The what, why and how of health and development

Trafficking law leaves Cambodian sex workers at risk of HIV

Efforts to tackle sex trafficking in Cambodia are leaving sex workers potentially more at risk of HIV and violent attacks, according to a report published this month in the journal Health and Human Rights.

In a survey carried out in 2009 and 2011, researchers interviewed 80 sex workers in Cambodia, where nearly one in four are living with HIV, to find out how the ‘Trafficking Law’ introduced in the country in 2008 was impacting their lives.

The new legislation was designed to tackle sexual exploitation and trafficking and led to police applying tougher force on suspected traffickers and shutting down brothels. As a result, many female sex workers were forced to continue working on the street or in entertainment venues such as karaoke bars. The researchers, led by Lisa Maher at the Kirby Institute at the University of New South Wales (UNSW), found that sex workers were now less likely to carry condoms for fear of being incriminated or being attacked by police.

One 28-year-old woman said that if police would order them to chew on any condoms they found on them and would beat sex workers with sticks and stones.

Another – 22-year-old Seiha – said that it is difficult to safely negotiate condom use with clients now she is no longer working in a brothel: “…We were safe living in brothel and we were not scared police. We also protected ourselves better by using condoms than now. Now some clients may force us not to use condoms but when we lived in the brothel we had more rights than clients and they dared not to force us because they come into our house.”

Seiha was not alone in reporting that brothels were, in relation to street prostitution, safer working environments. However, one interview where a woman explained brothels were safer because if you screamed someone would hear and come to help, reminds us that this ‘safety’ should only be understood in relative terms.

The researchers, led by Lisa Maher at the Kirby Institute at the University of New South Wales, also say they do not want to “paint a pretty picture” of brothel life but point out that their findings are in line with results from other studies.

They reference several NGO-led or academic studies that suggest the criminalisation of sex work has led to reduction in condom use, increase risk of violence, and difficulty providing health services to sex workers displaced to the street.

For example, the National Center for HIV, AIDS, Dermatology and STDs (NCHADS) reported a 26% reduction in women seeking STI services, a 16% decrease in HIV testing, and a 46% increase in the number of women working on the street following the introduction of the law in Cambodia.

Likewise, the belief that the risk of HIV is somewhat determined by the structural conditions of sex work, such as the legal and policy positions on trafficking and prostitution, was also reflected in a paper published in the Lancet last year.

Authored by Kate Shannon, from the British Colombia Centre for Excellence in HIV/AIDS, the Lancet paper used mathematical modelling to see how HIV rates amongst sex workers would be affected by changes in these ‘structural conditions’. They found that decriminalisation of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33–46% of HIV infections in the next decade.

Now in this latest survey on Cambodian sex workers, the researchers suggests that decriminalisation does not go far enough as a sex worker remains at risk of HIV and abuse because of the “lack of recognition [of them] as a person before the law”.

They conclude: “…focusing on the legal status of sex work in the absence of a commitment to the application of human rights standards means that the rights of sex workers to legal personhood, health, and the same protections and benefits as other workers, are in conflict with well-intentioned, if misdirected, attempts to tackle human trafficking.”

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