Holistic Approach to HIV/AIDS Vulnerable Groups

Holistic Approach to HIV/AIDS Vulnerable GroupsThe scale of the HIV and AIDS epidemic exceeded expectations since it was identified 20 years ago. Globally, an estimated 36 million people are currently living with HIV, and some 20 million people have already died, with the worst of the epidemic centered on sub-Saharan Africa. But just as the spread of HIV has been greater than predicted, so too has been its impact on social capital, population structure and economic growth. Responding to AIDS on a scale commensurate with the epidemic is a global imperative, and the tools for an effective response are known. Nothing less than a sustained social mobilization is necessary to combat one of the most serious crises facing human development.

Historically, sex work has been identified as a locus for sexually transmitted disease, women and men who sell sexual labour are commonly viewed as vectors of the disease. With the Caribbean having the second highest prevalence of HIV infection in the world and the highest incidence rate among women in the Americas, and with AIDS being the leading cause of death in some age groups in populations in the region, the sex industry is viewed by many as an important target for interventions to prevent and control the HIV/AIDS epidemic.

It is considered imperative that any change in the sex industry in the Caribbean region be informed by and shaped together with sex workers if it is to have any sustained and lasting impact, whether this is in the area of HIV prevention or law reform. This was one of the findings of a study conducted by Dr. Kamala Kempadoo titled: “Prostitution, Sex Work and Transactional Sex in the English, Dutch and French Speaking Caribbean – A Literature Review of Definitions, Laws and Research”.

Sex work (prostitution) in the Caribbean is multifaceted, covering a range of activities including brothel, club, tourist-oriented and street-based prostitution, exotic dancing and escort services. Predominantly women, and some men, provide sexual services and labour to local and foreign men and women and significant activity takes place within the tourist industry. Most sex work activities are viewed by the public as stigmatizing and degrading for those who provide the services, and the majority constitute acts that have been made illegal or criminal.

The aim of this study was to conduct a review of literature and legislation on sex work in the Caribbean for the period 1999-2009 so that the Pan Caribbean Partnership Against HIV/AIDS (PANCAP)/Caribbean Community (CARICOM) can better understand the ways in which sex work activities are organized, legislated, and defined throughout the region. The study also provides a comparison of the situations in the English, French and Dutch speaking Caribbean countries.

The study was commissioned by PANCAP with a grant from the International Development Association (World Bank IDA) and in collaboration with UNAIDS, in the context of its work on the Regional Strategic Framework on HIV/AIDS. According to the study, sex workers have been classified as a very vulnerable community in the Caribbean and it particularly points to legal contexts, stigmas and discrimination that cause or maintain such vulnerability, as well as the issues of transactional sex and migration, which blur sex work boundaries and complicate the vulnerability. All these, as well as the violence sex workers experience on multiple fronts, place them in very difficult circumstances, especially in the context of the HIV/AIDS epidemic. Nevertheless, Caribbean sex workers have organized around and struggled against the obstacles, as well as for respect, well being and rights, for a number of years.

In the 1990s, there was considerable attention for and organizing around sex workers’ rights in the Caribbean. In 1993, the Stichting Maxi Linder Association was formed; in 1995 in the Dominican Republic the first sex worker’s congress was held; and in 1996 the organization Moviemiento de Mujeres Unidas (MODEMU – Movement of United Women) took shape. In 1998, the conference The Working Sex, was held in Kingston, Jamaica at which sex worker organizations participated and presented, and by 2000 a number of sex workers had become acquainted with the Red Thread Women’s Development Organisation in Guyana and were involved in its activities. In 2008, a new sex worker’s organisation publicly emerged – the Guyana Sex Work Coalition.

All these organizations and activities underscored the need for sex worker empowerment, rights and recognition. By 2002, Red Thread had identified sex workers needs as follows:

  • The development of literacy and other skills, because they want alternative work that would enable them to provide food, shelter and clothing to their children;
  • The desire to organize in their own self defense, mainly against physical injury by clients and by the police, and;
  • Increased health safety and protection from HIV/AIDS.

The problems have changed little over the past two decades although they have been exacerbated recently by a globally-induced attention by governments to trafficking that brings with it greater surveillance of migrant women and sex workers. Over the past decade the sex workers’ struggle has intensified due to wider recognition of the vulnerabilities they face, greater mobilization and the inclusion of more men and transgender persons.

Important support for sex workers’ right struggles has recently been facilitated through the regional coalition of Caribbean Vulnerable Communities (CVC) that helped established a Caribbean Coalition of Sex Workers. This new Coalition links sex workers and sex workers’ rights advocates and non-governmental organizations (NGOs) in eight Caribbean countries, holding three consultative meetings since 2007 and participating in international events. The Coalition calls for a number of changes in laws and policy in order to protect their rights as workers, access to services, protection and greater inclusion (UNIFEM 2009). In 2008, the Coalition identified five areas for attention which include law reform, youth, diversity, human trafficking and substance use.

