sex equipment and accessories such as water-based lubricants. There is no direct relation between being a high class or resource-rich sex worker and safety or being a poor, low-priced sex worker and working in unsafe conditions. An escort who sees her clients in a five-star hotel is not necessarily safer than a brothel worker, as she is more vulnerable to violence from clients. Women who work in relatively low paid sex work in truck stop bars are safer, because there are many other sex workers around, they are on their own territory, and bar tenders offer security to some extent.
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2. The Policy FrameworkLegal systemsThe laws around sex work differ from place to place and affect sex workers daily lives as well as the success of interventions. Laws can be enforced differently. One place may have a strict law against sex work that is not enforced, while another may have less repressive laws that are heavily enforced. The most common legal models are prohibition, criminalisation and regulation. Prohibition refers to legislation that makes the act of selling sex illegal. This is the case in several countries, including Islamic countries that use Sharia, Thailand, and most of the United States. Criminalisation refers to laws that forbid certain activities related to sex work, such as advertising, soliciting, and recruiting sex workers but not the activity of selling sex itself. Examples of countries where sex work is criminalised include many countries in Western Europe, India, Canada and most of Latin America. Some countries that have made exceptions to criminal law in compliance to certain regulations. Such regulations often include requirements that sex workers are tested for STIs and HIV, or have national or regular immigration status. Regulationist models are in place in countries such as the Netherlands, Ecuador, Peru, and parts of Germany, Australia, and the United States. Some governments have enacted penalties against clients of sex workers, in response to protests that laws that penalise sex workers but not their clients are unfair and sexist, because they usually apply to women. Most sex workers complain that the criminalisation of clients makes their work more difficult and dangerous. Criminalisation of clients forces sex workers to minimise the time they spend negotiating with clients. Haste contributes to difficulty negotiating safe sex and failure to identify potentially violent clients. The effects of laws against sex workSex workers should have the same rights as workers in other industries. Unfortunately, because the sex industry is frequently regulated, sex workers have less autonomy and control in their work than other workers. The main argument put forward against the regulation of the sex industry which would ensure that sex workers have occupational conditions enjoyed by workers in other industries, is that sex work is inherently exploitative. The fact that laws are responsible for the creation of exploitative conditions within the sex industry is usually ignored. Laws against the sex industry discriminate against sex workers' access to mechanisms to address exploitation. These laws deny sex workers the right to form and join workers' unions and professional associations. Laws against sex work mean that unlike workers in regulated industries, sex workers do not have labour rights, sick pay, accident compensation, health and safety regulations, and protection from exploitation. Those who are self-employed are also denied civil rights such as health care, banking facilities and social assistance. Other effects of the law on sex workers' lives include frequent relocation to avoid arrests; contact with criminal activities; vulnerability to police abuse, harassment and corruption; and higher prices for services or goods such as rent or advertising. Laws against sex work put sex workers' families, friends and partners at risk of criminal prosecution or social reprisals for associating with sex workers. Sex workers may lose custody of their children because of their occupation. In some places, such as France, it is illegal for any family member including adult children to live with a sex worker because they are "living off the earnings of prostitution". Laws against sex work also justify violence against those who work in this industry. Violence against sex workers is often not taken seriously by the police due to a widespread belief that violence is part of the job. In no other industry are victims of violence blamed for their experiences. Violence against sex workers has sometimes been ignored even in cases involving multiple murders. Programmes for sex workers may need to advocate for sensitive and effective treatment by medical personnel and police. The criminalisation of sex work additionally hinders the implementation of STI education and prevention programmes among sex workers. In some cases, even outreach workers have been harassed or threatened with arrest for "promoting prostitution". Laws that criminalise sex work encourage stigma and discrimination. Those who suffer discrimination and stigma often experience self-esteem reducing experiences, such as arrest, verbal harassment, being spoken down to, and social exclusion. Stigma and discrimination limit sex workers participation in community activities, such as religious activities. Being part of a social or religious community is crucial to the psychological and emotional well-being of some sex workers. The denial of access and acceptance in mainstream institutions, including religion, is a major issue. For example, many sex workers revert to less formal institutions, such as the candomblé religion in Brazil.
