Female Sex Workers
Gaps in Research
- 1.
- Health care provider training is needed to increase confidentiality and decrease discrimination against sex workers seeking health services.
- 2.
- Interventions are needed to provide sex workers with greater control and access over money and resources, which can have a positive impact on HIV-related risk reduction.
- 3.
- Changing laws and policies, ending police violence, and other mechanisms are needed to protect sex workers from violence and rape.
- 4.
- Efforts are needed to avoid disruption of HIV and AIDS programmes during raids and other policing mechanisms.
- 5.
- Changes in strategies are needed for efforts that stigmatize sex workers and force mandatory testing without confidentiality.
- 6.
- Basic information on HIV such as where to access condoms and confidential HIV testing is still needed for sex workers in some settings.
- 7.
- All sex workers, but particularly sex workers living with HIV, need access to information and services for contraception and dual method use.
- 8.
- Efforts are needed to provide HIV prevention and services to children and adolescents aged 10 to 17 who sell sex.
1. Health care provider training is needed to increase confidentiality and decrease discrimination against sex workers seeking health services. Studies found that significant proportions of female and transgender sex workers did not visit health facilities because of lack of confidentiality, discrimination, and lack of counseling when accessing HIV testing.
Gap noted, for example, in Nepal (Ghimire and van Teijlingen, 2009); Vietnam (Ngo et al., 2007); Botswana, Namibia and South Africa (Arnott and Crago, 2009); Nigeria (Munoz et al., 2010a); and South Africa, Kenya, Uganda and Zimbabwe (Scorgie et al., 2011).
2. Interventions are needed to provide sex workers with greater control and access over money and resources, which can have a positive impact on HIV-related risk reduction. Studies found that if sex workers had access to resources under their control, women were more likely to negotiate condom use and that female sex workers in debt were less likely to report condom use.
Gap noted, for example, in China (Yi et al., 2010); India (Reed et al., 2010; Shahmanesh et al., 2009a; Shahmanesh et al., 2009b; Karandikar and Prospero, 2010); Dominican Republic (Ashburn et al., 2007); Nigeria (Oyefara, 2007); South Africa, Namibia and Botswana (Arnott and Crago, 2009).
3. Changing laws and policies, ending police violence, and other mechanisms are needed to protect sex workers from violence and rape. Studies found sex workers experienced high rates of violence and rape from clients and police, and that fear of arrest was a barrier to accessing health services. Studies also found that violence was associated with inconsistent condom use and HIV incidence. Studies also found high rates of violence from intimate partners and clients, but inability to press charges.
Gap noted, for example, in Turkmenistan (Chariyeva et al., 2011); China (Tucker et al., 2010; Choi et al., 2008); Nigeria (Munoz et al., 2010a); Croatia and Montenegro (Stulhofer et al., 2010); Mozambique (Lafort et al., 2010); Kenya (Okal et al., 2011; Tegang et al., 2010; FIDA, 2007); India (Karandikar and Prospero, 2010; Swain et al., 2011; Go et al., 2010; Go et al., 2011a; Panchanadeswaran et al., 2010; Erausquin et al., 2011); Russia (Decker et al., 2012); Brazil (Damacena et al., 2011); South Africa (Scorgie et al., 2011; Gould and Fick, 2008); Cambodia (HRW, 2010c); Botswana, Namibia and South Africa (Arnott and Crago, 2009); Serbia (Simic and Rhodes, 2009); Thailand (Decker et al., 2010b; Ratinthorn et al., 2009); Russia (Aral et al., 2003 cited in Stachowiak and Peryshkina, 2007); and globally (UNAIDS, 2011f).
4. Efforts are needed to avoid disruption of HIV and AIDS programmes during raids and other policing mechanisms. Studies found that HIV prevention efforts are disrupted during raids and that carrying condoms is used to prosecute sex workers.
Gap noted in South Africa (Scorgie et al., 2011) and China (Lau et al., 2007a).
5. Changes in strategies are needed for efforts that stigmatize sex workers and force mandatory testing without confidentiality. Studies in China found that sex workers are mandated to be tested for HIV in re-education camps but many are not informed of their serostatus. Studies found that sex workers were sent to labor re-education camps, were publicly shamed as sex workers and IDUs and had low rates of testing, condom use and access to services. Studies also found that cities in China that detain sex workers have a higher mean HIV prevalence compared to cities that do not detain sex workers.
Gap noted in China (Xu et al., 2011; Jianhua et al., 2010; Tucker et al., 2010; Wang et al., 2011).
6. Basic information on HIV such as where to access condoms and confidential HIV testing is still needed for sex workers in some settings. Studies found that sex workers lacked adequate knowledge of HIV and few had sought testing. Most did not know where to obtain condoms or understand that condoms could reduce the risk of HIV acquisition. Others had misconceptions that showering could reduce risk of acquiring HIV
Gap noted in globally (Overs and Hawkins, 2011); Turkmenistan (Chariyeva et al., 2011); Swaziland (Chipamaunga et al., 2010); Sudan (Abdelrahim, 2010); Somalia (Kriitmaa et al., 2010); Pakistan (Khan et al., 2010); Afghanistan (Todd et al., 2011a); Kiritbati (McMillan and Worth, 2010); and China (Zhang et al., 2011b).
7. All sex workers, but particularly sex workers living with HIV, need access to information and services for contraception and dual method use. Studies found that sex workers, particularly HIV-positive sex workers, lacked access to contraceptive options and had high rates of abortion. [See also Meeting the Sexual and Reproductive Health Needs of Women Living With HIV]
Gap noted in South Africa (Scorgie et al., 2011); India (Wayal et al., 2011); and Rwanda (Braunstein et al., 2011).
8. Efforts are needed to provide HIV prevention and services to children and adolescents aged 10 to 17 who sell sex. [See also Prevention for Young People: Increasing Access to Services] A number of studies show that significant numbers of sex workers selling sex when they are under age 18 and these adolescents are at high risk of acquiring HIV and have numerous legal and policy barriers, such as fear of the police, needing a guardian over age 18 to access HIV testing and counseling, and forced detention, in trying to access services.
Gap noted globally (McClure et al., 2015); in Jamaica (All in to End Adolescent AIDS, 2015b); China (Zhang et al., 2013); Burkina Faso (Grosso et al., 2015); Ghana (Onyango et al., 2015).