promoting health and human rights |
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promoting health and human rights |
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Chapter 2
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2.1 Policies and philosophies
"Policy framework" means the laws and policies which affect how the sex industry operates. It includes such things as:
Policy usually reflects laws and regulations that are imposed by governments. However, policy decisions and subsequent practices are often less formal. For example, police in some places traditionally do not prosecute certain types of sex work, even when they are illegal. Policy affects the way that health projects work. Project staff need to understand the policy framework in which they are working. Often health services are expected to contribute to the development of policy. This is an important opportunity to improve conditions for sex workers and to improve the effectiveness of the project. Agencies which provide services to sex workers must also develop their own policy. Organisational policy guides projects in such matters as what advice is given to service users; whether HIV testing will be provided or encouraged; whether families and associates are targeted or sex workers only; if both genders or only one are included; whether current, or only former, sex workers can be peer educators; whether to participate in research; and many more.
Donors, managers and project staff including peer educators should consider their own views about commercial sex. Learning about local policy, and formulating organisational policy can be an ideal opportunity for staff and managers to explore their own opinions about sex work and to become more informed. The following paragraphs could be used to begin discussion about a range of policy issues which affect the sex industry. Core valuesCommercial sex invariably raises complex questions about gender relations, human rights, sexuality and political economy. Almost everywhere people who sell sex are stigmatised. In many cases the stigma is compounded by association with homosexuality, transexualism, drugs, ethnicity or race. Discussions about commercial sex from community to international level are widely reported, particularly when changes are being proposed. Churches, governments, health, welfare and law enforcement agencies, human rights and women's organisations may all have influence on policy about commercial sex. In recent years sex workers themselves have had a greater role in determining policy which affects them in many countries. Questions which influence policy remain. Is sex work inherently exploitative? Are people forced into it or is it a valid choice? Can it ever really be safe? Should it be treated as ordinary work or actively discouraged? Why are sex workers so often powerless? What do sex workers think? These issues can be confusing but they cannot be ignored. Different core beliefs about sex work lead to different ways of approaching health promotion for sex workers. This means that effectively it is impossible to take a neutral position.
A new project observed dreadful conditions at the local STD clinic. Women were lining up to receive a few seconds of substandard treatment. There was no privacy or counselling and hygiene standards were low. The project director, who believes that sex work is degrading, regarded conditions at the STD clinic as evidence for that view. She cited her visit to the STD clinic as reason to dedicate project resources to helping women to stop working in the sex industry. A project manager with a different perspective might have viewed conditions at the STD clinic as a violation of the right of the woman's right to proper treatment and argued for improvements at the clinic. It is helpful for projects to express their core values in writing. These are the principles which guide the STD/HIV Intervention Project in Sonagachi, Calcutta:
Individual experiences
Do sex workers like being sex workers? Like any other work, sex work is not experienced in the same way by all women, transgendered people or men, even in one area or one culture. The way people feel about providing sexual services for income varies enormously. Some find it to be an easy, worthy or acceptable occupation while others dislike it and find it shameful, frightening or boring. Often individual sex workers change their attitude as they either become used to the work or tired of it. This means that projects must consider a range of individual experiences within the sex industry. It may be appropriate to assist one person to stop working while assisting another to advance her or his "career" as a sex worker. Management principlesHealth promotion services and advocacy are provided by a range of agencies from government departments and hospitals to projects of development agencies, local collectives and many more. All of these have quite different manangement structures and this handbook doesn't attempt to list or analyse them. However there are some principles which have been identified as effective management philosophy by various agencies:
There are several management challenges unique to sex work projects such as managing sex worker peer educators, involving sex workers in project design, co-ordination and negotiating with police and local communities. Many managers benefit from networking with others who are doing similiar work.The Network of Sex Work Projects, or other organisations listed in the Key information sources and suppliers section of this book, may assist in locating projects and technical advisors who can offer management support. Staff and skillsThere is general agreement that sex worker involvement in projects is essential, but it is not always easy to organise and it requires good planning. Sex workers and professional staff need relevant training and team-building. Good models of training are not always available. Again, established projects may be able to offer training and technical support and consultancy to newer projects. Some important principles:
Commercial sex and the law
Some or all aspects of commercial sex are illegal in many countries. Laws against homosexuality, public order provisions and local regulations are also used against sex workers and the sex industry. Levels of enforcement vary from place to place and often change over time. Some countries have very repressive laws that are weakly enforced, some have less harsh laws that are strongly enforced. The impact of law on sex workers' daily lives can limit the effectivness of interventions. The situation assessment for a project should identify what laws exist, how they are enforced and what effect they have on sex workers locally. Prohibition is where the act of accepting payment for sex, and, sometimes, paying for sex, is illegal and is punished. This is the situation for example in Islamic Gulf states and in most parts of the USA. There is prohibition in a number of other countries and areas but often the enforcement is weak or arbitary. Criminalisation of prostitution-related offences is where the law forbids certain activities related to paying for sex rather than paid sex itself. These activities include soliciting for clients, advertising, living off the earnings of prostitutes, using premises or communicating for the purpose of prostitution, recruiting sex workers, helping them to travel and many more. This is the most common legal framework for commercial sex as it exists throughout Western Europe, India, South East Asia, Canada, Australia and the Pacific and most of Latin America. Regulation of the sex industry is when exceptions to criminal law are made for those parts of the sex industry which comply with certain conditions. In the case of female sex workers such systems are often linked to official requirements that sex workers are tested for STDs/HIV. In recent years a number of governments have enacted stronger penalties against customers. This is a response to protests that laws which penalise those who sell sex but not those who buy are unfair (and sexist because they usually apply to women). Sex workers usually disagree with this. They usually say that criminalising their clients makes the situation more difficult for them as well. Some examples of government legislation
Effects of laws against sex work
A perspective on law reformIt is clear that anti-prostitution laws don't succeed in achieving their supposed aims and they should be removed. But what should take their place?
