Sex Work, HIV/AIDS, and Human Rights in Central and Eastern Europe and Central Asia

A report from the Central and Eastern European Harm Reduction Network, July 2005
Download the document in PDF format русская версия, English version.

From FOREWORD
In Central and Eastern Europe and Central Asia, for example, sex workers remain among the most marginalized members of society. Policymakers and authorities view them as nuisances to be ignored or immoral lawbreakers rather than as individuals who can and should be protected from violence and receive social and economic assistance and support. At the same time, the surging HIV/AIDS epidemic in the region places sex workers at increasingly greater risk of infection not only from HIV, but also from other potentially debilitating conditions related to sex work and drug use.
This report provides an overview of these and other important issues that sex workers face in the region as well as to the political, economic, and social factors that influence policies and attitudes toward sex workers. It focuses primarily on existing laws and policies and their consequences from the perspective of HIV prevention and treatment. The report also offers recommendations designed to uphold sex workers’ human rights and remove barriers that reduce their ability or willingness to obtain access to consistent and equitable health care and other social services.

Table of Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Executive summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
1.1 Background to the report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
1.2 Report structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
1.3 Methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
1.4 Structural and analytical limitations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
2. Sex Work and Associated Risk Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
2.1 Extent of sex work in CEE/CA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
2.2 Structure of sex work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
2.3 Demographic data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
2.4 Categories of sexual partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
2.5 HIV cases in the region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
2.6 STI cases in the region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
2.7 HIV infections associated with sex work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
2.8 Prevalence of HIV and STIs among sex workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
2.9 Sex work and injecting drug use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
2.10 Injecting risk behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
2.11 Sex work and condom use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
2.12 Internal and external migration in the context of sex work. . . . . . . . . . . . . . . . . . . . . .29
3. Legal Regulations of Sex Work and the Human Rights of Sex Workers . . . . . . . . . . . .31
3.1 International treaties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
3.2 National regulations of commercial sex work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
3.3 Human rights of sex workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
4. HIV/STI and Harm Reduction Interventions among Sex Workers . . . . . . . . . . . . . . . .53
4.1 Guidelines on service provision to sex workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
4.2 Brief history of harm reduction for sex workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
4.3 Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
4.4 Target groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
4.5 Service coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
4.6 Project services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
4.7 Advocacy and policy efforts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
4.8 Self-organizing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
5. Conclusions and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
5.1 Recommendations for policymakers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
5.2 Recommendations for health authorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
5.3 Recommendations for law-enforcement authorities . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
5.4 Recommendations for service providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75
5.5 Recommendations for external donors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76
5.6 Recommendations for researchers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77
6. References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
7. Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Table 1: New HIV infections in CEE/CA, 1997-2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Table 2: Syphilis diagnoses per 100,000 in CEE/CA, 1994 to 2003. . . . . . . . . . . . . . . . . . .88
Table 3: HIV prevalence among sex workers from routine testing. . . . . . . . . . . . . . . . . . . .89
Table 4: HIV prevalence in samples of sex workers and drug injecting sex workers . . . . .90
Table 5: STI prevalence in samples of sex workers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
Table 6: Project data: HIV/STI/HCV prevalence among sex workers
and drug injecting sex workers in CEE/CA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93
Table 7: Estimates of sex workers and overall population working
in selected CEE/CA cities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95
Table 8: Project data: Estimates of sex workers, drug use and type of drugs used
among sex workers attending harm reduction programs in CEE/CA . . . . . . . . . . .96
Table 9: Project data: Reported sexual risk behaviors and demographic
characteristics of sex workers attending harm reduction programs in CEE/CA. .100
Table 10: Legal regulation of sex work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103
Table 11: Estimated service coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116
Table 12: Project data: Services provided to sex workers, clients of the programs . . . . .117

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Quotes of the Month

“If you are independent, you are at the mercy of the police − they impose administrative fines on you or force you to have sex with them.”