36,656,825 and Counting

Larry Kramer

In 1983, Larry Kramer wrote an article for the New York Native filled with righteous anger, brilliant insight and, reading it now more than 30 years later, electric prophecy. It began, “If this article doesn’t scare the shit out of you, we’re in real trouble.” He proceeds to catalogue the inaction and sheer terror that defined the emerging epidemic.

Kramer recounts the failures of government officials, the medical establishment, researchers, the media, and the gay community itself. With prescient accuracy he connects disenfranchisement with vulnerability to HIV and describes the unrelenting stigma that even today shapes our still inadequate response to the epidemic. He is perceptive as he is relentless. His message: “we must fight to live.”

Kramer’s article was titled “1,112 and Counting.” After three decades, we’re still counting. More than 36 million people have died from AIDS and nearly as many are living with HIV. In India, roughly 150,000 people died from AIDS-related causes last year, ten times the number in the United States. For all our progress, the fight is not over.

Larry Kramer wrote “The Normal Heart” in 1985 during the grimmest and most uncertain days of the epidemic. No other play – no other work of art really – comes as close to capturing those times, and it resonates even today. A long time coming, the film version from HBO brings us back and in doing so reminds us what it takes to act up and fight back.

“The Normal Heart” aptly gets its title from a W.H. Auden poem “September 1, 1939” written as the world teetered on the brink of another epochal tragedy, World War II. What was true in 1939 was true in 1985 and remains true today:

Hunger allows no choice
To the citizen or the police;
We must love one another or die.

The AIDS epidemic has reached across the world in ways that perhaps only Larry Kramer would have imagined in those early days, and there is still no choice.


The author of this blog, James Robertson, is Executive Director of India HIV/AIDS Alliance in New Delhi.

Alliance India brings together committed organisations and communities to support sustained responses to HIV in India. Complementing the Indian national programme, Alliance India works through capacity building, knowledge sharing, technical support and advocacy. Through our network of partners, Alliance India supports the delivery of effective, innovative, community-based HIV programmes to key populations affected by the epidemic.

International Women’s Day 2014: Managing Cervical Cancer in Women Living with HIV in India

Women living with HIV are five-times more susceptible to cervical cancer than other women. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Women living with HIV are five-times more susceptible to cervical cancer than other women. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Cervical cancer is the most common cancer among women in India, and the leading cause of cancer-related mortality. Women living with HIV (WLHIV) are at a higher risk of developing cervical cancer than women in the general population. Most significant reason for this is the high prevalence of persistent human papillomavirus (HPV) infection, which is known to be the causal agent for most cases of cancer of the cervix.

HPV has been found in over 99% of cases of invasive cervical cancer (Sankaranarayanan 2008) and like HIV, is sexually transmitted. The virus has more than 100 subtypes and it is estimated that more than 50% of the sexually active population globally is infected with one or more subtypes of genital HPV; however, the infection resolves by itself in most cases. Only a few high-risk subtypes (mostly subtype 16 and 18) can trigger abnormal growth in infected cells and lead to development of cervical cancer. HIV, smoking, multiple births, early initiation of sex and long-term use of hormonal contraceptives are other co-factors that increase the risk of progression from cervical HPV infection to invasive cancer.

A weakened immune system due to HIV puts WLHIV at a higher risk of HPV infection. There is evidence that WLHIV have a higher incidence of HPV infection, especially with cancer-inducing subtypes. They also have a higher viral load of HPV; and HPV infection progresses more rapidly to cancer in these women. Worldwide, infection with HPV among WLHIV varies between 55 to 30% (Clifford 2006). A recent study in 103 HIV positive women in North India (Pundhir 2014) reported co-infection with HPV in 24% cases and 10% of the population had cervical dysplasia (pre-cancerous lesions). In another study in Mumbai (Isaakidis 2013), HPV DNA was detected in 32% of the WLHIV studied.

With decreasing CD4 counts, the prevalence of HPV infection increases, the infection is more persistent and progresses rapidly. There is up to a 10-fold risk of having an abnormal pap smear among HIV-infected women than uninfected women, with a higher risk of these lesions progressing to invasive carcinoma. In a cross-sectional survey of 786 WLHIV conducted by Koshish, a  programme implemented by India HIV/AIDS Alliance to improve the sexual and reproductive health of PLHIV and most-at-risk populations, 5.6% had abnormal pap smear.