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3. MobilityGlobal sex workers
People migrate for many reasons, including economic mobility, war, political situations and internal displacement. People do not migrate only because they have been forced to do so. Movement from small towns to large cities is common, sometimes across borders, sometimes within one country. The will to travel, to see different places, to change scenario is a normal and common trend among human beings. Sex work is an occupation that often offers opportunities for travelling. A change of scenery is often welcome by sex workers, even if it does not amount to a huge raise in income, living standards or occupation. Economic opportunity is the greatest reason for migration. Many people seek to improve their lives by relocating to a more stable or lucrative area. Many migrants are among the most ambitious members of their home communities. Migrants are frequently go-getters who have taken the risk of leaving their homes to seek their fortunes elsewhere. They may profit or lose in their new situations. A good way to describe migration and the associated risks is to compare it to a lottery: some win, others lose. Not all migrants are tricked into bad situations. Many migrants find themselves in beneficial or neutral situations, but some find themselves in situations where their autonomy is compromised akin to slavery. Money sent home by migrants is a significant source of capital in some regions. Internal migration is often a consequence of police actions against sex workers. Police hunt sex workers either because sex work is a criminal act or to extort money or services from sex workers. Police activity can encourage someone who might not otherwise move to relocate. Some sex workers move around so that they are seen as a new face by clients. Brothel owners often encourage this. In some cases, sex workers move to escape stigma from their local community. Some relocate when they stop working. National laws about migration can affect sex workers differently from other migrants. Women suspected of leaving their countries for employment in the sex industry elsewhere may be discouraged, denied exit or transit visas, or even denied their identity papers. Sex workers are prohibited from entering the United States, China, and some other nations. Rationalisation for these laws include attempts to restrict disease, but laws excluding sex workers do not affect behaviour. People everywhere take risks with sex and drugs without migrants or sex workers every day. Laws that constrict the mobility of workers in the sex industry promote abuse of migrants. Those who are determined to relocate despite the law will seek the services of someone who can help them procure fake documents or elude border patrols. This is not limited to sex work: undocumented immigrants work in sweatshops and domestic labour. This again is analogous to a lottery. Some people can offer their services at a fair price, and others are taken advantage of as migrants. One finds plenty of variation in types of migration, motivations and out-comes. Some migration is forced or exploitative, while there are plenty of cases of voluntary and fair deal migration. Some people are motivated by promises or hopes of high incomes, others merely look for a change in their lives. Many are successful, while others return empty-handed. The cost of movingMany people borrow money for travel and other expenses of migration. Some people promise to pay this debt with their future labour. This is not exclusive to the sex industry and happens in many other industries. Many lenders are honest and there are many reports of fair deals. The degree to which security measures imposed by the lender restrain the borrower's freedom varies considerably. There are reports of female sex workers in debt bondage. Debt bondage is not just the act of lending someone money but also can include restricting someone's movement or raising the amount owed, so that the debt cannot be repaid. In the worst cases, the amounts charged are far above the actual costs. There are cases of Chinese migrants entering into contracts for $50,000 US, with debts that increase and can never be repaid. Debt bondage is illegal in international law and is considered a modern form of slavery. However, some migrants willingly enter into such contracts in their efforts to relocate. Debt bondage and slavery are now called "trafficking in persons". Extreme cases of debt bondage occur in many industries, notably sweatshops and factory workers. Recent cases include people of many nationalities in many countries, working in industries as varied as domestic labour, vending and sales, agriculture and sex work. Sex workers are more vulnerable when they do not speak the local language, or have no local support networks. It is imperative to recognise the varied experiences of workers in the sex industry. As in most areas of the sex industry, understanding the variety of experiences is crucial in order to grasp the depth of the phenomenon of sex work. Without recognising this variety, analysis is shallow and meaningless. This is especially so with the multiplicity of forms of work, origins and backgrounds of workers, and the personal decisions made and compromises reached to facilitate relocation. Migration and healthMigrants have more risk factors than the general population for HIV/ AIDS, tuberculosis and other infections, but this is not due to the act of migration itself. Some activities undertaken during the process of migration may lead to increased risk. These can be compounded by a lack of information about HIV/AIDS and sexual activity, sex work or drug use. Special efforts to address migrants' health are recommended. Successful interventions can rarely be transported intact but tailored adaptations need to be developed for each specific environment. Pre-departure interventions for migrants, where possible, including language classes , health information and self-defence, are a recommended model. This is not limited to sex workers but may be applicable to migrants more generally. Harm reduction and a human rights-based approach are advocated for interventions with sex workers generally, but especially for migrants. It may be difficult to include people who are new arrivals in an area or who are markedly different from those already living there in existing interventions. Some local sex workers will resent or dislike new arrivals as a threat to their business and established client base, or may hold racist views against other ethnic groups. This may require special efforts beyond translation to reach new arrivals and even established migrants in an area. Migrants may return home with health problems including HIV and AIDS. Therefore, treatment is a crucial part of efforts to assist migrants.
