A new series in the medical journal The Lancet says achieving an AIDS-free generation will not be possible unless the human rights of sex workers are recognized. Researchers say sex workers face violence and discrimination and are not able to access the care, treatment and prevention measures they need.
The Lancet articles say people who sell sex - whether in high or low income countries -- "face a disproportionate risk and burden of HIV." These include women, men and transgenders. Much of the problem, the authors said, has to do with "repressive and discriminatory law, policy and practice."
The series was presented at the 20th International AIDS Conference in Melbourne, Australia.
Linda-Gail Bekker is one of the authors. She's a professor of medicine and deputy director of the Desmond Tutu HIV Center at the University of Cape Town.
She said, "Sex is something that all of us need to do as human beings. We're designed this way. This is what we're about. And if this is the way HIV is transmitted then we need to just kind of face that -- and address that in such a way that people can continue to live their lives in ways that are sustainable, but we can protect them at the same time."
She said those in the profession prefer the term sex worker rather than prostitute.
"The community is wanting to think of themselves as doing regular work. And I think that's in an effort to be recognized as individuals, who have dignity and are making a living. And work towards decriminalization of the profession."
Professor Bekker said that sex workers are a marginalized community.
"There is huge stigma and discrimination that goes with that. And as a result people find themselves on the fringe of communities - on the fringe of humanity."
Their activities are driven underground. She said they often do not have access to condoms, lubricants, HIV testing and treatment for sexually transmitted diseases.
"As a result," she said, "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 police. The very people, Bekker said, who are supposed to protect. She says sex workers often face stigma and discrimination when they go to health clinics.
"What I say as a public health individual is that I'm not here to decide on what people should or shouldn't be doing. What I need to do is use the tools at my disposal to make sure that individuals are protected from viruses, particularly when I've got the tools to enable that," she said.
Those tools now include PrEP, pre-exposure prophylaxis, whereby antiretroviral drugs are taken to prevent initial HIV infection. Also, new microbicides, or vaginal gels, are being developed that contain HIV blocking drugs.
Bekker said that the old ABC approach is no longer good enough.
"I don't know what planet we were on when we thought this was going to be as simple as telling people to abstain. You know, hello. Be faithful or simply condomize. Now, condoms are great. But it's clear that that's a hard thing for people to do year in and year out."
She said a successful HIV prevention and treatment program must include community mobilization that has input from sexworkers. Such programs have been effective in Thailand and India. Professor Bekker said they should include peer education and voluntary counseling and testing.
The Lancet series calls prevention programs for sex workers an "urgent international priority... backed-up by appropriate levels of funding from international and national health programs."