Globally, it is estimated that 500,000 women are diagnosed with cancer of cervix every year and 275,000 women die, with India contributing over a quarter of these deaths. This is particularly unfortunate as cervical cancer is preventable and curable if detected early. The development of cervical cancer takes about 12-15 years from the time of HPV infection. During this period, the abnormal cervical cells pass through several precancerous stages offering multiple opportunities for early detection.

With more than a million women living with HIV in India, who now have increased longevity due to improved access to anti-retroviral treatment (ART), more WLHIV are likely to develop cervical cancer. ART does not appear to have much impact on reducing progression of cervical dysplasia. Yet despite the fact that the country is facing a dual epidemic that is having a significant impact on the lives and health of women, India still does not have an organized screening programme for detection of cervical cancer. Lack of awareness among women, social power structures, lack of control of women over family resources, cultural taboos and silence over reproductive health issues make the situation worse.

Pap smear is the conventional screening method and has been successfully used in developed countries to screen women for cervical cancer, resulting in decreased incidence of the cancer in these countries. The test, though simple, requires trained cytology technicians and pathologists and good health infrastructure, and it is not widely available in India. Even in the places where the test is available, uptake of the test remains low because of low awareness, high associated cost, and multiple visits required to the health facility, since the test is not a point-of-care test. Moreover, the conventional Pap test is associated with high sampling and interpretation errors, leading to false negative results in 10-25% cases; and 30% of these false negative cases have been found to develop cancer cervix every year (Shingleton H, 1995).

Alternative screening approaches to pap smear, such as visual inspection with acetic acid (VIA) or Lugol’s Iodine (VILI) and HPV-DNA studies, have recently been considered for use in low-resource countries including India (Sankaranarayanan 2007, Isaakidis 2013). These studies have shown that VIA is more sensitive and the results become available immediately, allowing for the lesions to be treated during the same visit.  Recently, the Government of Tamil Nadu has introduced VIA testing in primary healthcare centres (PHCs) and has plans to scale-up to the entire state. Other low-cost rapid tests have been developed but not yet commercially available.

A higher prevalence of cervical cancer and an improved life expectancy of WLHIV with increased access to ART make a compelling case for initiating a well-organized regular screening programme. The American College of Gynecologists (ACOG) recommends cervical screening of HIV-positive women twice: a) once during the first year after HIV diagnosis and b) annual screening thereafter. Apart from introducing the screening at PHCs, there is an opportunity to integrate cervical cancer screening at India’s Integrated Counselling & Testing Centres, ART Centers and the STI clinics that support Targeted Interventions for HIV prevention among high risk groups, such as female sex workers. A network of these clinics is already established in all districts with high HIV prevalence; expanded services to WLHIV and most-at-risk populations that includes cervical screening and related services will help increase utilization of these clinics and improve health outcomes.

Finally, primary prevention of HPV will go a long way in reducing cervical cancer. Correct and consistent use of condoms is known to have reduced genital HPV infections, genital warts and cervical cancers. Recently, two vaccines, one quadrivalent (against subtypes 16, 18, 6 and 11) and one bivalent (against subtypes 16 and 18) have been developed that provide more than 95% protection against HPV. Suitable for both females and males, these vaccines are effective only if given before infection with these subtypes of HPV. The efficacy and safety of vaccine among HIV-positive women requires more research.

Echoing this year’s theme for International Women’s Day, equality for women living with HIV is progress for all. Increased investment in the overall health needs of WLHIV, including their sexual and reproductive health needs beyond HIV, will pay dividends for these women, their families and for society more broadly.

__________________________

The author of this post, Saroj Tucker, is a medical doctor working in the field of HIV and SRH for the last 12 years.

With support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Vihaan is establishing 350 Care & Support Centres across India that will help expand access to services, increase treatment adherence, reduce stigma and discrimination, and improve the quality of life of PLHIV. The centres will support PLHIV, including those from underserved and marginalized populations who have had difficulty in accessing treatment including women, children and high-risk groups in 31 states and territories.

With funding from the European Union, our Koshish programme strengthens civil society organizations and networks that work with PLHIV and other marginalized groups, such as men who have sex with men, transgenders, sex workers and people who inject drugs, to effectively advocate for policies to improve the sexual and reproductive health and rights of PLHIV in India. This programme is implemented in partnership with MAMTA, PWDS, VMM and CHETNA, along with state-level networks for PLHIV in Maharashtra, Tamil Nadu, Andhra Pradesh and Gujarat.