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4. Commercial SexSex workers have different kinds of sex with different clients, in different situations. Sometimes clients want to simply talk or have non-sexual physical contact, particularly if they cannot achieve erections or want, in some way to remain loyal to an idea or a person. In many cases men want entertainment as well as sex or sexual fantasies of various kinds. In most cases sexual transactions are fairly clear and time limited. In others they may be long term and/or more closely resemble a private rather than a commercial transaction. This is sometimes called informal sex work. In such transactions unprotected sex may occur so that it seems more like private or affection motivated sex. Commercial sex is usually quite different from private sex. In a commercial sex transaction, sex workers prefer to spend a minimum amount of energy and avoid mental and physical intrusion from clients. Sex workers often report avoiding deep kissing and prefer sexual positions that minimise penetration and the force of thrusting. Avoiding violence is often an important consideration for sex workers when they steer men towards different places to have sex and different sex acts and positions. More experienced sex workers often share stories and tips about which types of sex minimise the risk of violence in particular settings. For example, sitting on top of the man during sex gives more control than being under him. Scarves, "pony tails" and jewellery that can be used to trap or strangle a sex worker should be avoided. If a client is drunk, it is to the sex worker's advantage to have calming strategies. Confidentiality must be maintained when working with sex workers. This applies to behaviour, gender/sexual identity and health. Safe sex work skillsCondomsFemale and male condoms are effective in preventing transmission of HIV during vaginal and anal sex. Condoms, training and information should be made available. Services should provide condoms adequate for anal sex for male, female and transgender sex workers. Condom use is recommended, however 100% condom use programmes are not. These programmes allow brothels to operate with mandatory STI testing of sex workers. All mandatory testing is a violation of anybody's civil and human rights. Oral sexHIV and other STIs can be transmitted through practicing unprotected oral sex. Use of condoms or dental dams, when available, is therefore recommended. If, however a condom is not used, ejaculation should preferably occur outside the mouth, possibly on parts of the body that are not mucous membranae and do not have sores or cuts (e.g. neck or breasts). Swallowing sperm represents the higher risk of HIV or other STIs transmission. Dental hygiene is important because mouth sores and ulcers increase the risk of infection. Teeth should not be brushed, flossed or otherwise cleaned immediately before or after unprotected oral sex because cleaning often causes gum bleeding and small cuts. Some clients will want to perform cunnilingus on female sex workers. There are risks associated with this, including herpes, for both partners. Menstruating women may use a natural sponge or other barrier, like a diaphragm, to prevent detection of menstrual blood. Menstrual blood like other blood can transmit the virus which causes HIV and AIDS. While dental dams are recommended, they are frequently not used for cunnilingus for the same reasons that some people prefer fellatio without condoms: they may not enjoy the flavour or sensation as much. Non-penetrative sex and fantasiesClients often look for sexual services from a sex worker in order to experience sexual experiences that are different from usual. This puts sex workers in a good position to market safe sex practices, satisfying clients' needs and profiting from it. Safe sex fantasies, i.e., those that do not include opportunities for exchange of bodily fluids and in which the skin is not broken, include:
Some specialised or 'esoteric' services do involve risks. These include:
KissingKissing carries no risk of HIV infection but it may be a way of transmitting herpes, glandular fever, gonorrhoea and syphilis. Kissing is a sensitive issue for sex workers as they often find it too personal for commercial sex. For many sex workers, kissing is something that they do only with their private partners. Boundaries such as this (it can be any sexual activity) are often important for the sex workers' maintenance of good psychological health, as they define a boundary between commercial sex and sex for pleasure, or work and private life. Douching and cleaningSex workers often use harsh chemicals and detergents in their personal hygiene. These are detrimental to their sexual health because they break own the body's natural protection against infection and are the main cause of bacterial vaginosis among women. Microbicides and spermicidesMicrobicides are chemicals that kill germs or viruses, while spermicides kill sperm. A common spermicide is Nonoxynol9, also referred to as N9. Research has shown that this product does not have a microbicidal effect and does not reduce the risk of HIV infection. In fact, studies suggest that the risk of HIV is raised by N9 use, as it is responsible for skin irritation and breakage. Drug UseDrug use is associated with sex work in some circumstances. Some of the association of sex work and drugs may stem from the illegality or stigma shared by both commercial sex and drug use. Some sex workers use drugs and drug