Last month saw the publication of the long-awaited Report of the UNAIDS Advisory Group on HIV and Sex Work. The Advisory Group was established in 2009 by the Executive Director of UNAIDS, the Joint United Nations Programme on HIV/AIDS, to provide clarification and advice around certain matters addressed in the most recent (2009) UNAIDS Guidance Note on HIV and Sex Work.
I finally had a chance to read the document this week, and there’s a lot of really good stuff in it. One of its most significant aspects is that it pulls no punches on the question of criminalising clients – not merely subsuming this issue, as many previous UN-associated statements have done, under a general opposition to laws against consensual commercial sex, but addressing it head-on and in some detail. On pages 5-6, it includes the Swedish sex-purchase ban in a section called “Laws, enforcement and policies that impede effective HIV responses for sex workers: Criminal prohibitions against sex work or aspects of it” and says:
The approach of criminalising the client has been shown to backfire on sex workers. In Sweden, sex workers who were unable to work indoors were left on the street with the most dangerous clients and little choice but to accept them.
In its “Conclusion and recommendations” on legal regimes, on page 8, it says:
States can take many actions to establish legal and policy environments that are conducive to universal access to HIV services for sex workers. Among these are the following: States should move away from criminalising sex work or activities associated with it. Decriminalisation of sex work should include removing criminal penalties for purchase and sale of sex…
Also significant is its criticism of the “end demand” strategy in general. In the introduction, on page 4, it says:
Policies and programmes to reduce the demand for sex work, designed ignoring the voices of sex workers, often result in unintended harms including increased HIV risk and vulnerability
for sex workers and their clients
On page 6, it points out:
There is very little evidence to suggest that any criminal laws related to sex work reduce demand for sex or the number of sex workers. Rather, all of them create an environment of fear and marginalisation for sex workers, who often have to work in remote and unsafe locations to avoid arrest of themselves or their clients. These laws can undermine sex workers’ ability to work together to identify potentially violent clients and their capacity to demand condom use of clients.
On pages 10-11, it notes that
well-meaning but ill-informed service and healthcare providers and policy actors from community-based organisations, nongovernmental organisations, donors, international organisations and government agencies believe that they are helping sex workers by calling for criminalisation of clients. However, there is no evidence that these “end demand” initiatives reduce sex work or HIV transmission, or improve the quality of life for sex workers…These laws do not reduce the scale of sex work, but they do make sex workers more vulnerable.
It calls instead for a shift of emphasis to ending demand for unprotected paid sex – and states on page 11:
Empowering sex workers to have greater control over their working conditions, rather than “end demand” approaches, should be the focus of HIV prevention efforts…When sex workers can successfully ensure that their customers use condoms, sex workers are less likely to become infected by HIV.
Of course, since it’s (usually) the clients who have to wear the condoms, convincing them that it’s in their interest to do so would go a long way toward reducing the demand for unprotected paid sex. The report describes working with clients in this way as the more effective strategy for HIV prevention, noting on page 14 that
demonising and marginalising clients are approaches that create major barriers to effective HIV programming with sex workers
On page 13 it gives a real-life example, from China, of how greater condom use has been achieved through a programme that treats clients not as irredeemable villains but rather as partners in the battle against HIV and other STIs:
Men working in industrial sectors that require them to work away from their families often engage in risky behaviours such as unprotected paid and casual sex…To address this, the International Labour Organization is working with large and medium-scale mining companies in southern China to promote responsible sexual behaviours among mine workers, including proper treatment of STIs, consistent condom use and elimination of violence against women, including sex workers. Preliminary results, assessed through qualitative and quantitative surveys, show significant increases in condom use and health-seeking behaviours, and increased reported condom use in paid and casual sex.
The report goes on to address the issue of trafficking. Here, I have a small difficulty with it, as it divides the sex industry into two distinct categories of voluntary/not trafficked and involuntary/trafficked:
A woman deciding to sell sexual services in order to support herself or her family is not a trafficked person. (page 17)
This is not strictly accurate as a matter of law, as the international definition of “trafficking” is broad enough to encompass some forms of “voluntary” sexual labour, such as debt bondage. It also ignores the fact that for most working people, not just sex workers, consent and coercion exist along a continuum, rather than being a binary.
Nonetheless, it’s absolutely true that sex work abolitionists tend to draw the line on that continuum in such a way as to strip the agency from most sex workers, especially migrants – and the Advisory Group is correct to highlight the problems this causes for HIV programmes. On page 18 it states:
Anti-trafficking measures often concentrate on getting people out of sex work, without considering whether they are trafficked, or whether the efforts will disrupt the access sex workers have to services that safeguard their health and well-being, and that create opportunities for them to share information and seek assistance for individuals they are concerned may have been trafficked. Many projects that focus on rescuing trafficked persons interrupt and undermine efforts to provide sex workers with access to HIV prevention, treatment, care and support.
The next page continues:
Forced rescue and rehabilitation practices lower sex workers’ control over where and under what conditions they sell sexual services and to whom, exposing them to greater violence and exploitation.
