Could legalising sex work stop HIV spread?

A study presented at the International Aids Conference in Australia claims that scrapping laws that ban sex work would almost halve the number of new HIV infections within next decade.

But given the study is based mainly on research in Asia, would it work in South Africa? News24 investigates.

Why focus on sex workers?

HIV is by no means limited to one section of society in South Africa. It runs rife across the country, affecting almost one in five people between the ages of 15-49, according to the World Health Organisation (WHO).

But the South African National Aids Council (Sanac) has identified that sex workers, their partners and their clients account for 20% of all new HIV infections.

For Sanac then, sex workers are an “important community” and are “crucial in our plans to combat the spread of HIV”.

Read: US to consider decriminalising prostitution 

Can’t we just promote condom use?

Condom promotion has helped reduce HIV incidence in sex workers and their clients by more than 70%, according to research by Professor Linda-Gail Bekker Professor Linda-Gail Bekker, principal investigator at the Desmond Tutu HIV Centre.

But with more than 400 000 new HIV infections occurring in 2012, South Africa still suffers acutely – and was ranked first for HIV incidences across the globe, a recent survey by the Human Sciences Research Council (HSRC) found.

Read: Sex workers should be part of the national HIV plan 

For many sex workers, condoms are not an option. Lesego Tlhwale from the Sex Workers Education and Advocacy Taskforce (Sweat) said that many workers do not carry them for fear of being prosecuted by the police. She said: “Police officers use condoms as evidence that you are a sex worker.”

Furthermore, as Lisa Vetten, gender researcher at the Wits Institute for Social and Economic Research, points out, women get paid more for having sex without a condom.

Watch: Methods that will help control HIV/AIDS 

So what does the study say?

Researchers reporting at the 20th International Aids Conference said of all the policy options – such as promoting condom use or changing policing practices – decriminalising sex work would be the most effective way of reducing the spread of HIV.

The study, published by The Lancet, estimates that up to 46% of HIV infections could be averted in the next decade. 

How do they know?

The researchers, led by Kate Shannon of the University of British Columbia in Vancouver, based their study on 204 published investigations. But most of these were conducted in Asia – with very few taking place in sub-Saharan Africa.

The researchers acknowledged they had blanks in their database and also admitted that depending on the location, other methods could be useful.

They said that in Kenya, for example, if infected sex workers were given access to virus-suppressing drugs, this would help to reduce new cases of HIV by more than a third over the next decade.

Read: HIV and sex workers - the situation

Is there any evidence that decriminalisation works?

Yes. In Brazil, sex work is officially recognised as an occupation, entitling sex workers to labour rights.

According to The Lancet, community empowerment among legalised sex workers has reduced the odds of HIV in Brazil by 32%.

Could it help in South Africa?

Marcus Low of the Treatment Action Campaign said that the transmission of HIV among sex workers and their clients can have a significant impact on the wider HIV epidemic.

He added: "There are no good reasons to think that this is not true in the South African context."

For Vetten, decriminalising sex work is a “long burning argument”. She said that we can’t assume that research done predominantly in Asia would achieve the same results here in South Africa.

She said the patterns of sex workers in Asia could be very different to those in South Africa. However, she admitted that “it is very interesting that this research supports the decriminalisation of it”.

Read: Criminalising gay relationships threatens the fight against HIV/AIDS 

How might it help?

Sex workers and their clients are criminals in the eyes of South African law – which drives the practice underground.

This leaves sex workers without police protection and therefore more vulnerable to violence.

As Sweat’s Tlhwale explains: “They can’t report anything to the police, as the police would arrest them first for being a sex worker. Their clients know this.”

It also means that sex workers have limited access to services that are readily available to the rest of society’s workforce: the law or to healthcare services for example.

By legalising sex work, the police would have to protect workers more. But workers could also protect themselves more – they would be more likely to get advice about safe sex, use condoms and gain access to drugs that suppress the Aids virus.

Read: The basic rights of people living with HIV/AIDS

Then it’s about worker’s rights?

For Tlhwale, above anything legalising sex work is about making sure the human rights of sex workers are recognised, helping to create safer working conditions.

Certainly, the Commission for Gender Equality (CGE) concluded last year that the current legal regime that criminalises sex work has failed sex workers and perpetuated substantive abuse of their Constitutional rights.

It said: “The CGE is of the firm view that sex workers in South Africa cannot be denied these rights, regardless of any moral or religious response to the practice of sex work in our society.”

Vetten agrees, putting it simply: “They deserve rights”.

“I would want to see a process that puts more power into the hands of the workers themselves,” she said, pointing out that the workers often do not receive the lion’s share of the profits.

But she also pointed out that if legalised, sex workers could provide key “on-the-ground” information from the streets that may help make our society safer – such as instances of child prostitution and trafficking.

“These will never, ever be legal,” she said. “Sex workers see a lot of what’s going on, they are a good source of information.”

Source: http://www.health24.com/Medical/HIV-AIDS/News/Could-legalising-sex-work-stop-HIV-spread-20140723