Zero Discrimination Day 2014: Ending the epidemic of discrimination against PLHIV in India

Children living with HIV have the same right of education as others. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

Children living with HIV have the same right of education as others. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

March 1 is Zero Discrimination Day. HIV-related discrimination continues to plague the lives of people living with HIV (PLHIV). They are treated in dehumanizing ways, face barriers in accessing basic services like healthcare and education, and are often victims of violence and other forms of discrimination and marginalization.

Take the case of 13-year-old Prashant (name changed), from Kathua district in Jammu state in India. He is HIV-positive. His school learned of his status. The teachers mocked at him, and his peers abused him. His brother, two years elder to him, was also picked on.

“It was a horrifying experience. We were treated with disgrace. School was my favourite place to spend my day. No more!” recounts Prashant.

The mother of the boys made several rounds to school authorities, all in vain. She then approached the local Care & Support Centre (CSC) established under Alliance India’s Vihaan programme with support from the Global Fund. Responding to discrimination is a central activity of every CSC. The CSCs have established Discrimination Response Team (DRT) at district level to address these challenges. DRTs provide not only psychological support to PLHIV who have faced discrimination but also advocate on their behalf in response to discrimination they have experienced. The teams inform appropriate district or government authorities about the incidents of discrimination faced by PLHIV and take appropriate steps to address the same.

In this case, the DRT promptly organized a meeting with the sarpanch (head of the village government) and discussed the issue. The DRT educated him that the behavior of the school towards the boys was wrong. Together they approached the school authorities and encouraged them to treat the boys as any other students. The authorities were convinced after several rounds of discussions and committed to be fair to the boys.

“I am happy to be back to school. Though I see a change in behavior of my teachers and peers, it will take some time for me to adjust again,” says Prashant.

Discrimination denies PLHIV their dignity and respect and leads to reduced self-confidence, loss of motivation and withdrawal from society. This discrimination has profound implications on all HIV-related services, from prevention to treatment, care and support. It reduces people’s willingness to be tested for HIV, to disclose their HIV status, to practice safer sex and to access health care. Vihaan is committed to creating a stigma and discrimination-free environment for PLHIV, and the DRTs are already proving to be effect tools to proactively respond to discrimination.

__________________________

The author of this post, Ankita Bhalla, is Communications Associate at India HIV/AIDS Alliance.

With support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Vihaan is establishing 350 Care & Support Centres across India that will help expand access to services, increase treatment adherence, reduce stigma and discrimination, and improve the quality of life of PLHIV. The centres will support PLHIV, including those from underserved and marginalized populations who have had difficulty in accessing treatment including women, children and high-risk groups in 31 states and territories.

I did the HIV test: June 1994

Fear of societal stigma and discrimination often keeps people from getting tested for HIV. (Photo by Peter Caton for India HIV/AIDS Alliance

Fear of societal stigma and discrimination often keeps people from getting tested for HIV. (Photo by Peter Caton for India HIV/AIDS Alliance)

It was one of those moments. Alone at home, I looked up the number for a diagnostic lab close by. When I got there, my heart skipped a beat to see the words: ‘HIV ELISA TEST’ jump out at me from the signboard. This was 1994, and I was scared. I wasn’t quite sure if I was ready to hear the result.

The clinic was a set of three rooms, full of grimy lab stuff, cheap plastic decor that was as depressing as it was tasteless. The secondhand magazines strewn around only added to my sense of gloom.

As I approached the counter, my head was in a spin. I thought I was running fever. Then someone asked me, “Yes, what are you here for?” I was directed to a small room where the lab technician asked me, “ELIZA for?” I answered shakily, “For HIV.” The room came to a halt. At least a couple of people turned around to stare at my face.

Here I was telling for the first time – to a bunch of strangers, amid bandages, rubbing alcohol, syringes, and pictures of smokers’ lungs and brains on drugs – that I needed an HIV test. And they were outright insulting to me. I felt humiliated.

But we needed to get back to the business at hand. Other people waited their turns too, so I extended my arm and the nurse took my blood. After a few moments, she withdrew the needle and placed my bar-coded specimen in a pass-through cabinet on the wall. It was over; I was done.

