What Works for Women and Girls

2010). Transgender men and women also work as sex workers and are at particularly high riskfor HIV acquisition. Fifty-five independent studies from 19 countries (countries not specified)of 2,233 transgender women sex workers found a 33% HIV prevalence rate (Friedman et al.,2008). [See also 4F. Transgender Women and Men]Criminalization of Sex Work Hinders HIV Prevention“Sex work is currently a criminal offense in most southern African countries, as indeed it is inmost of the world…and much of the vulnerability of sex workers to HIV in southern Africa stemdirectly from the criminalization of their work” (Richter et al., 2010: 1 and 2). Simply decriminalizingsex work would not eliminate HIV; however, when “sensibly applied, legislative processescan be a most powerful public health ally. Equally, harmful law may obstruct and hinder publichealth” (Richter et al., 2010: 1 and 2). For example, criminalization of sex work as practiced inmany parts of the world makes access to health services difficult. Sex workers in some studiesstate that the reason they do not access services is fear of arrest. Criminalization means that sexworkers are less able to negotiate condom use and are more subject to violence from clients.They also may have difficulty accessing both legal remedies and PEP in cases of rape. [SeeChapter 11B. Strengthening the Enabling Environment: Addressing Violence Against Women]“The illegal status of sex work creates conditions in which exploitation and abuse can thrive”(Gould and Fick, 2008: 55). As one South African sex worker stated, “ There is nothing you cando if someone is violent with you. …you can’t go to the police…” (Gould and Fick, 2008: 49).A survey of 118 sex workers in South Africa found that 12% had been raped by police officersand 28% reported that policemen asked them for sex in exchange for release from custody(Gould and Fick, 2008). Participatory action research with sex workers and outreach workersfrom 13 sex worker projects in Central and Eastern Europe and Central Asia found that of 238male, female and transgender sex workers from 12 countries more than 45% reported physicalabuse by police and more than 41% reported sexual abuse, in addition to reports of forced HIVtesting. Police increase risks by confiscating condoms as evidence of sex work (Crago et al.,2008). A study conducted by sex workers and academics interviewing 164 sex workers in CapeTown, South Africa found that “sex workers would rather have their work treated as a legitimatejob with the legal protection that comes with that” (Gould and Fick, 2008: 7).In New Zealand, which has explicitly decriminalized sex work and adopted a human rightsand public health framework, sex workers report being able to negotiate safe sex and reportabuse to the police (New Zealand Government, 2008 cited in Richter et al., 2010).Condom Use in Sex Work is Critical to Prevent Infection but Implementation of 100%Condom Use Policies Can Violate Human RightsWhile Thailand is renowned for its 100% condom use policy that had a large impact on theHIV epidemic in that country (Hanenberg et al., 1994), subsequent evidence, for examplefrom Cambodia (Lowe, 2002), suggest that policies and programs that denigrate the rights ofsex workers tend not to be successful. While 100% condom use policies may have increasedcondom use, they have also been shown to be coercive to female sex workers, rather thanWHAT WORKS FOR WOMEN AND GIRLS77