Sex work has been labelled the oldest profession in the world, some citing biblical references and classic literature to demonstrate that this trade is ancient, albeit always associated with the underworld and denialism. Sex workers have been maligned and stigmatised through the ages and often abused by pimps, clients, the police and society at large. Such levels of social exclusion have not only marginalised sex workers but resulted in many health changes, including making them vulnerable to sexually transmitted infections. Thus the call for measures to re-humanise sex workers by giving them full protection and access to their inalienable human rights.
Sex workers are entitled to live free of discrimination, stigma and violence. Like all other human beings, their rights to life, health, privacy and bodily autonomy should not be infringed. Civilised societies are expected to provide these protections irrespective of the legal status of sex work. Humans remain human whether they are educated, poor, rich, professionals, prisoners etc.
Hence the argument that sex workers have equal rights and protection under the Universal Declaration of Human Rights, and in the case of South Africa, under the Bill of Rights. Research has shown that supporting sex worker rights is key to promoting the safety and health of sex workers, in addition to making progressive laws that protect and regulate sex work. Various international human rights principles and legal instruments have been generated through the United Nations to put forth state obligations to protect and honour these inalienable rights.
For example, there are several international legal documents such as the Universal Declaration of Human Rights, the Convention on the Elimination of All Forms of Discrimination Against Women, and the International Protocol on Civil and Political Rights. South Africa ratified the Optional Protocol to this in 2002, thus allowing people to complain about breaches of these rights to the UN Human Rights Committee.
Yet, in South Africa, sex work is still criminalised and sex workers are harassed by the public, their clients and the police. However, there is a growing call from various quarters for sex work to be permitted by law to address health, psycho-social, violence and crime concerns. Public health professionals are arguing that in an HIV hyper-epidemic country like South Africa, decriminalising sex work will directly impact on our incidence (new HIV infections) numbers.
The legal status of sex work is a critical factor defining the extent and patterns of human rights violations, including violence against sex workers. Where sex work is criminalised, violence against sex workers is often not reported or monitored, and legal protection is seldom offered to victims of such violence.
Addressing and reducing violence against sex workers has the potential to reduce HIV transmission. Modelling estimates from Unaids papers in two different epidemic contexts (Kenya and Ukraine) showed that a reduction of approximately 25% in HIV infections among sex workers may be achieved when physical or sexual violence is reduced.
There is also strong evidence that the criminalisation of sex work increases vulnerability to HIV and other sexually transmitted infections. Fear of arrest and/or police-led sexual and other physical violence forces sex workers to remain mobile in order to avoid detection by the authorities. This significantly affects their access to health services, including adhering to treatment for those who are HIV-positive and enrolled in the treatment programme.
As I have argued in the pages of Daily Maverick before, criminalising sex work entrenches social stigma which forces sex workers to avoid accessing health services and conceal what they do from healthcare providers. Consequently, they present themselves very late for treatment or fail to adhere to the treatment requirements.
There are countless stories of how health service providers often neglect their duty to provide care when seeing sex workers, while the police and other law enforcement officials often violate the human rights of sex workers rather than promote and protect them.
We learn from statistics that the sex worker population is hardest hit by the HIV epidemic in South Africa with infection rates ranging between 20% and 50%. That is more than double for all other population groups. An analysis undertaken by Unaids in 2012 within 16 countries in sub-Saharan Africa showed a pooled prevalence (people living with HIV) of more than 37% among sex workers.
It is in this context that work has begun to reduce stigma and to provide sex workers with a comprehensive package of health services and protection, including HIV testing, access to prevention programmes and treatment. Both sex workers, their intimate partners and clients are targets of this programme.
South Africa cannot end its Aids epidemic without protecting and treating HIV-positive sex workers. HIV does not just circulate within the sex worker community – it moves from and into households of married couples and everywhere else.
On 11 March 2016 then-Deputy President Cyril Ramaphosa launched the National Sex Worker Plan in Johannesburg, in his capacity as Chair of the South African National Aids Council (SANAC). March, being Human Rights Month in South Africa, was carefully chosen for this launch where Ramaphosa said:
“It is fitting that we are launching the National Sex Work Sector Plan during Human Rights Month. Because this plan is about human rights. It is about affirming the equal worth of every person. It is about affirming the right of all South Africans to life, to dignity, to health – regardless of their occupation and regardless of their circumstances. This plan is also about public health.”
Most importantly, the Chair of SANAC emphasised that sex work is work!
International organisations such as the World Health Organisation and Unaids have praised the South African National Aids Council for adopting the National Sex Worker Plan.
“We applaud the South African Government for this bold plan and for offering early testing and treatment and PrEP to sex workers,” said Dr Gottfried Hirnschall, Director of WHO’s HIV/Aids Department.
For his part the Unaids Executive Director, Michel Sidibé said: “This plan is an important step to scaling up treatment towards ‘treat all’ and to reducing HIV transmission effectively and rapidly. South Africa continues to lead and innovate… By listening to sex workers and collaborating with the community, South Africa’s tailor-made national HIV plan offers real hope for sex workers, who are often left behind in the Aids response.”
And so, as we match forth to the sixth democratic administration, expectations abound that both as a human rights and health matter, the policy conversation on decriminalising sex work will gain momentum – much like South Africa has made progressive policy choices on other difficult areas like termination of pregnancy and recognition of same-sex relations.
This is a difficult but necessary dialogue. Sex workers should be re-humanised and given full rights and protections that we all enjoy in a democratic country. The 25% HIV infection estimates cannot be reduced by stigmatising sex workers. The same goes for high levels of violence and abuse they experience daily.
Sex workers are our daughters, neighbours, sisters and in some cases our intimate partners as well. Let’s embrace them without conditionalities for it is patriarchy and capitalism that pushes women into sex work. DM