In countries where all working conditions are regulated it is unrealistic to expect conditions around sex work to be unregulated.So what laws and regulations should apply to the sex industry? Some countries have legalised brothels in which sex workers (usually female) are strictly controlled and It is illegal to work anywhere else.This system has been tried in Nevada, USA and in some states in Germany, India and Australia. Many sex workers cannot get jobs in the legal brothels or conditions in them are so harsh that most prefer to work illegally. In other places individual sex workers are licensed and they can work, sometimes relatively freely, as long as they go to clinics to be tested for STDs. This system has had varied success. Sex workers' willingness to obey these rules depends on matters such as whether they are treated well at the clinics, whether or not the records are confidential and whether registering actually results in less harassment. Most sex workers' organisations favour repeal of the criminal laws against sex work so that the sex industry is subject to the same controls as other businesses. They argue that nuisance and violence can be dealt with by existing laws and that sex workers with civil rights are better placed to control their lives and secure better working conditions. In many countries, much of the economy is informal (small scale trading and manufacturing, market gardening etc.) and significant sections of the population are deprived of civil rights and social support. In these situations, existing prostitution laws are problematic and should be repealed because they ensure that sex workers are permanently deprived of fundamental rights and are vulnerable to arrest and abuse for crimes such as "vagrancy". Being under the age of consent is also a barrier to civil rights, a matter which particularly affects young men who sell sex. Sex work activists in some developing countries argue that where stigma and corruption underpin the persecution of sex workers, reform of sex work laws alone is unlikely to secure sex workers equal civil rights.
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2.2 STD/HIV policyMany countries have implemented registration or licensing systems in which sex workers are expected to register with a governmental agency (generally the health department or police) and comply with frequent STD and HIV testing. Most systems aim to prevent a person who has an STD or HIV from selling sex. This is usually done by withholding the card or certificate that the person needs in order to work legally. The documents are checked by police, other authorities or brothel and bar keepers. The system is controversial both because it is doubtful that it actually identifies infected sex workers or prevents them from infecting others and it is widely regarded as a human rights violation because it forces one partner involved in sex to submit to medical examination. Arguments against compulsory registration and STD testing of sex workers
Living with HIV and the double stigma
People living with HIV and selling sex raises ethical and practical questions. Sex workers who already face stigma and persecution are often faced with a difficult decision about continuing to work in the sex industry. Many do not have other options. Usually people with HIV are advised that they can be sexually active with out infecting others if they have safe sex. Yet often medical practitioners and counsellors are not comfortable giving this advice when the sex in being paid for. In many countries laws have been passed which are intended to prevent people with HIV from selling sex and these laws are frequently used against sex workers. However, such laws almost always drive HIV-positive sex workers away from the support systems and services which could help them to live well and safely. Where this is the case, such laws and policies are clearly counterproductive.
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2.3 Coercion and human rights
There is much discussion about those aspects of commercial sexual activity which violate human rights including sex tourism, child prostitution, violent coercion and trafficking in women and young people. Often these issues create practical questions. For example, should projects work with young people or are they supporting abuse by giving them condoms? What should services do when they become aware of people who are being forced to work or held against their will? Unfortunately for health projects, these debates don't offer useful information or practical insights which could guide service providers. There is no agreement about questions such as what constitutes force. Some say poverty is force while others say force must be physical. At what age, if ever, are people able to consent to sell sex? Some say 16, others 18, 21 or even 25, although in many countries people begin their sexual and reproductive lives at puberty or soon after. Groups which advocate increased punishment and suppression of the sex industry illustrate their campaigns with unsourced statistics and lurid accounts. Young people and sexual exploitation
There is some evidence that demand for underage sex workers has increased in some places in the last decade because young people are perceived as being less likely to have HIV. (This underlines the need for health education to encourage safe sex practices with all partners rather than cosidering the chances of potential partners' HIV status.) It is true that economic conditions in some parts of the world mean that there are large numbers of impoverished children who sell sex, among other things, to survive in informal economies. But the reality of young people's involvement in selling sex is more complex than the often sensationalising media images. Health workers should understand that child exploitation and adolescents selling sex are different issues which give rise to different needs. Unfortunately, there is no simple formula for understanding young people, gender and sexuality, either at policy level or when working with individual young people. Some issues require multidisciplinary responses which include health promotion and social work skills, while some require the same responses as adult sex work, even if that presents cultural challenges to professionals. Service providers must consider their duties and responsibilities to children and adolescents and how to carry out those duties. Staff should be trained to deal with young people and know which local services are likely to deal appropriately with young people who sell sex.
