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HIV and sex workers

  • Female sex workers are 30 times more likely to have HIV than the general female population.
  • Of all new HIV infections in 2021, 12% were among sex workers.
  • Around 33% of sex workers do not know their HIV status.

Sex workers are adults who have consensual sex in exchange for money or gifts, either regularly or occasionally.

They can be any gender, but data and services for sex workers often ignore male and transgender sex workers.

Sex work is criminalised in many countries which makes sex workers fearful of accessing HIV services.

Why are sex workers at higher risk of HIV?

It is hard to always use a condom

Many sex workers are fearful of going to clinics to get condoms in case their occupation is revealed. Others are scared to carry them in case the police arrest them claiming having condoms is proof of being a sex worker. For some, it can be difficult to negotiate condom use with clients who prefer condomless sex. This can be an attractive offer when a client offers more money or gifts if they don’t use a condom.

Sex workers have multiple partners

Unless a condom is used every time, having multiple partners increases the risk of exposure to HIV via unprotected sex.

Injecting drug use is more common

Injecting drugs is more common among sex workers than the general population. This adds another route of potential HIV transmission.

Sex workers experience more violence

Sex work is often stigmatised and viewed as morally wrong. This results in sex workers being subjected to higher levels of violence which increases their risk of HIV.

HIV services often don’t reach street-based sex workers

Street-based sex workers receive fewer HIV services than brothel-based sex workers. This is because it’s easier to provide services in a venue, rather than on the street.

Sex work is often criminalised

Sex work is often illegal, so sex workers have to provide their services underground where they are more likely to experience violence.

Sex workers often experience negative attitudes

Professional service people like healthcare workers, the police and other law enforcement agents are often discriminatory towards sex workers. This prevents sex workers from accessing HIV services and reporting crimes.

How can HIV services meet the needs of sex workers?

Involve sex workers

Involve sex workers in the design and delivery of HIV services. This way the service is more likely to meet the needs of sex workers.

Provide services where sex workers are

Don’t just provide services in established sex work venues such as brothels. If there is a popular place that sex workers use to find clients, go there to provide HIV services.

Remove negative attitudes

Provide sensitisation training for healthcare staff to help reduce judgmental, stigmatising and negative attitudes towards sex workers, so that they are more likely to come back again.

Make condoms available

Have condoms available at the same place that sex workers access other HIV services to make it easier for them to always have condoms to hand.

Provide PrEP and PEP

Many HIV infections could be avoided if sex workers could access PrEP (pre-exposure prophylaxis) before they are exposed to HIV, or PEP (post-exposure prophylaxis) after they are exposed to HIV.

Cater for different groups of sex workers

Not all sex workers are the same. They can be female, male or transgender, young or old, rich or poor. Think about each of their intersecting needs so that HIV services for sex workers are relevant.

What systemic changes could reduce sex workers’ risk of HIV?

Decriminalise sex work

Sex workers would be more likely to access HIV and police services if there wasn’t a constant threat of being criminalised. This would also protect sex workers from violence and abuse.

Stop police harassment

If police harassment stopped, sex workers would not have their condoms confiscated, they wouldn’t need to provide their services in underground places away from authorities and they would be able to report crimes.

End stigma and discrimination

Community beliefs and social norms that view sex work as wrong prevent sex workers from receiving the health services they need. Ending stigma would help reduce sex workers’ risk of HIV.

Recognise sex work as work

Sex work is work and needs to be recognised as such so that sex workers can receive workers’ rights such as health and social safety nets.

Make violence against sex workers illegal

No-one should experience violence because of the work they do. Laws that protect sex workers from violence would enable them to access health and police services.

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