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SEX WORKERS AS SAFE SEX ADVOCATES: SEX WORKERS PROTECT BOTH THEMSELVES and the WIDER COMMUNITY from HIV Julie Bates and Rigmor Berg

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SEX WORKERS AS SAFE SEX ADVOCATES: SEX WORKERS PROTECT BOTH THEMSELVES and the WIDER COMMUNITY from HIV Julie Bates and Rigmor Berg AIDS Education and Prevention, 26(3), 191–201, 2014 © 2014 The Guilford Press BATES AND BERG SEX WORKERS AS SAFE SEX ADVOCATES SEX WORKERS AS SAFE SEX ADVOCATES: SEX WORKERS PROTECT BOTH THEMSELVES AND THE WIDER COMMUNITY FROM HIV Julie Bates and Rigmor Berg Since the advent of HIV, significant changes have made the Australian sex industry one of the safest in the world. Creating this safety has been in large part due to the ability of sex workers to act as safe sex advocates through peer-based health promotion; to negotiate with sex business owners; and to inform and participate in the development of government policy. Empower- ment of sex workers through legislative reform and government funding of sex worker organizations has been central to the prevention of HV trans- mission, as has been the development of genuine partnership between sex worker organizations, government departments and those working in pub- lic health. The paper describes these responses in some detail and explores some of the current issues facing sex workers in Australia. In Australia today, HIV and other sexually transmissible infection (STI) rates among sex workers are very low, with no recorded cases of transmission from sex worker to client or vice versa and condom use approaching 100% (Donovan et al., 2012). However, when HIV arrived in Australia in the early 1980s, there was potential for the virus to spread rapidly throughout the sex industry and beyond, because condom use was the exception rather than the rule and STI rates among Australian sex work- ers were comparable to those found in the developing world (Donovan & Harcourt, 1996). It was largely due to the efforts of sex workers themselves that the potential for the rapid spread of HIV throughout the general community was not realized. Their early efforts were supported by health and allied professionals and then by national and state funding for sex worker representative organizations (Donovan & Harcourt, 1996; Mulhall, Hart, & Harcourt, 1995). Collective action was and remains central to this successful response. Australian responses to HIV have generally been pragmatic and bi-partisan, enabling multi-sectoral partnerships involving governments, clinicians, social and Julie Bates was a foundation member of the Australian Prostitutes Collective, served on the Australian National Advisory Committee on AIDS and is now Principal of Urban Realists, providing planning and occupational health and safety advice to the sex industry. Rigmor Berg is Principal of BB Professional Services, providing HIV-related social research, evaluation, and strategic planning consultancy and social impacts expert evidence. Address correspondence to Julie Bates, P.O. Box 559, Darlinghurst, NSW 2010, Australia. E-mail: julie@ urbanrealists.com.au 191 192 SEX WORKERS AS SAFE SEX ADVOCATES epidemiological researchers, and the communities most affected by HIV (gay men, people who inject drugs, and sex workers). Australia had free and confidential sex- ual health testing and treatment services in place and the adoption of the health promotion approach outlined by the Ottawa Charter (World Health Organization and Welfare Canada, Canadian Public Health, Association, 1986), which recognizes that prevention requires cooperation and empowerment of affected communities, allowed innovative and effective responses to begin early. The Sixth National HIV Strategy 2010–2013 (Commonwealth of Australia, 2010) acknowledges that com- munities affected by HIV are best placed to address HIV risk through funded com- munity organizations that develop and deliver their own styles of health promotion. While HIV prevalence is low in this population, sex workers remain a priority population under the Australian Government HIV/AIDS Strategy (Commonwealth of Australia, 2010) because of the risk of HIV transmission associated with large numbers of sexual partners and the high turnover of sex workers (Donovan et al., 2012). HIV transmission risk is also a function of structural impediments to safe working environments. Although the Australian Government’s aim is to ensure that legislation, police practices, and models of regulatory oversight create supportive en- vironments for HIV prevention and health promotion, risk remains where sex work- ers are isolated from health services and from their peers (Berg, Bates, & Harcourt, 2011; Donovan et al., 2012). Key to ensuring continuing safety in the sex industry is decriminalization of all aspects of adult sex work, with recognition that sex work is legitimate and valued work and that sex workers must be afforded the same human and