MELBOURNE, AUSTRALIA – A remarkable and unprecedented collaboration between scientists and community leaders, the special issue of The Lancet on HIV and sex workers was launched at a symposium in Melbourne on Tuesday. The effort marks the first Lancet special issue that has included a community person as a guest editor and each of the papers in the issue has a sex worker as a co-author. The Lancet’s Richard Horton, who moderated the session began with acknowledging that “even at this conference individuals from this community have been prevented from leaving their own countries to attend.”
The symposium included six presentations highlighting the major papers in the issue: Global Epidemiology of HIV among female sex workers, Combination prevention for female sex workers, A community empowerment approach to the HIV response among sex workers, Human rights violations against sex workers, Male sex workers, HIV risk and preventive interventions in transgender women sex workers, and An action agenda for HIV and sex workers.
Common themes echoed across all the presentations. The research base on sex work and HIV risk is inadequate especially for male sex workers and transgender women. Major gaps in the research literature hinder responses in countries with the highest HIV burdens—in Africa, across Russia and in Eastern Europe. Structural interventions are critical to reduce HIV risk in this group. Decriminalization of sex work has the strongest impact on reducing HIV risk in both generalized and concentrated epidemics. Violence is pervasive in the lives of sex workers and at least half of the violence is promulgated by law enforcement actors. Community empowerment and supportive work environments reduce HIV risk for sex workers. Community empowerment is not an intervention but an approach that coordinates interventions and services within a human rights framework. Sex work and sex trafficking are distinct, and their conflation hampers community empowerment. Evidence-based interventions and community empowerment would be cost-effective or cost-saving, would benefit the general population and must be brought to scale.
The issue was funded by the Center for Public Health and Human Rights at Johns Hopkins Bloomberg School of Public Health, The Bill & Melinda Gates Foundation, the United Nations Population Fund, and Johns Hopkins University Center for AIDS Research, a National Institutes of Health funded program.