Sunday, July 11, 2010

HIV Industry Withholding Vital Evidence

Some former sex workers in Uganda have set up an organization to represent sex workers , called the Women's Organization Network for Human Rights Advocacy (WONETHA). WONETHA believes that women who are involved in sex work should be supported as sex workers, rather than persuaded to change occupation. Trying to persuade sex workers to find another way of making money may be well intentioned (though it probably isn't). But in addition to not bothering to ask sex workers what they would like, such attempts fail to take into account the economic realities.

If you take a large number of women off the streets and give them other jobs, several things happen. Other women move into sex work, probably attracted by the higher price that sex work receives because there are fewer doing the work. Also, wages in the more conventional job market go down, as a result of more people looking for jobs and employers being able to pay even less than before. There are already lots of people doing some kind of subsistence or low paid work. It's often because they are so badly paid that they get into sex work in the first place.

People here have assured me that it is always possible to get a job or find some way of making money, that it is not necessary to resort to sex work. They don't seem to see that it is the fact that some people are not competing with them for these other jobs that makes it possible for them to find such work. Many other people, too, benefit from sex work, directly and indirectly. Police, security people in bars, clubs and hotels who get money from sex workers to allow them to do their work, other people who 'protect' sex workers or just bribe them, bar, club and hotel owners and various others.

Sex workers very often do look for alternative work, sooner or later. Many that I have spoken to have tried to work in the hospitality industry, to make money buying and selling things or by providing various services. But they often return to sex work, if they are not too old to do so, because there are already too many people trying to make money in these ways. The best thing civil society can do for sex workers is to advocate for better conditions for them, the protection of the law, access to safe medical services and full recognition of their human rights.

The motivation behind some of the efforts to persuade sex workers to give up sex work is the HIV epidemic, to which commercial sex work was said to have contributed greatly. Perhaps it did, though this is not clear. The most recent Modes of Transmission Survey for Uganda finds that sex workers, their clients and the partners of their clients contributed around 10% of new infections in 2008. Compared to this, over 40% of infections were from people in monogamous relationships. In other words, it is safe sex that is giving rise to a lot of HIV transmission, not unsafe sex.

The greatest contribution to HIV prevalence is said to come from people engaging in multiple partnerships and their partners. However, the percentage of people engaging in multiple partnerships is no higher in Uganda than it is in many Western countries and it is lower than in some. Very high rates of HIV transmission in Uganda are not explained by sexual behavior when the same behavior only results in very low transmission rates in other, more developed countries.

In the mid eighties, HIV prevalence among sex workers in Nairobi was found to be 81%. However, HIV rates, along with rates for other sexually transmitted infections (STI), began to fall over the next few years and continued to fall thereafter. And this happened in the absence of any HIV prevention programs. Whether earlier STI prevention vaccination programs had spread HIV among sex workers is debatable but such high rates among sex workers are unusual. In some countries, sex workers are unlikely to be HIV positive unless they are also intravenous drug users. So there is still a problem explaining why HIV rates are so much hither in developing countries than in developed countries.

Sex workers may face high risk of being infected with HIV and other STIs through their work. But they also face other risks that are much easier to avoid than sexual risks. For example, sex workers (and others) often use injectible contraceptives. They also regularly visit clinics for checkups and vaccinations against various STIs. If any of these clinics are reusing needles, syringes or any other equipment, a lot of infections could be transmitted by such unsafe practices. The Modes of Transmission Survey finds that 0.06% of HIV infections are transmitted in this way. But this figure is questionable in a country that has ongoing shortages of medicines, contraceptives, equipment, trained personnel and clinics.

Non-sexual HIV risks could be avoided but no one is going to avoid them if they don't know they exist. Sex workers are constantly being told about the risks they face through unsafe sex. But they are never told about the risks they face in clinics. Yet, they are being sent to these clinics in ever growing numbers. Sex workers have a right to know that HIV is not just transmitted sexually. Telling them about condoms and unsafe practices will not help them avoid non-sexual risks. And people who are not sex workers also need to know about non-sexual risks. They are quite mistaken in their belief that sex workers play a big part in transmitting HIV.

The most disgusting thing about the belief that HIV is almost always transmitted sexually in African countries is that it emanates from the HIV industry, which goes on about reducing stigma. There is no better way to promote stigma than to label people as 'most at risk', especially when they are known not to be most at risk. The HIV industry is well aware that unsafe medical practices can be far more efficient transmitters of HIV than unsafe sexual practices. And while they warn their own employees about these risks when they are visiting developing countries, they tell people who have to live in those countries that they needn't worry about injection safety or anything else that may result in exposure to contaminated blood.

Much of the stigma that sex workers and HIV positive people face is manufactured by the HIV industry, who know that non-sexual HIV transmission plays a part in the epidemic. They just don't want to admit that this phenomenon exists or to carry out any research that could reveal the exact contribution it makes to HIV epidemics in developing countries. Sex workers, HIV positive people, HIV negative people in developing countries and anyone concerned about human rights should be advocating for the right to know about something that represents such a huge threat to people's health and welfare. Until people know, they will not be able to protect themselves.


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