Recognized as “key” and “most at risk,” populations to reach in responses to HIV globally, people who inject drugs and people who earn income through sex work face double the risks and double the barriers to support, protection and health services when their categories overlap. Their risks and challenges triple if they also are sexual minorities, and quadruple if they also have HIV. Yet, a report released jointly by the Global Network of Sex Work Projects and the International Network of People Who Use Drugs notes, the needs of those populations continue to be addressed in isolation, in efforts of limited scope, and without the input of the populations themselves. In fact, the report argues, the most pervasive responses to both sex work and injecting drug use continue to be punitive ones that further intensify harms.
The report, Sex Workers Who Use Drugs, Experiences, perspectives, needs and rights: ensuring a joint approach, describes the forms and impact of criminalization, discrimination, stigma and stereotypes surrounding sex work and injecting drug use, how they overlap, and how they limit effective responses. It begins with views of sex work and injecting drug use as behaviors that require rescue and pose inherent danger to others. As a result, effective interventions — to provide support to sex workers, sterile syringes and opioid substitutes to people who inject drugs — are frequently perceived by policy makers as encouraging behaviors that should instead be stopped, limiting support for harm reduction responses, the report notes. Yet, the report also notes that individuals’ measures to improve the safety of selling sex or injecting drugs are challenged when possession of condoms or injecting equipment can serve as grounds for arrest.
In addition, responses to health needs of people who inject drugs and who engage in sex work are often limited in scope and focus on HIV, when barriers to health services encompass those for a broader range of illnesses and risks.
The report also offers examples of groups and programs seeking to fill the gaps. They include “High Ladies,” an organization supporting service provision and advocacy for sex workers who use drugs launched by KESWAS — Kenya Sex Work Alliance.