Violence in Health Care and Custodial Settings a Major Contributor to Sex Workers’ Vulnerability to HIV

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A new report published and co-authored by UNDP, UNFPA, APNSW and SANGRAM  highlights the extreme physical, sexual, emotional and economic violence that sex workers face at work, in health care and custodial settings, in their neighbourhoods and in their homes. The report also calls for the decriminalisation of sex work and activities associated with it. This includes the removal of criminal laws and penalties for the purchase and sale of sex, the management of sex workers, living off the earnings of sex work and other activities related to sex work.  

The violence that sex workers face undermine their fundamental human rights — to equal protection under the law; to protection from torture and from cruel, inhuman and degrading treatment; and to the highest attainable standard of physical and mental health. Research is increasingly showing how violence contributes to the spread of HIV. In Asia, the HIV epidemic remains concentrated among key populations, including sex workers, people who inject drugs, men who have sex with men and transgender people. Realising the human rights of female, male and transgender sex workers requires an understanding of the intersecting factors that affect their safety and their protection from violence.

The report is the result of a collaborative process and a research partnership among United Nations agencies, governments, sex worker community groups and academics. The partnership was formed to address gaps in knowledge regarding the links between sex work, violence and HIV in Asia. A multi-country qualitative study was developed, with research carried out in Indonesia (Jakarta), Myanmar (Yangon), Nepal (Kathmandu) and Sri Lanka (Colombo). The objective of the study was to better understand female, male and transgender sex workers’ experiences of violence, the factors that increase or decrease their vulnerability to violence and how violence relates to risk of HIV transmission.

The findings are numerous and it is clear from the report, that sex workers of all genders face an extremely high level of violence including; sexual extortion, harassment and abuse by the police, abuse by managers of establishments where sex workers work, violence and harassment from the general public and neigbours, as well as discrimination and abuse in health settings.

Violence against sex workers has lifelong and life-threatening consequences for their physical, mental and sexual health and increases their risk of HIV infection significantly. Sex workers are seldom inclined to report their experiences of violence to the police or medical services particularly when the police or health care workers are the perpetrators of violence against sex workers.

The criminalisation of various aspects of sex work and law enforcement practices led to a higher incidence of violence by police personnel and clients. This is due to criminalisation giving the police broad powers to arrest and detain sex workers, promoting impunity, pushing sex work underground,  reducing sex workers’ ability to negotiate safe work practices and increasing stigma and discrimination.

More positively, the report also highlights factors that decreased sex workers’ exposure to violence and HIV risk and these include:

  • Safe workplaces, including those with more well-defined workplace safety frameworks, decent work conditions, responsible and responsive establishment owners or managers and supportive employers and co-workers
  • Information on rights, complaint mechanisms and access to redress for experiences of violence
  • Collectivisation, strong sex worker-led networks and individual access to knowledge and skills to conduct sex work more safely  
  • Learning from past experiences on how to keep safe
  • Access to non-stigmatising and non-discriminatory health care services

You can download the full report here and the summary here.

The report is in English.