I got no counseling about what an HIV test was and what it meant to get a positive or negative result. When I went to collect my result, I was met with the same attitude of disdain. An envelope containing my result was literally thrown in my direction and that was it.

Back home, out of relief, I put on a favorite song. I did conquer my demons around HIV that day. But more importantly, I promised myself that I will never let anyone treat me the way that clinic did. It’s a promise I have kept.

__________________________

The author of this post, Shaleen Rakesh, serves as Director of Technical Support at India HIV/AIDS Alliance. He initiated the fight against Section 377 of Indian Penal Code while on staff at the Naz Foundation (India) Trust in 2001. A collection of his poems, The Lion and The Antler, was recently published.

By the Community, for the Community: India’s Own Curriculum for Vulnerable Sexual Minorities

mods2Pehchan (which in Hindi means ‘identity’ or ‘recognition’) is one of the largest programme of its kind not just in India but in the world catering to the health and development needs of men who have sex with men, male-to-female transgender and hijra (MTH) populations. The five-year programme, which began in 2010 with support from the Global Fund is implemented in 17 states by India HIV/AIDS Alliance through six regional partners – Humsafar Trust, Pehchan North Region Office, SAATHII, Sangama, SIAAP and Alliance India Andhra Pradesh. The six regional partners together support 200 community-based organizations (CBOs) of MTH people. These CBOs are at the frontline of programme implementation at the district-level.

One of the biggest programmatic exercises in the first phase of Pehchan (2010-12) was the development of a comprehensive package of thematic training modules for the CBO staff. The themes ranged from Pehchan-specific management issues to leadership and organizational development; basics of STI and HIV prevention, care, support and treatment to mental health concerns; identity-gender-sexuality to family support and issues of MTH individuals with female partners; legal and human rights to trauma and violence; positive living to life skills education. It is unlikely that such a diverse set of training modules  – 16 in all – have ever before been prepared for any marginalized community in the context of national programmes focused on HIV and associated issues of sexual and reproductive health (SRH) and rights.

The scale of development of Pehchan Training Curriculum: MSM, Transgender & Hijra Community Systems Strengthening was not only in keeping with the scale of Pehchan itself, but also in terms of the objectives of the programme. ‘Community System Strengthening’ – catchwords for the programme – is envisaged in two ambitious ways –  formation and strengthening of 200 MTH CBOs across 17 states of India; and provision of a comprehensive basket of SRH and HIV services to 453,750 MTH through these CBOs. Pehchan not only seeks to complement the National AIDS Control Programme but has also put in place a precedent for future health and development programmes for MTH or even larger LGBT populations.

The module development exercise went through three broad phases. In the first phase, experts were involved in a civil society consultation to glean inputs for each of the modules. This resulted in the development of information rich pre-modules. In the second phase, the module contents were embedded with adult-learning focused training techniques and activities through a workshop involving the master trainers who were supposed to deliver the training to CBO staff. The workshop also provided the master trainers a rehearsal on the training skills and approaches they needed to adopt for a target audience that would largely consist of first-time learners.

The modules were further streamlined in the third phase to match the programmatic priorities as well as trainee profiles and learning abilities. The third phase exercise was the most challenging as it required a team of experts and master trainers to pare down the content to make it precise, relevant, visually compelling and feasible for conveying message in a limited period of time. This phase also led to the development of the modules in manual form, which provided clear instructions to the trainers on the “how-to” of administering each module.

At a personal level I enjoyed my involvement in all stages of the module development exercise, but more so during the third phase when I led the final editing of some of the modules. The completion of work on each module provided a moment of satisfaction after weeks and months of intensive writing and re-writing. Here I must acknowledge the work done by all co-developers, topic experts, master trainers and colleagues from all partner agencies to make the modules a reality.

Of course, the exercise was far from perfect. The deployment of the training modules in the first phase of the project provided hands-on learning on the effectiveness of the modules. In the second phase of Pehchan, when cadre-based trainings have replaced theme-based trainings, the use of job aids based on the modules will provide further feedback on how the modules could be improved. However, even in their present form – as at the time of the launch – the modules are a rich repository of information and knowledge available for anyone and everyone – in India and around the world – interested in applying them in their work, or better adapting, translating, replicating and improving them!

