UN Chronicle | The United Nations, Governments and Sex Workers Join Hands to Confront HIV/AIDS

New Partnerships Emerging in AIDS Education: The United Nations, Governments and Sex Workers Join Hands to Confront HIV/AIDS
By Nuchhi R. Currier for the Chronicle

Web Article

On the heels of the "education vaccine"—the Education for All initiative to combat the spread of HIV/AIDS in Africa—comes the first-ever meeting between representatives of Governments, sex workers associations and the United Nations was held in Geneva on 21 and 22 January 2003. Held in Geneva on 21 and 22 January 2003 as part of a series of workshops focusing on groups particularly vulnerable to HIV organized by the Joint United Nations Programme on HIV/AIDS (UNAIDS), the consultative workshop identifies strategies to halt the spread and mitigate the impact of the HIV/AIDS epidemic in sex workers' communities. In the Declaration of Commitment on HIV/AIDS, adopted unanimously in June 2001 at the UN Special Session on HIV/AIDS, Governments agreed to make high-risk groups a priority in the AIDS response.

Even though sex workers have been among the most vulnerable groups to the scourge of the disease, they have also been the most neglected. Stigma and discrimination, criminalization, limited access to health services and information, as well as exploitation and violence, exacerbate this vulnerability. Governments have been notoriously slow in addressing their plight even though sex work, a global phenomenon, is a significant economic factor in many countries, accounting for more than 2 per cent of the gross domestic product in four Southeast Asian countries in the late 1990s, according to International Labour Organization estimates.

Despite these odds, sex workers have managed to mobilize and empower themselves by becoming leading advocates and educators on HIV prevention and care, according to Aurorita Mendoza of UNAIDS. "Over the years, we have witnessed sex workers become one of the biggest mobilizers in the AIDS response, both on the care and prevention front", she said at the workshop. Prime examples of success are countries such as Bangladesh, Benin, Cambodia, the Dominican Republic and Thailand, which have succeeded in reducing the incidence of the disease due to policies supporting condom use among sex workers.

All parties agree that there is a vital need to expand activities that focus on people most at risk of infection. Targeted interventions in the sex-worker industry would inhibit the disease becoming established in the wider population. Cambodia, with the highest adult HIV-prevalence of any Asian country, saw a decline in HIV/AIDS cases from 42 per cent in 1998 to 29 per cent in 2002, with the decline most pronounced among sex workers. This suggests that prevention efforts focused on them are yielding positive results, particularly among new entrants to the field under age 20 (almost three quarters engage in sex work for less than two years). Consistent condom use is the most important behavioural change, from 37 per cent in 1997 to 90 per cent in 2001.

The most vital element in successful HIV-prevention is the direct involvement of the affected community. In this case, by making sex workers responsible for the development and implementation of care and prevention programmes, their reliance on outsiders diminishes, solidarity is promoted, and they are able to reach more of their peers to share their knowledge on health matters. Experience in the field has already established that sex workers are among those most likely to respond positively to HIV-prevention programmes.

Governments, for the first time, are becoming aware of the need to scrutinize their policies towards sex workers. There is a general consensus that in addition to addressing factors that force men and women to take up sex work as a means of livelihood, their protection, access to HIV prevention and care, creation of legal frameworks that do not discriminate against them, empowerment programmes for young women and elimination of violence against women are all vital issues to be addressed.

Globally, 42 million people live with HIV/AIDS, of which 38.6 million are adults and 19.2 million women.

In 2002, some 3 million lives were lost to AIDS.

Only 4 per cent of HIV/AIDS patients receive antiretroviral treatment in low- and middle-income countries.

Fewer than 10 per cent of HIV/AIDS patients have access to palliative care or treatment for opportunistic infections.

Go Back Top