The study shows that there are a number of gaps and inconsistencies in the region when it comes to sex work:

  • There is a lack of common terms of legal and conceptual frameworks to refer to and define sex work across the English, Dutch and French speaking Caribbean. In the law sex work is an unknown term, while in social and epidemiological studies prostitution is a term that is barely used. In a few studies or laws prostitution or sex work is fully defined;
  • There are inconsistencies in the gender identifications of prostitutes or sex workers, brothel keepers, procurers, solicitors, loiterers etc in the laws;
  • Little information is available on how the existing laws are enforced or violated or how everyday policing of prostitution takes place, other than the occasional media reporting of arrests of mainly migrant sex working women, often in violation of immigration laws;
  • To date, there is scant solid evidence of trafficking, yet there is much official activity around this phenomenon;
  • From the research evidence available, situations in countries where the sex trade is highly criminalized (the English-speaking Caribbean) do not appear to be different from those where laws are minimal or sex work is state regulated (Haiti and Curacao respectively);
  • Little research describes in any detail the sex industry owners, managers, coordinators and facilitators, irrespective of whether they operate underground or in the formal legal sectors of the economy;
  • While the laws concentrate on prostitution, which in most countries refers to payment for sex, there are numerous other arrangements where sex is exchanged for material and other benefits that cannot be explicitly identified as prostitution, and involve many young women and men. There is a lack of insights and information about “transactional” or “tactical” sex and of the various factors that may drive (young) people into affective-sexual-economic challenges, including pleasure, emotion and spiritual beliefs, and how these exchanges differ from sex work;
  • Little research exists on the demographics and sexual behaviours and desires of demand side/clients.

The study notes that although a considerable amount of information has been generated about knowledge, behavior and practices concerning HIV/AIDS among groups of sex workers, in studies of sex work little information is provided about sex workers’ needs beyond safe sex practices and little attention has been given to the development and support of sex workers’ rights.

Additionally it is recognized that some countries are heavily dependent on tourism and that the sex trade plays a considerable role in the national economy, yet there are no recent studies in English, Dutch or French speaking Caribbean territories that examine the linkages between sex work and tourism and no exact figures are available on the sex tourism industry.

A primary focus since 1999 in studies on sex work in the Caribbean has been on HIV/AIDS. The report suggests that there is a lack of holistic approach to the study of the health and well being of sex workers in the region, in which other factors that could play a role in risk taking behavior are concealed.

Recommendations from the study point very clearly to specific areas of research as well as legal and social action that can be undertaken in the Caribbean to come to terms with sex work. Some of these recommendations are as follows:

  • Definitions, terms and laws need to be harmonized in the region, especially within CARICOM;
  • Any debate on legal reform must go merely beyond what is criminalized and how severely it is punished;
  • Attention to trafficking needs to be carefully considered. Given the tendency of the United States to classify almost every action within the sex trade as trafficking, and the propensity to extend the definition into almost every area of migration, and that Caribbean governments are annually evaluated by the US on their anti-trafficking efforts, greater care needs to be taken to distinguish activities that realistically fall under trafficking and to ensure that sex workers’ rights are not harmed by the war on trafficking;
  • Knowledge needs to be developed about the organization of the sex industry and the ways that it is linked to the national economy as well as about the organizers, managers, facilitators and clients in the industry;
  • Affective sexual economic relations “transactional” or “tactical sex” needs careful and sustained research in order for the distinctions from sex work to be better made;
  • A broader approach to HIV/AIDS prevention needs to be developed that takes into account the clients and others involved in the sex industry and considers them co-responsible in transmission as well as in the fight against the epidemic;
  • Safe, sustainable income generating alternatives, that may include but not place a premium on sexuality, should be created for men and women to participate in the global economy.

The study further concludes that a holistic approach to sex workers’ lives and activities is needed, which would allow sex workers to be treated and viewed respectfully and according to their rights as full citizens of CARICOM member countries.

The epidemiological impact of HIV only begins to convey the full impact of HIV/AIDS on the current and future capacity of societies to sustain the dignity and security of human life. AIDS magnifies its impact into the future because it erodes social capital. Because AIDS affects primarily young adults and in many cases initially spreads more extensively in the more mobile, wealthier and better educated parts of populations, its effects ramify across all social and economic sectors.

Allison S. Ali

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    One Reply to “Holistic Approach to HIV/AIDS Vulnerable Groups”

    1. Now i read the article posted on the vulnerability group for HIV/AIDS and have seen no reference material no in text citations and have seen refer to information which is not of opinion or evidenced in this article.

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