__________________________

The author of this blog, Pawan Dhall, is a gay rights activist in India and was instrumental in drafting of the Pehchan Training Curriculum: MSM, Transgender & Hijra Community Systems Strengthening. He has been involved in queer community mobilization and development in eastern India since the early 1990s and also works with SAATHII, a non-profit that builds the capacities of individuals and agencies in the areas of sexual and reproductive health and HIV. His newest venture is Varta, which promotes dialogue on gender and sexuality as issues intimate and integral to human development in India through newspapers and other publications.

With support from the Global FundPehchan builds the capacity of 200 community-based organisations (CBOs) for men who have sex with men (MSM), transgenders and hijras in 17 states in India to be more effective partners in the government’s HIV prevention programme. By supporting the development of strong CBOs, Pehchan will address some of the capacity gaps that have often prevented CBOs from receiving government funding for much-needed HIV programming. Named Pehchan which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme is implemented by India HIV/AIDS Alliance in consortium with Humsafar Trust,  PNRO,  SAATHIISangama, and SIAAP and will reach 453,750 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single-country grant to date focused on the HIV response for vulnerable sexual minorities.

“Fearless”: Improving Sexual & Reproductive Health of Female Sex Workers

Targeted Interventions allow female sex workers to access services in a more supportive and less stigmatizing environment as compared to government hospitals. (Photo by Peter Caton for India HIV/AIDS Alliance)

Targeted Interventions allow female sex workers to access services in a more supportive and less stigmatizing environment as compared to government hospitals. (Photo by Peter Caton for India HIV/AIDS Alliance)

In India, as elsewhere, female sex workers (FSW) have considerable unmet sexual & reproductive health (SRH) needs due to their occupation and social marginalization. They shy away from accessing SRH services due to stigma and discrimination, negative attitudes of healthcare providers, and fear of law enforcement agencies, clients and people opposed to sex work.

Under the country’s National AIDS Control Program (NACP), targeted interventions (TIs) for FSWs are implemented to provide access to HIV prevention services. TIs allow FSWs to access services in a more supportive and less stigmatizing environment as compared to government hospitals. Unfortunately, TIs do not include SRH services in spite of the immediate relevance of these services.

Evidence, both global and national, has shown that linking HIV and SRH services provide a valuable impetus to encourage uptake of prevention, treatment, and care and support services, especially by people living with HIV (PLHIV) and key populations, including FSWs. With this approach in mind, India HIV/AIDS Alliance with support from MAC AIDS Fund has initiated a pilot programme Abhaya – meaning ‘fearless’ in Hindi – for FSWs in Andhra Pradesh and Gujarat.

Within existing TIs for FSWs, Abhaya expands access to complementary SRH services. The project enables FSWs and their partners to reach to a broader range of services like SRH information, counselling, referral and linkages to facilities providing relevant services. Along with this, the intervention also builds the capacity of existing healthcare providers and other relevant stakeholders to ensure a responsive attitude towards FSWs. Abhaya will also engage in advocacy with the government to identify opportunities to adapt and scale-up these expanded services in a stigma-free environment as a part of the national strategy.

Abhaya gives a significant role to FSWs and their partners in the implementation of the programme at all stages to increase ownership and the potential for sustainability of the initiative. Over the pilot year, the programme will reach 3,000 FSWs, helping them to better identify their SRH needs and access quality services thus empowering them to protect their overall health and wellbeing.

 __________________________

The author of this blog, Kumkum Pal, is Programme Officer: HIV & SRHR at India HIV/AIDS Alliance.

Supported by the MAC AIDS Fund, Abhaya expands access to sexual and reproductive health (SRH) services as part of HIV prevention interventions for female sex workers (FSWs) in Andhra Pradesh and Gujarat. The programme will complement the existing targeted intervention (TI) programme under the country’s National AIDS Control Program (NACP) by providing key SRH services and linkages and increase the desirability and value of the TIs for FSWs. Alliance India is implementing the programme with support from Sakhi Jyot in Gujarat and Prema Sangam Mahila Mandali in Andhra Pradesh.

