As new medical technologies are increasingly being promoted in the prevention and treatment of HIV, and heralded as interventions to be used within communities of key populations including sex workers, NSWP urges the international HIV community and donors to take the concerns of sex workers presented in this report seriously and continue meaningful engagement with key populations in this shift towards the use of biomedical interventions. For years sex workers around the world have been developing and sustaining sex worker-led HIV prevention, treatment, care and support programmes. The successes of these community-led programmes have been recognised by UN and international partners including the World Health Organization, United Nations Population Fund, Joint United Nations Programme on HIV/AIDS, The World Bank, USAID and the Bill & Melinda Gates Foundation, with their most recent guidelines ‘Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions’( (SWIT, 2013) clearly supporting sex worker-led programmes as the most effective in reducing sex workers’ vulnerability to HIV. These sex worker-led efforts must be continually supported and not hampered by any biomedical intervention that does not take seriously, and ensure to mitigate, the risks involved of strategies such as PrEP and early treatment as prevention strategies. NSWP also urges those reading this report to consider the potential benefits and risks of PrEP and early treatment as prevention strategies carefully through the three lenses of impact;
- impact on the individual sex worker;
- impact on the wider sex worker community; and
- impact on wider society and overall HIV prevalence.
Whilst these new prevention technologies may have the potential to significantly reduce HIV prevalence amongst wider society by targeting key populations, the risks to the individual and to sex worker communities’ long‑term efforts to reduce prevalence through community empowerment must be recognised.
This report is an initial step in highlighting the experiences and concerns of sex workers around the world in the hope that dialogue and meaningful engagement with key populations will continue. Increased vulnerability amongst key populations is fuelled within structural contexts of criminalisation, stigma and discrimination, particularly in relation to healthcare access. NSWP recognises, in line with the diverse opinions of sex workers across the world, that there is a place for biomedical interventions in the global fight to end HIV. However, these will fail if implemented at the expense of supporting and empowering sex workers and other key populations to take ownership of their health needs, related policies and programmes, and they are not implemented within a rights-based framework. Sex workers must be fully engaged in this growing debate, as noted by NSWP members: ”Sex workers are not the problem; we are part of the solution!”
This report has been funded by the Bridging the Gaps Programme.
You can download this 28 page document above. This resource is in English.