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Sex Work, Health, and Human Rights: Global Inequities, Challenges, And Shira M. Goldenberg Ruth Morgan Thomas Anna Forbes Stefan Baral Editors Sex Work, Health, and Human Rights Global Inequities, Challenges, and Opportunities for Action Sex Work, Health, and Human Rights Shira M. Goldenberg Ruth Morgan Thomas • Anna Forbes Stefan Baral Editors Sex Work, Health, and Human Rights Global Inequities, Challenges, and Opportunities for Action Editors Shira M. Goldenberg Ruth Morgan Thomas Faculty of Health Sciences, Simon Fraser The Matrix University, Burnaby, BC, Canada Global Network of Sex Work Projects Edinburgh, UK Centre for Gender and Sexual Health Equity Vancouver, BC, Canada Stefan Baral Center for Public Health and Human Rights Anna Forbes Department of Epidemiology Independent Consultant Johns Hopkins University Kensington, MD, USA Baltimore, MD, USA This book is an open access publication. ISBN 978-3-030-64170-2 ISBN 978-3-030-64171-9 (eBook) https://doi.org/10.1007/978-3-030-64171-9 © The Editor(s) (if applicable) and The Author(s) 2021 Open Access This book is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this book are included in the book's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the book's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifc statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affliations. Cover image: Rows of opened red umbrellas. © jvphoto / Alamy Stock Photo This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland This book is dedicated to the global sex workers’ rights movement which has and continues to demonstrate incredible resilience in their tireless advocacy for sex workers’ human rights, dignity, well-being, and safety. Preface Sex workers comprise a diverse population which includes women, men, transgen- der, and gender-diverse individuals; people living with HIV, people who use drugs, people who have experienced incarceration, documented and undocumented migrants, and indigenous people and others. Sex work takes place across a wide range of different work environments (e.g. brothels, entertainment venues, indoor and outdoor public and private spaces, and online). Sex work happens across many different socio-cultural, legal, policy, and human rights contexts. Globally, sex workers continue to face unacceptable health and human rights inequities, including an elevated burden of violence, HIV and sexually transmitted infections, unmet sexual and reproductive health needs, and gaps in appropriate primary and mental health care. In stark contrast to popular misconceptions, sex workers also exert agency in their work and labour mobilisation efforts—including through powerful community empowerment initiatives advocating for decriminalisation of sex work, improved working conditions, and protection from violence and discrimination. Whereas the vast majority of research on sex workers’ health needs has focused on biomedical and behavioural approaches to HIV and STI prevention and treat- ment, the broader health and labour needs of sex workers remain much less well understood. Research clearly shows the need to move beyond individualistic approaches to sex workers’ health to address the crucial infuence of structural fac- tors. These include punitive and criminalised legal and policy environments; stigma and discrimination; migration and mobility patterns; disproportionate experiences of violence; and unsafe labour conditions. For example, criminalisation of sex work in various forms remains widespread across most global settings and is linked to negative outcomes including HIV and STI transmission, and increased rates of vio- lence and mortality among sex workers. Public discourse and policy in many coun- tries tend to lean toward outcomes that punish sex workers and their clients further. This response drives sex workers underground, where unmet health needs and unsafe working conditions are worsened rather than improved. This edited volume documents an important body of research across diverse global contexts affrming the salience of these structural factors in shaping sex workers’ health and labour outcomes, indicating that interventions with a corresponding emphasis on vii viii Preface ameliorating these structural inequities are needed to produce meaningful and sus- tainable improvements. To inform effective actions to advance the health and rights of sex workers, this edited volume aims to provide a comprehensive overview of health and social ineq- uities faced by sex workers globally; articulate structural determinants of sex work- ers’ health and occupational outcomes (e.g. legislation, migration, healthcare delivery settings); and describe evidence-based interventions and ‘best practices’, including the roles of the full decriminalisation of sex work, community empower- ment models, and multi-level and integrated intervention approaches. This book documents the importance of supporting sex workers and their organisations in pro- moting, defning, and demanding fulflment their own health and occupational needs. To overcome barriers posed by stigma, criminalisation, and other structural factors, sex workers in numerous countries are adopting ‘community empower- ment’ approaches to advocate for their human rights, including their right to non- judgmental health care and security of the person. Designed by and for sex workers over the last three decades, community empowerment is a framework to guide sex workers in diverse settings to move toward collective advocacy for their rights, including rights-based health care and recognition of their human and labour rights. This book reviews the progress, challenges, and the diverse issues raised by imple- menting this approach. Evidence Gaps and Opportunities Addressed by this Edited Volume This edited volume draws upon both academic and community perspectives to syn- thesise research evidence as well as lessons learned from regional and local-level experiences across different global settings. A rich body of information has docu- mented the needs of sex workers and ‘best practices’ for reducing them, from both academic and community perspectives over the past few decades, including struc- tural, behavioural, and biomedical interventions. This edited volume strives to bring together these understandings to catalyse action and inform future research, policy, and programming. Now, perhaps more than ever, is a time where we need to step up to close the gap in sex workers’ health and human rights. The current COVID-19 pandemic has exacerbated these longstanding inequities, magnifying the already-precarious con- ditions in which sex workers work and live. Since the pandemic began, sex workers across diverse regions of the world have been facing severe hardship and injustice, including a loss of income; increased crackdowns by the state, including raids, dis- placement, and other forms of police harassment and brutality; and increased stigma and discrimination [1, 2]. Sex workers are often unable to access government ben- efts and supports afforded to other types of workers, such as emergency and ongo- ing fnancial employment-related support, particularly in settings where sex work is Preface ix criminalised. These barriers are further amplifed for migrant workers, who also face barriers to social protections due to gaps in eligibility for foreigners as well as fear that disclosure of engagement in sex work could result in negative conse- quences when it comes to immigration. For example, in an April 2020 survey con- ducted by the Butterfy sex work project in Toronto, Canada, 40% of migrant sex workers said they were either not eligible to apply for emergency employment ben- efts during COVID-19 because of undocumented work status or were afraid to apply because of criminalised or undocumented work and immigration status; yet most reported that they required support for income (71%), food and health support (40%), rent (31%), or the operation of a small business (27%) [3]. These and similar reports from other contexts worldwide indicate the critical importance of enacting policy changes to ensure that sex workers as equal members of society are afforded access to social protection schemes, along with rights-affrming health care
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