It goes on to say that when sex workers’ livelihoods are disrupted in this way,
this leads to social disintegration and a loss of solidarity and cohesion (social capital) among sex workers, including reducing their ability to access health care, legal and social services. Low social capital is known to increase vulnerability to sexually transmitted infections among sex workers and therefore has a detrimental impact on HIV prevention efforts.
Not surprisingly, therefore, it states on page 7 that
From the perspective of universal access to HIV services, undermining sex worker organisations is one of the most important negative effects of law enforcement practices.
Furthermore – and this is incredibly important for the migrant sex workers whom abolitionists are always fretting about:
The conflation of sex work and trafficking directly limits the ability of migrant sex workers to protect themselves from HIV, since they are often assumed to be trafficked. Migrant sex workers often live with the constant threat of being reported, arrested and deported which creates a real barrier to accessing health and welfare services.(page 19)
Of course, this is an immigration issue which would exist even if there was no question of trafficking. But the moral panic around trafficking has unquestionably created a greater impetus for raids on sex industry venues, which frequently lead to deportations of the people alleged to have been “trafficked”. (I think perhaps the report could have made this clearer.)
As with the battle against HIV, the battle against trafficking also needs sex workers’ participation if it is to have any real effect. On page 18, the report notes that
anti-trafficking efforts typically ignore the possibility of engaging sex workers as partners in identifying, preventing and resolving situations that do involve trafficked people. Sex workers themselves are often best placed to know who is being trafficked into commercial sex and by whom, and are particularly motivated to work to stop such odious practices.
To this end, it promotes the establishment of sex worker organisations, saying on page 20:
Organised groups of sex workers are also best placed to establish safe working norms within the sex industry, and influence other actors in the industry to ensure that trafficked adults and children are not retained in sex work…self-regulatory mechanisms, which are established, implemented and overseen by sex workers’ organisations can limit trafficking into the sex industry as well as the sexual exploitation of children. They also form a platform for addressing labour exploitation of sex workers.
The last major issue addressed in the report is the need for sex workers to be economically empowered. The main point here is that such programmes shouldn’t seek only to remove people from sex work, or be made conditional on their willingness/ability to leave the industry, but should aim to also improve the economic circumstances of those who remain in it:
By increasing economic options, sex workers can achieve greater financial security, which makes it easier for them to make important decisions that affect their lives…Improving economic options also helps sex workers to reduce the likelihood of having to accept clients’ requests for unprotected sex or that they will be put in situations that inhibit their ability to negotiate with clients and reduce the risk of violence or abuse. (pages 22-23)
Some interesting examples are provided of successful programmes around the world, such as one in Andhra Pradesh, India, where
Among the 803 sex workers interviewed, involvement in economic independence programmes was positively associated with control over both the type and cost of sexual services provided and with consistent condom use. (page 24)
I can predict a couple criticisms of the report. The make-up of the Advisory Group will probably discredit it in some eyes, since it includes affiliates of the Global Network of Sex Work Projects (along with “independent experts from academia and civil society organisations, representatives of UNAIDS Co-Sponsors and the [UNAIDS] Secretariat”). My response to that is to ask whether it would be reasonable for a UNAIDS Advisory Group on HIV and Men Who Have Sex With Men to not include any organisations comprising or working with MSMs. Of course it would not. They would rightly be seen as experts on the subject, and any “advisory group” without them would be seen as lacking in credibility.
It may also be argued that this is merely a report of the Advisory Group and not a UNAIDS policy document as such. This is true. However, its conclusions are entirely consistent with things UNAIDS has been saying all along, even if takes them a bit further. It justifies its positions by reference to earlier UNAIDS publications, such as on page 5 where it says:
The UNAIDS Strategy 2011-2015: Getting to Zero identifies as one of its 10 goals that the number of “countries with punitive laws and practices around HIV transmission, sex work, drug use or homosexuality will be reduced by half”
and on page 9 where it states that the 2006 International Guidelines on HIV/AIDS and Human Rights by the Office of the High Commissioner on Human Rights/UNAIDS note that
states have a responsibility to ensure that criminal law is reviewed with the aim of removing criminal sanctions on sex work and ensuring that any non-criminal regulations support safe sex in sex work and ready access of sex workers to comprehensive HIV services.
The fact of the matter is that UNAIDS, and many other global health and human rights organisations, have been saying for a long time that criminalisation of sex work is a barrier to effective HIV prevention and treatment. They have focused on criminalisation of the seller because that is how criminalisation manifests itself in most of the world; the Nordic model may look pretty significant from where I’m sitting in the north west corner of Europe but globally, it’s little more than a footnote. So the fact that it hasn’t specifically been addressed by UNAIDS (or the other international health and human rights groups who oppose criminalisation generally) should in no way be taken to indicate that they approve of it. Given all that we’re learning about how it actually works in practice, in fact, it’s pretty inconceivable that they would.
Of course, abolitionists won’t care what UNAIDS thinks about it anyway, since their view is that sex work would be bad and wrong even if it cured HIV. But most people are not abolitionists, and I think they would appreciate the significance of UNAIDS publishing this document. It is a valuable addition to the growing catalogue of material showing the health and human rights failures of criminalisation of sex workers’ clients, anti-trafficking policy and the fixation on ending demand.