Sex work is one of the issues around which our moral blinders cause such great tunnel vision that we end up causing more harm than good.  We create laws and policies that we assume are for the “good of the victim” without ever consulting the persons engaged in sex work to see what their own knowledge, expertise, and approaches might suggest.  As a result, we end up not only undermining the fundamental human rights of vulnerable populations such as sex workers, we also undermine the very efforts to improve public health, such as through preventing the spread of HIV, into which we pour billions of dollars.

Cambodia, for example, was until recently praised by the international public health community for efforts to fight the spread of HIV, including a 100 percent condom use program, under which condoms were promoted for sex workers as well as more generally.  But a national anti-trafficking law introduced in 2008 broadly criminalized sex work, and sent sex workers into hiding.  The law in Cambodia and other countries came in part under pressure from the United States, which has adopted such a broad definition of “trafficking” and so demonized sex work under laws such as the President’s Emergency Plan for AIDS Relief (PEPFAR) that as much as a decade of gains in public health interventions with sex workers have been practically wiped out in a number of countries.

“The technology is there to prevent infections, but punitive laws get in the way,” Steve Krauss, regional director of UNAIDS Asia Pacific, told IRIN News.

IRIN reports that according to the multinational Independent Commission on AIDS in Asia, “Asia’s AIDS epidemic is linked primarily to unprotected paid sex, but policies outlawing sex work are undermining HIV/AIDS prevention efforts by fragmenting and stigmatizing the sex workers and turning condom possession into an act that could lead to jail time.”

This presents a dire problem in a region where carrying a condom has been construed as evidence of illicit activity, but 10 million women sell sex to 75 million men, who then have sex with another 50 million people.

Sex work is a fact of life in an extremely poor country like Cambodia.  A July 2010 Human Rights Watch report states:

People engage in sex work for a variety of reasons that are not unique to Cambodia. One primary reason is economic. Cambodia is one of the poorest countries in South East Asia, ranking 87 among 135 countries on the UN’s Human Poverty Index, well below Burma at 77. In Cambodia, 40 percent of the population earns less than $1.25 a day. The net enrollment ratio for girls in secondary school is 28 out of every 100 girls of secondary school age. In the current economic climate, women face even more limited employment opportunities and sex work may seem an attractive economic option.

According to a 2004 Asia Development Bank report cited by HRW, “gender inequalities are endemic in Cambodia’s labor markets.”

Traditional attitudes towards girls’ education and ‘appropriate’ occupations for women and men have shaped existing inequalities and continue to perpetuate disparities in employment.” The report confirms that most employed women in Cambodia work in the garment or informal sector. While a textile and garment factory worker will earn between $45 to $80 per month, a sex worker can earn a monthly income ranging from $90 to $160. Among those interviewed by Human Rights Watch, many entered sex work as a result of economic pressures (often arising from health problems of family members or landlessness) and a lack of other opportunities for education and employment.

Some sex workers therefore engage in this work because it is economically rational for them.  Others are coerced or trafficked into sex work.  While it is difficult to estimate the number of sex workers working out of choice versus the number of trafficking victims, HRW cites at least one credible source of data.

The HRW report states:

An academic study by Thomas Steinfatt funded by USAID in 2003—one of the few studies using statistical estimations based on actual counts—concluded there are about 20,829 direct and indirect female sex workers in Cambodia, with 5,250 in Phnom Penh. Of this number, the majority are over 18 years of age. A 2006 report by the Ministry of Health says there are 6,000 direct female sex workers and 26,000 indirect female sex workers. Many sex workers are ethnic Vietnamese. In addition, there are male-to-female transgender sex workers and male sex workers, but exact figures are not available.

While some women enter sex work voluntarily, others are trafficked or coerced. Steinfatt estimates that of a sample of 20,829 female sex workers, 2,488 women and children are trafficked for sex work in Cambodia, or approximately 12 percent. This is similar to a 2006 study conducted by White, Sidedine, and Mealea amongst 250 brothel based sex workers (all female), which found that 14 percent were trafficked, whereas 86 percent chose sex work on their own

Working with sex workers to secure their human rights, ensure they are free from violence and coercion, especially at the hands of police and government authorities, and building trust with sex work communities laid the foundation over many years to build effective HIV prevention interventions in Cambodia and elsewhere. 

But the new law criminalizing sex work led to the closure of most brothels and drove thousands of sex workers into underground karaoke bars, massage parlours and parks, making them more vulnerable to police corruption and HIV infection, according to Andrew Hunter, founder of the Asia Pacific Network of Sex Workers based in Bangkok.

“The full impact of this new law is still unknown,” said Hunter on 15 October, speaking at a conference in Thailand that gathered 140 civil society and government officials and sex workers from Cambodia, China, Fiji, Indonesia, Myanmar, Pakistan, Papua New Guinea and Thailand, to discuss issues of HIV/AIDS and sex work.

What is clear is that police are now interpreting the new law in ways that not only criminalize sex work and reduce condom use, but also implicate even those who distribute condoms in public health outreach campaigns.

“Police actually think they have a duty to arrest sex workers and use condoms as evidence. They need legal training – most countries do not accept condoms as evidence in court – but most sex workers never make it to court,” Hunter said.

IRIN cites UNAIDS as noting that the Cambodian law is but one example of policies driving an industry into hiding and making containing HIV a challenge. A coalition of agencies working on HIV/AIDS reported that all the eight countries at the conference on which IRIN reported had created obstacles to accessing HIV services for vulnerable sub-populations: Cambodia and Papua New Guinea specifically criminalize HIV transmission or exposure.

While new International Labour Organization (ILO) standards adopted in June 2010 include sex workers in all areas of non-discrimination, effective education of authorities and effective implementation consistent with the spirit of such new policies lags behind, and until these are addressed, “the stigma and violence that surround sex work will continue to threaten human rights and HIV prevention.”

These concerns do not go unnoticed by sex workers. “Most sex workers say access to justice and process is equally important to law reform – they have no faith that changing the law will make a difference,” Hunter said.