1.1  Commercial sex in context Commercial sex and public health Responses Why this handbook? 1.2  What is in this handbook? Developing programmes and projects Successful strategies 1.3  Commercial sex: complex issues Commercial sex will continue Sex workers cannot do it alone On sex workers' terms 1.4  Understanding sex work The sex industry, formal and informal Who are clients? Who are sex workers? Women  Men Transgender sex workers Partners of sex workers Commercial sex business owners and managers

1.1 Commercial sex in context

Throughout this handbook a sex worker is defined as:  "a person past puberty who receives money or goods in exchange for sexual services and consciously defines those activities as income generating. The definition of the gender of the people involved and whether or not they do this on a full, part time or occasional basis. Prostitutes were called 'soiled doves' in the American West in the 19th century.

 
 
Commercial sex and public health 
Commercial sex has always existed. However, there have been few times and places in which sex workers have been free from persecution, stigma and violence. HIV is the most recent issue in the long history of recurring moral and practical questions and conflicts raised around prostitution. The ancient Romans decided to restrict brothels to special areas as a result of discussions which were remarkably similar to those taking place today in many countries about how the sex industry might be appropriately located and controlled.

Commercial sex, or at least that practised by women, was seen as an important public health issue throughout the 19th century. Concern about it declined in the 20th century, due to improved management of sexually transmitted disease (STD) and contraception and more liberal views about sexuality. However, HIV has refuelled concern, and public health again dominates the way that most societies think about, and deal with, commercial sex. 

When HIV was first identified, sex workers were immediately named as potential carriers of a fatal, sexually transmissible disease. This reaction had immediate practical consequences. It was clear that sex workers, and possibly their clients, would be vulnerable both to HIV and to HIV-related discrimination. Responses developed at different rates across the world, ranging from repressive measures to effective community mobilisation and public health programmes. Innovative programmes by governments, communities and sex workers themselves now face the renewed challenge of making sex work safe.

Patterns of STD, HIV and hepatitis vary from country to country, as do sexual behaviour and the social conditions which affect health in general. It has become increasingly clear that vulnerability to HIV and HIV-related illnesses is greatest among poor and marginalised people. Women, young people and men who have sex with men are particularly vulnerable.

It is not known how many people living with HIV are selling sexual services. However, enough information exists about patterns of HIV and STD infection among sex workers to inform development of effective support services. Patterns of infection reveal the conditions which cause vulnerability: relatively high HIV and STD rates in the general population; lack of access to condoms, information and civil rights; and poverty. Those most likely to be subject to such conditions are young men and women, uneducated women, transgendered people, and people who have migrated to a new country or city.

In parts of Africa HIV rates among sex workers may be as high as 60 per cent. Rates of around 30 per cent are common in Thailand and some parts of India. In Western countries, HIV rates among drug-using sex workers, urban male sex workers and transgender people are higher than average. However, in Canada, China, Austria, Australia and Germany, rates among female sex workers are lower than among comparable groups of non-sex workers. 

There are no figures which reveal to what extent sexual services carried out by HIV-positive sex workers result in transmission to clients. Speculation is too often coloured by prejudice and stigma to be useful. Scientists often see no need to provide evidence for the assumption that HIV-positive sex workers infect clients.

The term "sex worker" is repugnant to some of those who are concerned about the horrors of women and children being kept captive and forced to submit to what is effectively repeated rape. They often accuse the sex workers. rights movement of not taking these horrors seriously because we are trying to legitimise the sex industry. Nothing could be further from the truth! Look at the logic. Children being shackled to looms in the carpet industry does not mean that no carpet should ever be woven again. It means that there should be proper standards in the carpet industry. Legitimising is exactly what is needed to end these absolutely illegitimate practices.  Sexual slavery is a meaningless idea. Slavery (including child labour) involving sexual services, carpet weaving or any other form of labour is so fundamentally abhorrent that it is pointless to qualify it in any way. What are these people saying? That one form of slavery is worse than another or 'should be abolished sooner? Slavery is slavery is slavery. Abolishing every form of slavery from every corner of the earth, forever, is the only proper goal. Anything less, any qualifications, any prioritising is an obscenity in itself. And it is the aims of the sex workers' rights movement which will achieve this in the sex industry, not the confused, emotive ideology of the anti-prostitution lobby. Network of Sex Work Projects Bulletin, June 1995

1.2 What is in this handbook?

Developing programmes and projects 
Before considering what project to set up, it is important to find out about the type and scale of sex work and related activities, such as drug use or religious culture. These activities will influence which strategies to choose. Choice of strategy depends on the visibility of sex work and related activities. It is relatively easy to design and implement projects in areas where projects are adequately funded, the sex industry relatively well structured and sex workers well organised. By contrast, when legal or cultural conditions force sex workers to operate in secret, the task may be more difficult, but by no means impossible. 

Making Sex Work Safe covers technical aspects of developing a programme or project such as conducting a situation assessment, developing objectives and activities to address key problems, and monitoring and evaluation.

It provides basic information on planning, monitoring and evaluating a project with sex workers. However, it is not intended as a detailed manual on project planning (see Further Reading for a list of manuals).

Successful strategies 
Making Sex Work Safe contains many examples of strategies and activities which have been developed throughout the world. They are divided into two main categories: "educational" and "enabling". Generally, the most successful projects are those which include aspects of both.