use may be common in some venues and rare in others. Sex workers, like other people, may use drugs in order to cope with difficulties or to alter their moods. Some sex workers say that drugs make the work easier to do. Sex workers who use drugs may have needs that require specific efforts to meet, such as needle exchange or other provision of clean needles (bleach kits) and drugs-related health concerns. Although sex workers may work in order to feed a drug habit or use drugs in order to work in the sex industry more comfortably, there are other possible relations between sex workers and drugs. For example reports from the Middle East suggest some female sex workers are given drugs against their will. These drugs are usually imposed on her in order to calm her down (barbiturates) or give her energy to see more clients over a longer period of time (amphetamines). They may also be given drugs for a number of reasons, including contraception. Illegal drugs are not the only products that sex workers may inject. Medicines, hormones, vitamins and silicone are also injected. Sex workers should have access to equipment and information on how to use them in the safest possible way. Women and transgender people who use drugs have a whole range of health and welfare needs, often denied to them by drug agencies. Female drug users have needs such as reproductive health services, information on drugs and drug substitution during pregnancy and parenting support. Women who inject drugs are often less visible than men, however, there is a considerable population of female sex workers who use drugs. Young adultsIn this booklet the terms young adult and young person refer to people who have reached puberty but who are not yet eighteen years old. Despite almost universal consensus that young people should not work in the sex industry, and a range of national and international laws and policies to prevent it, young people continue to sell sexual services in most parts of the world. In some places this has been made even more common since the advent of the HIV pandemic by men seeking younger sex workers in the belief that they are more likely to be HIV negative. Understanding discussions about young sex workers and child exploitation may be made more difficult by UN conventions and local laws that categorise all people under 18 as children. This can hide the very different issues and situations of a young man or woman of 17 and a child of 10, both in commercial sex as well as other industries. The lack of differentiation between children and young adults can hinder development of appropriate responses to those different situations. This distinction is especially important in places where economic independence and sexual and reproductive life often begin relatively soon after puberty, especially among poor people. In reality many NGOs and welfare agencies must make difficult decisions, often at individual or case level, about how to work with young adults generally and those selling sex specifically. Most agencies, including and maybe especially sex worker organisations themselves, agree that pre-pubescent children should be removed from vulnerable situations. In most cases sexual exploitation will be one of a number of abuses to which those children are routinely exposed. Sex workers in brothels in India and Bangladesh have operated programmes to assist repatriation of children who have usually been sold into the brothel system. Interestingly, those same sex workers may have their own children living with them in those brothels but their children are unlikely to sell sex and are less vulnerable while they live there with their mothers. In this model programme, sex workers rather than outsiders define and react to children's vulnerability. Most social workers would agree with those sex workers when they say that the "success" of any kind of "rescue" of children from commercial sex depends to a large degree on the alternative provided. Children repatriated to abusive families or inadequate institutions are likely to remain vulnerable. Adolescents that sell sex are also frequently vulnerable in a number of ways at the same time. These can include drug abuse, premature pregnancy, health risks associated with homelessness and violence and persecution by police, their families and others. Some older teenagers may be pressured or even forced to sell sex but many do so voluntarily and are not significantly more vulnerable than people on the other side of their 18th birthday. Welfare agencies and NGOs that provide strategies aimed at reducing individuals real vulnerabilities often find that determining the exact age of older adolescents, and even the extent to which they sell sex, are not central to effectively reducing their vulnerability. Young adults and children who sell sex may call themselves sex workers but instead trade sex for favours. This means that projects for sex workers will not reach them. Programmes that work with people under eighteen years old should consider the sensibilities of the young people involved. Transgender sex workersTransgender is a term used to describe people born as one sex who live as another, some of whom undergo sex change or cosmetic surgery or take hormones to change their bodies. Others use clothing only to indicate their gender roles these people can also be called transvestites. Transgender includes people born female who live as male, but most transgender sex workers are male-to-female (MTF). Some transgender, such as India's hijra, identify