23 December 2004

HIV and sex workers

A sex worker is a person who performs sexual acts for payment. Many different kinds of people become involved in sex work,


What is meant by a “sex worker”?
A sex worker is a person who performs sexual acts for payment. Many different kinds of people become involved in sex work, and the conditions under which they work also vary a great deal:

  • Most sex workers are women, but some are male or transgendered (people who have undergone operations to change their gender).
  • Sex workers work in various locations. Some work on the streets, others from their homes. Many work in brothels, escort agencies, massage parlours, clubs and bars. Working conditions vary: in some workplaces, sex workers are treated very badly; in others they are treated and paid well.
  • Some sex workers work with a pimp (an intermediary between sex worker and client). Some pimps help protect the sex worker; others are exploitative and abusive.
  • People enter the sex industry for different reasons, but primarily economic: for basic survival; because there are no other jobs open to them that pay as much as sex work; or to support a drug habit. A few sex workers say that they are in the industry because they enjoy the work.

Generally speaking, the worse their working conditions, and the less choice sex workers have in terms of with whom and how they have sex, the greater their risk for contracting HIV.

Why are sex workers a high-risk group for HIV?
Sex workers are particularly vulnerable in terms of contracting and spreading sexually transmitted diseases (STDs), including HIV. This is not only because sex work involves having high numbers of sex partners.

It is also because sex work is illegal in most countries, and is highly stigmatized (viewed in a prejudicial way by society). This means that sex workers have poor legal and societal protection and support, compared to other citizens, and must often operate secretively.

The result is that many sex workers suffer physical and sexual violence - including rape and other forms of sexual abuse - from clients and pimps, and sometimes members of the local community and the police. High levels of violence and rape mean a high level of unprotected sex and increased risk for contracting HIV. Sex workers also often experience economic and emotional abuse, which further undermines their position.

Sex workers cannot make full use of support services, such as safer-sex programmes and post-infection prophylaxis, because they fear they will be reported to the police, or be despised and blamed for the work they do. For the same reasons, and also because of the stigma faced by rape survivors in general, sex workers are reluctant to report assault and rape.

It is difficult for sex workers to practise safer sex. Many male clients still do not want to use condoms, and some become violent when the sex worker insists on safer sex. Sex workers may not even bring up the issue of safer sex for fear of a violent response. Also, clients are less willing to pay as much for sex with a condom; some may offer more money for unprotected sex. Sex work is competitive, and the sex worker may not be in a strong enough position financially to refuse a client.

Sex workers often lack access to alternative sources of income, and may choose short-term economic survival over potential HIV infection in the long-term. There are additional reasons why sex workers may not use condoms. For example, they may hope that, if they “keep the client happy”, he may become a long-term partner.

The inferior status of women impacts on female sex workers. Women often do not have the power to negotiate for safer sex, and are thus vulnerable to forced unprotected sex. This situation is even worse for female sex workers, who are often at the mercy of their clients’ wishes.

Effective HIV awareness and prevention programmes among sex workers are hampered by the fact that sex work is illegal. This makes it difficult to reach and mobilise sex workers in the fight against Aids.

Many sex workers are reluctant to be tested for HIV. They fear they will test positive and would rather be uncertain of their HIV status than know a positive result. They feel that receiving a positive result will mean having to give up sex work, their only way of making a living. Sex workers often find it difficult to find other jobs when potential employers find out about their previous involvement in the sex industry.

Are sex workers responsible for spreading Aids?
Everyone needs to take responsibility for stopping the spread of HIV. Sex workers are often accused of spreading HIV, but the virus is spread by the behaviour of individuals, not by a particular group. Both sex workers and their clients are responsible for practising safer sex. People tend to forget that clients can also transmit HIV to sex workers. In fact, given that transmission of HIV is more likely from male to female partners than the reverse, female sex workers are at higher risk of contracting HIV/Aids than are their clients.

Will clamping down on the sex industry help prevent HIV/Aids?
There is little evidence that criminalising sex work and trying to eradicate sex work will help prevent the spread of HIV/Aids.

Organisations such as the Sex Worker Education and Advocacy Taskforce (Sweat) advocate legalising the sex industry and working towards ending stigmatisation, which includes not blaming sex workers for the spread of HIV. Sex workers will best be able to practise safer sex, and benefit from Aids prevention programmes and support services, in an environment where they are assured of their legal, health, labour and social rights. De-criminalising the sex industry would also facilitate programmes aimed at clients.

Advice and support for sex workers
For contact details of useful organisations, as well as more information regarding HIV, other health concerns, and safety and legal issues for sex workers, log on to the Sweat website


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HIV/Aids expert

Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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