Educational strategies inform sex workers and others about sexual health and aim to motivate people to make changes which promote health. They include activities such as face-to-face counselling or information dissemination through leaflets, newsletters or the mass media. Educational strategies are particularly important where sex workers do not know about HIV/STDs and safe sex or how to access health services.

Enabling strategies aim to make it easier for people to protect their health by increasing their control over their lives. sometimes called "empowerment". Activities include improving access to health care, supplying condoms, making agreements with police which enable sex workers to carry condoms, and supporting sex workers' rights organisations. Where these work well they enable sex workers to put knowledge into practice. As educational aims are realised and sex workers learn how to maintain their sexual health, these enabling activities increase in importance. 

These categories. educational and enabling. are simply a way to think about strategies. They are not mutually exclusive. For example. making STD clinics more accessible is an enabling strategy which may include the educational strategy of counselling and providing safe sex information. Expanding educational efforts to include third parties. such as sex business managers or police. is both an educational and an enabling strategy. 

Unfortunately, sex work projects often find it difficult to raise funds for projects which aim to improve the commercial sex environment through enabling activities based on human rights. Improving conditions in the sex industry is sometimes regarded as an approval of prostitution. This problem is one of the greatest challenges facing sex work projects. especially in obtaining funding. However. without widespread. fundamental change in how sex workers are treated by governments and societies. educational strategies alone will fall far short of their objective of making sex work safe.

We're doing prostitution Although it's no solution It's just a substitution We make a contribution We've found a resolution We don't want persecution We're doing prostitution It's an age old institution  You know it's not pollution We need some absolution Perhaps a revolution A brand new constitution To end this persecution.  Anonymus  ....

Commercial sex will continue 
The goal of sex work-related STD/HIV prevention should be to reduce the health risks associated with sex work. Although some individuals and organisations believe that commercial sex is wrong and should be abolished, many sexual contacts in almost all societies are paid for, regardless of attempts to eliminate the sex industry. Punishing sex workers clearly fails to end the sex industry, and programmes which assist people to stop sex work do not appear to reduce its size. Academic researchers have offered many explanations for why people decide to sell sex. Perhaps the best one is simply that it is to meet demand. It is reasonable to assume that while demand exists it will always be met, regardless of economic and social conditions.

Experimental programmes to decrease demand for paid sex (with female sex workers) are taking place in Scandinavia and North America. They aim to convince men that paying for sex degrades women. Results are not yet known. However, even if the programmes do decrease demand. they are not likely to be transferable to other cultures in the foreseeable future.

 
 
Sex workers cannot do it alone 
The success of projects depends on involving a range of people who influence commercial sexual activity, either directly or indirectly. They include:
 

	clients (or men who are likely to be clients)
	owners and managers of commercial sex establishments and meeting places
	people who help clients and sex workers contact each other
	police and judiciary
	health officials who establish policies that affect sex workers
	community leaders and the media
	neighbours, families and other personal contacts.

Principles for successful projects: 
 

	Health and human rights: the theory  Health is a state of complete physical, mental and social well being, and not merely the absence of disease or infirmity. Health is a fundamental human right.
	Health and human rights: the practice  Organisations should deliver health services to improve the health of sex workers because sex workers have a right to health - not to prevent sex workers from infecting clients.
	Informed consent  Health tests should only take place if the nature of the test has been thoroughly explained and the person consents to it.
	Confidentiality  No information about people using services should be shared without their consent.
	Accountability  In any project there are several "stakeholders" such as donors, local health authorities and sex workers. Each project should be clearly accountable to the various stakeholders. In particular. it is important to explore ways of becoming accountable to local sex workers.
	Challenging discrimination  Since vulnerability to HIV and STD is made worse by stigma and discrimination, projects working with marginalised communities must be prepared to challenge discrimination.

 

On sex workers' terms 
It is essential that any intervention makes things better for sex workers. At least, it must not make matters worse, for example by resulting in greater law enforcement or punitive measures to enforce condom use. Often health is not the main concern of sex workers who are experiencing violence. poverty and/or legal and social persecution. The most successful health programmes are delivered within a framework that reflects sex workers' priorities and their perceptions of their needs.

1.4 Understanding sex work

In South East Asian cities the sex industry mostly take place in formal settings such as brothels and escort agencies Sex workers display safe sex promotional materials at the 9th international Conference on AIDS

 
 
The sex industry, formal and informal 
Commercial sex occurs in some form allover the world. In some places there are obvious exchanges of sexual services for money in recognised settings such as brothels, bars and known street areas. These places form a market in which prices are similar.

Commercial sex also takes place informally. Sometimes there is confusion about the difference between casual sex work and other relationships. Often the exchange is not obvious and those involved do not openly define themselves as a sex worker or a client. Examples include a domestic relationship or a chance meeting of an older, wealthy man with a younger man who needs money. Payment in these situations may take the form of gifts. Levels of payment may be less predictable. 

If one partner in the exchange knows that sex with the other would be unlikely without the income, the exchange is commercial. One sex worker commented:

"People know why they are having sex with people they're not attracted to who give them money or gifts. Just because they don't want to tell others about their activities, and they don't call themselves a prostitute, doesn't mean they don't know what they are doing and why."

In most countries commercial sex takes place in a mix of formal and informal settings. Each setting requires a different approach from health and welfare service providers. Some campaigns are aimed at people whose behaviour may be classified as prostitution, but who genuinely do not see their work as income generating. While parts of this book may be helpful to such projects, this is not what is meant by sex worker. Programmes reach people by addressing them as they see themselves and not as others see them.