industrial rights that other workers take for granted. ORIGINS OF THE SEX WORKER RIGHTS MOVEMENT The Sex Worker Rights Movement grew in tandem with the Women’s Rights Move- ment. On June 2, 1975, International Women’s Year, several hundred French sex workers took over St. Nizier’s Church in Lyon, protesting the social and legal ineq- uities sex workers faced, particularly police harassment and inappropriate responses to crimes committed against them, demanding that sex work be recognized as a job like any other. Strikes and sit-ins in Paris and elsewhere followed (Mathieu, 2001). This date is celebrated globally by sex workers as the beginning of the modern Sex Worker Rights Movement (McNeill, 2012). Similar actions led to the establishment of international networks of support (Kempadoo, 2003). The International Committee for Prostitutes Rights (ICPR) conducted two World Whores’ Congresses held respectively in Amsterdam in 1985 and Brussels in 1986 and created the World Charter for Prostitutes Rights in 1986 (Pheterson, 1989). This was followed by the global Network of Sex Work Projects (NSWP),1 which formed in 1991 to promote sex workers’ health and human rights through member organizations in more than 40 countries. The Asia-Pacific Network of Sex Workers (APNSW)2 formed in 1994 to facilitate information sharing on tech- 1. See www.nswp.org 2. See www.apnsw.org BATES AND BERG 193 nical and policy issues and advocacy and to build leadership among sex workers regionally. Sex workers from Australia, Thailand, and the USA were involved in high level meetings and consultations with the WHO Global Program on AIDS from the be- ginning, and strategies and guidelines for the prevention of HIV in sex industries around the world were developed with input from sex workers. PEER-LED SEX WORKER ORGANIZATIONS IN AUSTRALIA Sex worker organizing in Australia began in the late 1970s. Groups such as the Pros- titutes Action Group of Victoria, the Australian Prostitutes Collective New South Wales (APCNSW), and the Scarlet Alliance in South Australia, were formed to act as advocates for sex workers on a range of personal, health, industrial and legal concerns (Bates & Sebastian, 1989). From the early 1980s, recognizing the potential of HIV to devastate sex workers’ lives and livelihoods, these groups formalized their organizations, some with name changes, and new groups emerged in all states and territories. In 1986, the APCNSW became the first group to receive government funding (Donovan & Harcourt, 1996), soon followed by the Prostitutes Collective of Victo- ria and the Prostitutes Association of South Australia. Funding enabled sex worker groups to elect governing bodies, employ staff, develop programs, and formalize their peer education approaches based on the tradition of experienced sex work- ers teaching newcomers (Mawulisa, 2002). Because the education programs offered were based on accurate understanding of worker-client and worker-management relationships, were relevant to the lived experiences and concerns of sex workers and were accepted and trusted by sex workers, peer-led programs succeeded in improv- ing working conditions, educating clients, and promoting safe sex practices. These initiatives encouraged sex workers to share skills in the practical application of safe sex principles and built professionalism, pride, and greater assertiveness among sex workers. Sex worker organizations were able to persuade brothel owners that, if they wanted their businesses to survive in the new context of HIV, they must adopt safe sex policies and promote the health of their workers. Furthermore, the setting of boundaries between sex workers and their clients as well as brothel owners resulted, not only in the development of a safe sex culture, but also better attitudes towards sex workers (Mawulisa, 2002). Tracking the new safe sex culture emerging in the sex industry, research con- ducted by the Sydney Sexual Health Centre found that condom use in Sydney broth- els increased from less than 11% of sexual encounters in 1985 to more than 90% in 1989, and the sexual health of sex workers improved commensurately (Donovan & Harcourt, 1996). Health promotion efforts have also focused on migrant sex workers with initiatives such as the multi-cultural peer educator outreach team at Sex Workers Outreach Project NSW and Sydney Sexual Health Centre’s community language sex worker clinics. The result was that condom use became the norm in this sector too by the end of the 1990s (Donovan, Harcourt, Egger, & Fairley, 2010; Scarlet Alliance—Australian Sex Workers Association and SWOP, 2006). Recent research has shown that condom use in Sydney brothels approaches 100% and that 194 SEX WORKERS AS SAFE SEX ADVOCATES the prevalence of four common STIs is now equal to or lower than rates for the gen- eral population (Donovan et al., 2012). Today there are funded and unfunded sex worker organizations, groups
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