Study suggests decriminalising sex work could dramatically reduce HIV infections

24 July 2014
An HIV ribbon

A new study presented at the 2014 International AIDS Conference has found that decriminalising sex work could reduce HIV infections by 33-46 percent over the next 10 years. Published in the Lancet’s new series, HIV and Sex Workers, the study researched HIV among female sex workers (FSW) across Canada, India and Kenya. Exploring the structural determinants that increase sex workers vulnerability to HIV and outlining several key areas that require attention including scaling-up antiretroviral therapy, challenging the violence and harassment FSW are exposed to and changing laws and policies surrounding sex work.

FSW are 14 times more likely to have HIV than other women, making them a key population to consider in the fight against HIV, yet FSW inclusion in prevention, treatment and care remains low. The study found that in Canada and Kenya, factors such as sexual violence impacted profoundly upon non-condom use. Furthermore, elimination of violence amongst police and clients could reduce HIV infections among FSW by 17-20 percent. Findings show that police harassment of FSW is particularly problematic in HIV prevention, resulting in FSW neglecting condoms and displacing FSWs to increasingly dangerous and concealed venues. One FSW was quoted saying “…they [the police] found me on the street, took all my condoms I had and destroyed them”, highlighting further the police harassment endured by FSW increases their vulnerability to HIV. Other factors such as increasing antiretroviral access for FSW are also highlighted in the study, suggesting that it would reduce HIV infections by 34 percent for both FSW and clients.

These structural factors result in FSW being less likely to seek testing, support and treatment due to a fear of criminalisation. New South Wales, Australia, is one example of a place that has decriminalised sex work and has resulted in FSW having lower HIV incidence rates than the general population. Programmes need to effectively include these structural factors impeding FSW prevention, treatment and care if the HIV epidemic is to be curbed and HIV incidence among FSW reduced.

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