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Fight HIV, not sex workers

  • Published at 12:02 am December 18th, 2016
  • Last updated at 01:22 am December 18th, 2016
Fight HIV, not sex workers

“My father died in a road accident when I was only four years old. I never got a chance at schooling. At six I was sent to Dhaka for domestic work and continued till 13. Then my mother wanted me to get married, but I didn’t want that at the age of 13, so I escaped with a friend. But later I fell into the trap and became a sex worker. Since then I am into this trade, and often I am a victim of physical and sexual assault.” -- A sex worker.

Each year we observe World Aids Day on December 1 along with the globe seeking to lift up awareness to prevent the spread of HIV or AIDS. Though Bangladesh has had a historically lower rate of HIV infection compared to the rest of the world, violence against female sex workers still remains a big threat in terms of HIV and AIDS.

They are one of the key groups most vulnerable to HIV infection in Bangladesh and also in other countries of the world, along with people who inject drugs, men who have sex with men, male sex workers, and transgender/hijra.

But sex workers are among those who are most vulnerable to HIV infection, as it spreads rapidly among sex workers. In many cases, sex workers have no access to condoms, or are not aware of their importance. They are simply powerless to negotiate safer sex.

Clients may refuse to pay for sex if they have to use a condom, and use intimidation or violence to force unprotected sex, and in many cases, they are raped. But because of the social stigma and marginalisation, they can’t even bring charges against their attacker.

Criminalisation of sex work contributes to an environment in which violence against sex workers is tolerated, leaving them less likely to be protected from it. Many sex workers consider violence “normal” or “part of the job,” and do not have information about their rights. As a result, these contribute to their vulnerability to HIV.

According to a recent study, the total estimated number of female sex workers in Bangladesh ranges from a minimum of 82,884 to the maximum of 102,260. In Bangladesh, they are mostly vulnerable due to social exclusionary factors such as low income, poverty, debt, unemployment, poor education, etc.

Therefore they are mostly mobile, hidden, and likely to avoid disclosure of their status due to stigma and discrimination. Moreover, more than half (55.8%) of female sex workers interviewed reported to having sex for the first time before the age of 15, and the use of condoms during the last sexual encounter was relatively lower among young sex workers aged as compared to sex workers aged 25 years and above, which put them at a high risk of HIV infection.

The risk of sexual transmission of HIV infection is well-established. An estimated number of 102, 260 female sex workers are engaged in this trade through brothels, hotels, residences, and street-based set-ups.

Violence against sex workers is not only widespread, but is also perpetrated, legitimised, and accepted by many

With their identities, they hardly get any basic services from hospitals and mainstream health providers. In situations where sex workers do not have access to condoms, HIV prevention information, and sexual health services, or are prevented from protecting their health and using condoms for any reason, they are at increased risk of contracting HIV.

The story of the abovementioned sex worker is a real life experience that has reason to make us depressed about humanity. At 13, she was trapped in a cycle of sex work, and when she was 18, she got married to a man who was her pimp, and gave birth to a baby girl in the following year. But her husband didn’t welcome the girl child, and attempted to kill the little one. Luckily, her mother managed to escape with the girl.

“I want to give my daughter education and a good life and I know I need money for that. That’s why I am still in this business and taking life risk to go with the clients in unknown places and do whatever they want me to do. Many times I faced gang rape and sex without condoms. I was heavily injured at times and managed to escape from being murdered.”

Violence against sex workers is not only widespread, but is also perpetrated, legitimised, and accepted by many. It undermines HIV prevention efforts and increases sex workers’ vulnerability to HIV transmission in several ways. We need to get our act together to stop the violence against sex workers and help in preventing HIV.

There is growing recognition that effective HIV prevention policies and programs focusing on sex workers must incorporate violence prevention strategies. Interventions to promote safer sex among sex workers must be part of an overall effort to ensure their safety, promote their health and well-being more broadly, and protect their human rights.

There is also a need to recognise that not all sex workers see themselves as victims, oppressed, or exploited. Instead, many can and are taking control of their own lives, finding solutions to their problems, acting in their individual and collective interests, and contributing to the fight against HIV/ AIDS.

Different international development organisations in Bangladesh, like Save the Children, have been operating 43 drop-in-centres (DICs) for female sex workers since 2008 to give psychological support and essential health services in 26 districts with support from the Global Fund.

There are almost 26,000 female sex workers getting support. But that’s not enough. When responding to the HIV epidemic among sex workers, empowering them and involving them in HIV prevention are necessary.

We also need to address the underlying social and structural problems that make sex workers vulnerable to HIV. By giving them greater legal protection against violence, and by reducing the discrimination they face, HIV prevalence could be cut dramatically.

Lima Rahman is Chief of Party, HIV/AIDS Program, Save the Children. Md Abdul Quayyum is Head of Communication and Media, Save the Children.