Criminalisation increases vulnerability to HIV by fuelling stigma and discrimination, and limits access to sexual health services and condoms.
Sex Work and the Law is a new study that examines the laws and policies across 48 countries in Asia-Pacific that affect the rights of sex workers and the impact these policies have on access to HIV treatment and other health services.
The report is a joint-effort, issued by the United Nations Development Programme, the UN Population Fund and the Joint UN Programme on HIV/AIDS.
Interviewer: Liam Cochrane
Speaker: Julia Cabassi, Regional HIV Adviser, United Nations Population Fund.
CABASSI: Well, we looked extensively at the laws on the books, but one of the important things is understanding how the laws are applied on the streets. So as part of this process we did an extensive desk review, but also conducted both in-country and regional consultations with legal experts, with sex workers and with governments, really trying to understand how these laws are applied on the ground.
COCHRANE: So tell us a bit about the laws? Obviously it varies from country to country, but what are some of the laws and practices that have some positive outcomes?
CABASSI: Look I think that's what's important about the report Liam, it certainly does demonstrate that there are lots of challenges in terms of the extent of criminalisation of sex work, but there's also some very good examples of the way governments are taking forward laws and policies that actually support an effective HIV response. One of the big challenges the report found that there were 11 countries where sex workers report condoms are confiscated or there's been police harassment for possessing condoms. Now clearly this is a very direct impediment to effective programming, because on the one hand you've got governments supporting HIV responses, and on the other, cracking down on those responses by not enabling people to carry condoms. But what we've seen is there are a number of countries that are issuing directives to police that condoms are not to be used as evidence for arrest, and we see that in Cambodia and Myanmar. But perhaps more progressively, more effectively is countries that have decriminalised sex work. And we found that that's been very effective, removing criminal penalties in New Zealand and also in the state of New South Wales in Australia, has really demonstrated that implementing workplace health and safety standards and seeing this as a health issue has been much more effective in ensuring access to HIV and health services for sex workers and the carrying and use of condoms.
COCHRANE: Now that might work in places like New Zealand where there is quite a sophisticated workplace health and safety kind of background and practice, but what about in developing countries in Asia where there might not be that culture and legal framework? Would decriminalising sex work have the same positive effect?
CABASSI: Look I think it's perfectly possible to implement. In fact what we've seen from examples in the region of 100 per cent condom programming that's been particularly lauded as a success in Thailand, is that they've taken an approach that tries to create an enabling environment in the sex industry for sex workers to negotiate condom use, making it a norm in the industry. I think one of the challenges has been that in implementing that program in various guises in a number of countries, including Cambodia, China, Indonesia, Myanmar among others, that when that environment becomes coercive, when you're essentially trying to push, impose the sanctions for the non-compliant, you're not really achieving the outcomes and you've still got sex workers being fearful of being able to carry condoms and use them. So I think the lesson there is that 100 per cent condom programming properly implemented, really looking at a review from a health perspective where you have health authorities looking at the effectiveness of occupational health and safety standards, so there is actually an environment in some countries where they've tried this and what we need to do is involve health authorities in reviewing the occupational health and safety standards in the industry.
COCHRANE: I guess one of the arguments that's raised against the decriminalisation of sex work in a general sense is the notion that if it were legal there would be more sex workers and more prostitution. Is there any evidence to say whether that's the case?
CABASSI: No actually, what's interesting is in both New Zealand and New South Wales where sex work has been decriminalised, they've actually found that there's no evidence that decriminalisation leads to an increase in the number of sex workers. In New Zealand the sex work industry was decriminalised in 2003, and five years later they conducted a parliamentary review and specifically found that decriminalisation didn't lead to an increase in the number of sex workers, and that it did improve the working conditions and abilities to negotiate safer sex in the sex industry. I think it also shows that you can reduce the opportunities for police corruption, and that that's really key in ensuring an industry, focussing on an industry where we can ensure health and safety standards.
COCHRANE: That's an interesting point to raise because it is very often part of the picture across Asia. Were you able to get into any sort of detail about the interplay between the sex industries in various countries and the police?
CABASSI: That's absolutely key, and I think what's interesting in the report is really looking at that police harassment, and sex workers' fears of arrest are actually often driving their inability to reach services and to be prepared to test for HIV. And this obviously reduces their ability to understand their health status, to know whether they're positive, to look after their own health, have access to treatment, and also to prevent infection to others. So for example we know that there are low levels of testing rates in countries such as Vietnam, 48 per cent, China, 34 per cent, even in Thailand among venue based workers
COCHRANE: These are rates specifically amongst sex workers are they?
CABASSI: These are the rates of sex workers who have been tested in the last 12 months and know their status. And that's not so much an issue of whether or not testing is available, it's actually whether or not sex workers have the confidence to test, and this means providing non-stigmatising testing services and ensuring there's confidentiality in those testing services.
COCHRANE: We've been talking mostly from a legal point of view, but you mentioned the issue of stigma, I mean are there some practical things that will have some sort of fairly short term benefit? Is there policy changes that can be made to try and reduce the stigma for sex workers doing things like carrying condoms or getting STI tests?
CABASSI: Yes absolutely. I think one of the key lessons in the region is that as governments have become more aware of the value of sex workers peers being able to reach each other with information on referrals, access to condoms, there's a lot more confidence to access services. And one particular example, there's a program in China where there's been a really important relationship brokered between the community-based organisation Dark Blue, and the provincial health authority CDC. And the health authority recognises the comparative advantage that the community can reach hidden and marginalised populations of sex workers with information, with condoms, and ensure their access to services. And in fact they provide, the community based organisation provides access to rapid testing, but the CDC provides access to rapid testing kits. So there's a recognition that if we want to take a public health approach, governments and communities working in partnership to ensure we're reaching populations, and ensure that we're creating an environment in health services where sex workers are confident to go and access services. And there are multiple examples across the region where community based organisations of sex workers have been instrumental in ensuring access to non-discriminatory health services, both by providing them, but working in partnership with government and NGO health service providers to make sure that those services are sex worker friendly.