Sex work and HIV/AIDS

■ While sex work is a universal phenomenon, it is also frequently illegal and, therefore, clandestine. This makes it difficult to determine the true extent of the sex work industry, although it is acknowledged to be substantial and has apparently been increasing in recent years. This increase has been attributed to various factors, including changes in political, civil and socioeconomic conditions and increased population mobility. ■ Effectively addressing the HIV/AIDS epidemic among sex workers and their clients calls for a multi-faceted approach that coordinates a range of diverse responses. To determine which responses will be appropriate, it is important to understand the forces that drive people into sex work. These forces can vary—sometimes widely—in any given community and among the subpopulations in that community. Many people enter sex work for economic reasons; that is, it may be the only, or the best-paying , employment option. Others are coerced into sex work through violence , trafficking or debt bondage. Some, particularly adults, freely choose sex work as their occupation. Entry into sex work can also have socially rooted causes that can be traced to traditions, beliefs and norms that perpetuate gender inequalities. For example, most societies have different sexual standards for men and women. Thus, when sex work intervention programmes are being designed, they must take into account cultural as well as socioeconomic determinants of entry into sex work. ■ Significantly higher rates of HIV infection have been documented among sex workers and their clients as compared to most other population groups within a country. HIV infection often spreads among sex workers before spreading into the general population. The true extent of HIV transmission from sex workers and their clients to other populations remains generally unknown. Studies indicate, however, that sex workers are among those most likely to respond positively to prevention programmes relating to HIV and sexually transmitted infections (STIs)—for example, by increasing their use of condoms with clients. Efforts to support sex workers' extending safer sex practices to their regular or stable sexual relationships need to be strengthened as well. ■ Factors that appear to heighten sex workers' vulnerability to, and risk of, HIV infection include: • stigmatization and marginalization • limited economic options, in particular for women • limited access to health, social and legal services • limited access to information and prevention means • gender-related differences and inequalities • sexual exploitation and trafficking • harmful, or a …