Want to change the course of HIV epidemics? Decriminalizing sex work could have greatest impact, researchers say

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Infections could be averted through combined impacts on violence, police harrassment, workplace dangers, as well as improved condom access, peer outreach, modelling indicates

Of the different factors that can increase the likelihood of a person who is involved in sex work getting infected with HIV, the least examined type have been those stemming from the broader society, authors of an article published in The Lancet this week say. The article, about a review of published data on factors influencing HIV transmission risks among sex workers, and a modelling exercise based on that data, indicates that gap represents missed opportunities.

While biomedical interventions, including earlier availability of antiretroviral treatment for infected individuals, and programs promoting consistent condom use, have been shown to modestly lower transmission rates on their own, the authors note that laws, policies, social inequities, and economic conditions keep the promise of those measures being realized. The article, first published online as part of The Lancet’s series on HIV and sex workers that was launched  at the 2014 International AIDS Conference, also notes that those factors, defined in the series as structural determinants, foster violence, feed poverty, add to stigma, and increase the marginalization of already vulnerable individuals. Of the measures they considered, decriminalizing sex work could have the greatest effect on lowering HIV incidence, they conclude.

Among the effects they examined were those stemming from restrictions and elimination of work places, arrests, stigma, and the impacts of those on homelessness and poverty, and access to health care. All decrease the odds of condom use, and increase risks of transmission, they note.

The article,  Global epidemiology of HIV among female sex workers: influence of structural determinants, was originally published online in July, a couple of months after U.S. Reps. Randy Hultgren (R -Ill) and Chris Smith (R- NJ) introduced a bill that would increase pressures on foreign governments to criminalize sex work, and a couple of months before the bill was sent to the Subcommittee on Africa, Global Health, Global Human Rights and International Organizations, where it died.

The article is accompanied by a look at combined measures to prevent HIV transmission to sex workers. The issue also includes two commentaries from the series, Bringing sex workers to the centre of the HIV response, and Dispelling myths about sex workers and HIV, as well as a report on sex work in sub-Saharan Africa, a topic authors of the review noted, that has been neglected.

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