not as male or female but as a third sex. It is crucial to respect different gender identities and for programme activities to reflect these multiple realities. Transgender sex workers face the same problems as female and male sex workers but have additional needs and issues related to their gender identity. Social and cultural issues and health must be taken into account when working with transgender sex workers. Social discrimination makes it very difficult for transgenders to find other employment. Transgender sex workers have a range of particular general and sexual health care needs and are also at higher risk of STIs and HIV. Rates of HIV and AIDS reflect that treatment is crucial for transgenders, but treatment may be even more difficult for transgenders to secure than others both for their double stigma of sex work and transgender identity and for the cost of treatment. General health care issues are often related to transgender sex workers maintenance of femininity. They include the high incidence of ingrown hair, a consequence of shaving and waxing body hair frequently (male hair follicles are more prone to ingrown hairs than female counterparts), especially when low quality equipment or products are used. Hormone treatments often have side effects, again especially if treatment is of low quality. Unfortunately, low cost and low quality treatments are often the only option for disadvantaged transgender sex workers. Similarly, plastic surgery and cosmetic procedures such as self-administrated silicone injections, have a range of side effects and are to a certain extent dependent on the quality of the procedures. The inappropriate use of cosmetic products causes many kinds of dermatological problems. Nutrition is often an important issue for transgender sex workers, as it is for most poor people. Often the costs of maintaining a feminine persona takes transgender sex workers' small income away from basic needs such as nutrition. There are also some important issues around sexual health, mostly due to the frequency of anal sex and the altogether too frequent occurrence of violence and anal rape. Violence against transgenders is not limited to rape and many transgenders have experienced attacks on their person. Self-defence and safety skills are perhaps even more important for transgender sex workers than for other sex workers. More specific issues around safe sex include risks carried on by a common practice among transgenders of to taping genitalia to the body. This causes skin lesions and breakage in the pubic region, which increases risk of STI and HIV transmission and undermines the safety of thigh sex. Transgender sex workers need therefore to learn and use skills to tuck genitalia in and to avoid taping. Sharing syringes among those who inject hormones presents a high risk of STI and HIV transmission. Clean needles are as important for people who inject hormones as for those who inject other drugs. Transgender sex workers are at a higher risk of tuberculosis and other similar infections, because they are more likely to live in crowded environments. This is due to discrimination in society, rejection by families, and poverty. A major issue for transgenders is changing their legal name and gender status to match their gender identity. In some places it is possible to change personal documentation such as passports but it is very difficult to change a birth certificate. At present, the only way to change one's civil status is by undergoing sex change surgery. This is a problem as many transgenders either do not want to undergo such surgery or do not have the money to pay for surgery. Male sex workersMale sex workers are often less visible than female sex workers and are therefore more difficult to reach. Their lack of visibility is usually related to taboos on homosexuality. However, it is very important not to assume that male sex workers are homosexual. Homosexuality is defined by identity and lifestyle, not sexual behaviour on its own. Many male sex workers do no identify as gay. HIV prevention projects directed at gay men may not reach male sex workers who do not identify as gay. The term "men who have sex with men" (often abbreviated to MSM) is recommended to differentiate between sexual identity and behaviour. Terms like kothi and panthi to indicate different sexual roles rather than one's partner's sex those of penetrator or "fucker" and receiver or "fuckee" and "double decker" for someone who takes either role. It is necessary to include male sex workers who perform any of these roles with any other person. Some young men sell sex to other men in order to explore their sexuality. For these men, sex work has an important role in their personal development. For others, sex work by young gay men can be akin to a rite of passage. Men also sell sexual services to women. The most visible form of this type of sex work can be found in tourist resorts. Cultural attitudes and the law shape the conditions of male sex work and the quality of support and services available to male sex workers. For example, some men are able to work with less interference from police if the police concern themselves more with female sex workers, while those in places where sex between men is illegal may have greater legal difficulties.
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Created: December 2, 2002 Last modified: September 27, 2004 |
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Network of Sex Work Projects Email: secretariat@nswp.org |
