As deadline approaches for HIV control testing and treatment targets, sex workers still face “glaring gaps” between services and access

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Authors of 2014 recommendations to tackle HIV among sex workers revisit literature and find impacts of pandemic, structural drivers continue to be “under addressed and under-resourced”

When, in the months leading up to the 2014 International AIDS Conference in Melbourne, a team of researchers put together a series of articles examining the drivers and impacts  HIV among sex workers, they found that missing data on incidence, care, treatment, and prevention services and missing efforts to address structural obstacles that included discriminatory policies, attitudes and laws were stalling the progress that could be made, and that had been made across the broader pandemic. They concluded the series of articles with recommendations to fill those gaps, calling for expanded research, policy changes to address risks and barriers to services, and recognition that criminalization of sex work was fueling the pandemic not only among sex workers, but the pandemic as a whole.

Sex workers rights groups protest exclusion from international donor HIV response planning at AIDS 2018 in Amsterdam.

Little has changed since, a review of research and reports by the authors released in The Lancet today shows. Over the years that followed, the authors of the review note, prevalence of HIV among sex workers remains high, while treatment access remains low. And rather than more countries moving to decriminalize sex work — among the early moves widely credited for success against the epidemic in Amsterdam, the host of AIDS 2018 — the authors found an increasing trend to add to criminalization with laws penalizing clients as well. Those laws, the authors note, have been found to contribute to stigma and dangers facing sex workers. At the same time, they note, Amnesty International took an official stand supporting the decriminalization of sex work.

They cite some progress in research, with studies adding data on the feasibility of care, prevention and treatment models, as well as incidence, risks, and access. That data has expanded particularly, they note, in studies producing findings specific to transgender women. The most unequivocal progress, they write appears to be in launches of studies examining acceptability of PrEP — pre-exposure preventive use of antiretroviral medicines, and ways to ensure it is accessible to sex workers.

In addition, they note, in the time following the 2014 recommendations, the World Health Organization made its own recommendation — that  communities, including sex workers, facing the highest risks and greatest barriers to services, have access to PrEP.

Studies examining structural drivers of HIV risks among sex workers produced findings supporting their call for greater investment in addressing human rights issues, and supporting self-empowerment efforts among people selling sex for a living. Political attention and resources to addressing those barriers, however, continue to lag, they note. As a result, they write, the pandemic among sex workers “remains under-addressed and under-resourced, with glaring gaps in comprehensive measures of HIV prevalence, incidence, and ART coverage . . .” And they note, as long as sex workers remain driven by law into hiding, the data needed to comprehensively address the pandemic will remain out of reach.

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