‘Has anything changed?’ A Decade of International Day to End Violence Against Sex Workers

Community mobilisation and peer support can make a significant difference in the lives of female sex workers, helping to reduce the impact of criminalisation, social stigma and vulnerability to HIV. (Photo: Peter Caton for India HIV/AIDS Alliance)

Community mobilisation and peer support can make a significant difference in the lives of female sex workers, helping to reduce the impact of criminalisation, social stigma and vulnerability to HIV. (Photo: Peter Caton for India HIV/AIDS Alliance)

The International Day to End Violence Against Sex Workers was created to call attention to violence and other hate crimes committed against sex workers all over the world. Conceptualised by Dr. Annie Sprinkle, the first annual day was observed in 2003 by the Sex Workers Outreach Project USA (SWOP-USA) as a memorial and vigil for the victims of the Green River Killer in Seattle, Washington. On that day sex workers gathered to honour women and sex workers murdered by the serial killer Gary Ridgeway. In the killer’s own words: “I also picked prostitutes as victims because they were easy to pick up without being noticed. I knew they would not be reported missing right away and might never be reported missing. I picked prostitutes because I thought I could kill as many of them as I wanted without getting caught.”

Today, ten years from that first annual observation we should to pause and take stock. Has anything changed substantively in the last decade?

“Sex workers are subject to violence from the general community, who do not view us as deserving of protection. Sex workers are often rejected by family and peers, and for transgender and HIV-positive sex workers, the stigma can be even more intense.” (Friends Frangipani, Papua new Guinea, Asia-Pacific Regional Dialogue, 16–17 February 2011, quoted in Global Commission on HIV and the Law (GCHL) report “Risks, Rights & Health”)

In a public letter, Sprinkle states: “Violent crimes against sex workers go underreported, unaddressed and unpunished. There really are people who don’t care when prostitutes are victims of hate crimes, beaten, raped, and murdered. No matter what you think about sex workers and the politics surrounding them, sex workers are a part of our neighborhoods, communities and families.”

The GCHL report published in July 2012 highlights that more than 100 countries globally criminalise some aspect of sex work. Some countries, such as most of the United States, Cuba, People’s Republic of China, Iran, Vietnam and South Africa, outlaw sex work entirely. Some in Western Europe, Canada, Latin America, and South Asia prosecute activities related to sex work such as brothel-keeping or transporting sex workers, communicating for the purposes of prostitution, street soliciting and living off its profits. Norway and Sweden do not criminalise workers themselves, but paradoxically criminalise buying sex and arrest clients of sex workers.

Most countries use other laws against civil and administrative offences such as “loitering without purpose”, “public nuisance”, and “public morality” to penalise sex workers. Often anti-human trafficking laws are targeted against adults involved in consensual sex work rather than ensuring that the enforcement of those laws identify and punish those who use force, dishonesty or coercion to procure people into commercial sex, or who abuse migrant sex workers through debt bondage, violence or by deprivation of liberty.

The report goes on to say that for sex workers, the threat of violence – from both police and other actors – is a daily reality. Criminalisation, in collusion with social stigma makes sex workers’ lives more unstable, less safe and far riskier in terms of HIV. There is no legal protection from discrimination and abuse when sex work is criminalised. These kinds of laws invite police harassment and violence and push sex work underground, where it is harder to negotiate safer conditions and consistent condom use. Some sex workers fear carrying condoms, which are used as evidence against them, sometimes as an explicit provision of law. Police violence prevents sex workers from seeking their assistance, which ingrains a culture of more client and police violence.

Stigmatised, criminalised sex workers are unable to access programmes of HIV prevention and care. Police, criminals and clients deploy the threat of criminal sanctions to control and exploit sex workers. Rape and assault are difficult to report when the sex worker fears that she will be arrested, and sexual violence heightens exposure to HIV. Working in the informal sector reduces sex workers’ access to education and housing, thus increasing their dependence on others, including pimps.

Today, to make the observation of the International Day to End Violence Against Sex Workers meaningful, we must join the demands of sex workers, and their friends and allies to address the structural factors that continues to perpetrate, condone, and justify persistent violence against sex workers world-wide. Given this unsupportive legal environment around the world and the stigma against sex work, sex workers, and their clients, the critical first step towards ending violence against female, male, or transgender sex workers would be to repeal laws that prohibit consenting adults to buy or sell sex, as well as laws that otherwise prohibit commercial sex, such as laws against “immoral” earnings, “living off the earnings” of prostitution and brothel-keeping. Moreover, sex workers must have access to justice to ensure safe working conditions and security against violence from state and non-state actors.

 __________________________

The author of this blog, Nandinee Bandyopadhyay, is an independent consultant. She has been working on issues of class, gender, and sexuality for over thirty years. She has worked extensively with sex workers’ movements in India and internationally.