Sex Workers in Greece Face Forced HIV Testing, While Those in Malawi Fight Back

Rights-based public health measures should seek to protect all people from HIV infection, and provide those who are HIV-positive with the tools to live healthier lives. 

Greece has been a mainstay in the international press as it endures harsh austerity measures in the face of the global economic crisis. But recent news reports have also focused on another disturbing reality: At the end of April, Greek police began systematically arresting sex workers, forcing them to undergo HIV testing, and posting the names and photographs of those who test HIV-positive on official police websites. The sex workers face criminal charges of intentionally causing serious bodily harm, even though there is no evidence they were aware of their HIV status.  

The Joint United Nations Program on HIV/AIDS (UNAIDS), Amnesty International, the Global Network of Sex Work Projects, and the Global Network of People Living with HIV/AIDS, have all condemned the Greek authorities’ actions as incompatible with human rights and discordant with proven public health measures to prevent HIV transmission.  State-sanctioned forced HIV testing of sex workers also occurs elsewhere, including in the southern African country of Malawi. But in Malawi, something inspiring has happened – sex workers are fighting back.

It began in 2009, when police officers in southern Malawi raided a bar, arresting male patrons and female sex workers. The police later released all of the men but took the women to the district hospital where they forced them to undergo HIV tests without their consent. The sex workers who tested HIV-positive were charged with “spreading disease dangerous to life,” and before sentencing, a judge read out their HIV status results in open court. During this period, other Malawian sex workers reported similar instances of forced HIV testing to human rights groups. 

The Malawian sex workers involved in these cases could have returned to their homes and swallowed the bitterness of these indignities.  Instead, fourteen sex workers decided to sue the government and challenge the constitutionality of forced HIV testing. The legal case, among the first of its kind, is making its way, slowly but hopefully, through the Malawi courts.

The human rights organization representing the Malawian sex workers requested help from the human rights legal clinic I direct; my students and I contributed to the case by conducting international and comparative law research on the human rights implications of forced HIV testing. The results were clear: Because forced HIV testing is physically invasive in nature, it violates the right to bodily integrity and security of the person.  Because it’s a coercive and stigmatizing measure that discourages people from seeking voluntary counseling, testing, and treatment, it violates the right to the highest attainable standard of health. And “outings” of individuals’ HIV status without their consent, as was done in open court in Malawi and on police websites in Greece, violate the rights to privacy and dignity, especially because such revelations can lead to stigma, discrimination, and even violence.

Greek officials have attempted to justify the forced HIV testing of sex workers by stating that they’re protecting public health after an increase in AIDS cases in the country in the past year. This logic feeds into the stigmatizing notion of women as the main source of sexually transmitted infections and the misguided idea of female sex workers as “vectors of disease” from whom we must protect the general population. Rights-based public health measures should seek to protect all people from HIV infection, and provide those who are HIV-positive with the tools to live healthier lives. 

As UNAIDS and the Office of the United Nations High Commissioner for Human Rights have argued, coercive measures in the fight against HIV/AIDS, including forced HIV testing, produce bad public health outcomes by alienating at-risk groups. Mandatory HIV testing breaches medical confidentiality and facilitates stigma and discrimination against people living with HIV/AIDS, therefore discouraging vulnerable groups from seeking out what we know works to stem the tide of HIV transmission – voluntary and confidential counseling, testing, and treatment. Discriminatory state action like the forced HIV testing of sex workers drives further underground some of the people most in need of public health services that facilitate HIV prevention. It also alienates groups, like sex workers, who make fantastic peer educators on HIV.

Our eyes should remain on Malawi as this band of defiant sex workers takes a brave step to affirm their rights and the rights of all people, especially the marginalized, to live free from coercive practices that do not safeguard public health.

Sign the online petition to Greek authorities to stop the forced HIV testing of sex workers.