Police must play role in preventing HIV among criminalised groups

Delegates at the 20th International AIDS conference are tackling the issue of law enforcement policies and practices that often undermine the efforts of public health officials to reduce HIV transmission.

Delegates at the 20th International AIDS conference are tackling the issue of law enforcement policies and practices that often undermine the efforts of public health officials to reduce HIV transmission.

An estimated 4.9 million people now live with the virus in the Asia and the Pacific region, and criminalized groups including sex workers and people who use drugs account for the majority of new HIV cases in many countries.

Criminalization of sex work

Daisy Nakato Namakula is a sex worker from Uganda. She is also a founding member and executive director of the Women’s Organization Network for Human Rights Advocacy, which advocates for sex workers’ rights.

As an activist she speaks out strongly about abuse and violence against sex workers in Uganda. Speaking at the conference, she said: “Sex workers are facing a health and human rights crisis in Uganda, yet very little is being done to protect their rights. Criminalization of sex work leaves sex workers particularly vulnerable to sexual and physical abuse from law enforcement officials and the general public.”

Laws in Uganda criminalize both sex workers and other groups at high risk of HIV such as the lesbian, gay, bisexual and transgender community; and this is threatening progress in the global effort to fight AIDS. Namakula advocates for more comprehensive health care services for sex workers, including those that address rape, sexual violence, mental health, substance abuse, HIV, adolescent health, nutrition, antenatal care and allowing sex workers the protection and benefits of the law.

Human rights of sex workers

A new series ‘HIV and sex workers’ in the medical journal The Lancet, presented at the conference, says achieving an AIDS-free generation will not be possible unless the human rights of sex workers are recognized.

According to one of the authors, Linda-Gail Bekker, professor of medicine at the University of Cape Town: “Sex workers’ activities are driven underground, they often do not have access to condoms, lubricants, HIV testing and treatment for sexually transmitted diseases, as a result, they become incredibly at risk for HIV acquisition. This virus is a non-discriminator of human beings and it preys upon vulnerable individuals. Much of the violence sex workers face comes from the police, the very people who are supposed to protect citizens. Sex workers also face stigma and discrimination when they go to health clinics.”

The Lancet’s editor, Richard Horton, said: “It is unacceptable that none of the next generation of HIV prevention technologies and approaches have been specifically evaluated among sex workers. It is imperative to know what works, what sex workers want and will use and how to scale up interventions. These gaps and deficiencies should be promptly addressed.”

There are tools now that can protect sex workers from the virus which include PrEP (pre-exposure prophylaxis) where antiretroviral drugs are taken to prevent initial HIV infection, as well as new microbicides and vaginal gels in development which contain HIV blocking drugs.

Professor Chris Beyrer, director of the Johns Hopkins Centre for Public Health and Human Rights, who coordinated the series, noted: “Efforts to improve HIV prevention and treatment by and for people who sell sex can no longer be seen as peripheral to the achievement of universal access to HIV services and to eventual control of the pandemic.”

Diversity of sex workers

The diversity of sex workers also needs to be recognized say the authors. The settings in which female sex workers operate can vary enormously, the series also looks at the issues facing male and transgender sex workers.

While they face many of the same vulnerabilities and risks as female sex workers, such as violence or inadequate access to healthcare, they also have unique characteristics that need to be understood by those implementing HIV prevention strategies.

A lack of quality HIV research specifically addressing male and transgender sex workers means there are substantial gaps in understanding how the HIV epidemic affects them, and they remain underserved by the global health community.

Sex work and police

An Open Society Foundations report ‘To protect and serve’ indicates that, in a growing number of countries from Kyrgyzstan to Kenya, police are working with sex workers and drug users to reduce HIV infections and to end harmful law enforcement practices that drive people away from life-saving health services, for example treating condoms or clean needles as evidence of criminality, and harassment or arrest outside of health clinics.

Emerging partnerships between police, health experts, and community groups are beginning to prove that law enforcement and HIV prevention programmes can work together to save lives while reducing crime.

With HIV rates across Asia, Central Asia, Eastern Europe, and Africa rising among sex workers and people who use drugs, it is imperative that police recognize the critical role they can play in preventing the transmission of HIV among these criminalized groups.

Read more about HIV and human rights