Where young people sell sex and live away from their families they are sometimes in environments which, although not ideal, may provide forms of social support which are not immediately apparent to service providers. This has important implications for agencies who are considering taking steps which may result in a young person being removed from that environment and placed in another. Will it be better, and on whose terms? The definition of a child varies legally and culturally between countries and cultures. "Child" prostitution statistics are certainly inflated by lobby groups, who include young people older than the legal or culturally acceptable age of consent in their definition of "child".These statistics blur a distinction which is important for service providers who must develop appropriate responses to the different needs of prepubescent children and young men and women aged 18 years. Trafficking
Sex workers who want to work in more lucrative markets often travel to do so, often illegally and often with the assistance of others. Sometimes they are assisted by individuals but often highly organised brokers make unfair profit by providing transport, the necessary paperwork for the journey (passports, visas, letters of support) accommodation and employment in the destination country. Typically brokers recoup their fees by taking the woman's earnings in the destination country. Often her freedom is limited until the debt is paid and even beyond that. This form of labour contract, debt bondage, is illegal but not uncommon. Recently, women of Eastern Europe and the former Soviet states who have travelled to Western Europe and beyond have been subject to these kinds of arrangements, as are some of the women and transsexuals who travel from Latin America and Africa and countries where poverty is endemic or those where leaving is difficult such as Haiti or Cuba. Stories of girl children being sold into prostitution are familiar to most people. In some cases women and children are forced or tricked by net works of professional brokers into travelling to work as prostitutes. Others make arrangements voluntarily but find that the brokers have lied about standards of employment and accommodation and the legality of the documents they will provide. The latter typically receive less sympathy. In both instances, women and (in much fewer cases) men exist in slavery-like conditions in the destination country until they are deported, or freed.
In most cases where sex workers reach an otherwise inaccessible country and find opportunities to earn a lot of money, they are satisfied with what they see as a good service, even if the arrangements do not reach standards which are either acceptable to others or legal. Despite sensationalist press and influential "anti-trafficking" lobby groups which disseminate information about the worst scenarios, most arrangements are voluntary and many are, in fact, completed to the satisfaction of the sex worker involved. The problems for sex workers who have been "trafficked" are similar in many ways to those of other labourers who travel from poor to rich countries for work.These include extreme vulnerability to exploitation or even enslavement and little or no access to health and welfare services. In some places there are organisations which provide assistance for such immigrants, although this is usually seen as different from that offered to other immigrants.
While there is a clear duty to try to assist anyone being held against their will, project staff should not take actions on their own since this situation can be extremely dangerous. There should be clear procedures in services for staff members who come across people in such situations. When sex workers are subject to agreements with brokers there are addi tional obstacles to health promotion. They may not be permitted to leave where they are working or staying, or they may be escorted when they do so. Because there is risk to the brokers if police or immigration authorities are notified, they may be deliberately prevented from making contact with anyone in the destination country. Nevertheless, in many places outreach workers have had successes at reaching women on contracts and even gained enough trust to enable them to visit health services. Organised networks do not appear to control the movement of men for sex work from poorer to richer countries, although there are reports of boys being trafficked, particularly within Asia. Sex tourism
Awareness of exploitation by tourists who travel to developing countries for cheaper or exotic sex has also increased. Some countries are introducing laws which enable them to prosecute their own citizens for crimes committed abroad. Tour operators who organise sex tours are also being targeted for prosecution. Some governments and NGOs provide safe sex advice to travellers. There are a number of projects which work with sex workers in developing countries whose clients are Western tourists. These projects often arrange language classes aimed at increasing a sex worker's ability to negotiate safe services with her or his client.
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2.4 Drug policyIn some cases projects are required to comply with national policies, or policies of potential donors, who may have guidelines about how drug services are delivered. Sometimes organisations who work with sex workers have input into the formulation of local drug policy. Again, this is an important opportunity. HIV prevention and social support services for sex workers are more successful in places in which there is realistic drug policy. Realistic drug policy is access to a variety of effective treatments, clean needles and syringes and accurate information about drugs. Unrealistic drug policy is that which criminalises drug users, deprives them of support and forces drug prices upwards — all of which impact negatively on sex workers' capacity to exercise control over their personal circumstances. |
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Created: March 24, 1999 Last modified: January 2, 2006 |
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Network of Sex Work Projects Email: secretariat@nswp.org |
