This article is a follow up to the 2014 Lancet series on HIV and sex work in which the authors issued a call-to-action to address barriers to the health and safety of sex workers. This article lays out continuing barriers to progress, including the criminalization of sex work across most of the world.
The authors offer a new prevalence estimate of the global HIV burden among sex workers of 10.4% while acknowledging substantial limitations in surveillance data and significant regional variation. The authors also argue that there is too little public health research on structural determinants of HIV, such as law/policy or work-environment factors. Consistent use of health care and prevention options are still undermined by extreme stigma, violence, and discrimination. Community empowerment models remain insufficiently funded, making wider scale-up and evaluation difficult.
While progress on the decriminalization of sex work continues to be extremely slow internationally, the authors acknowledge the importance of Amnesty International’s 2015 resolution in favor of full decriminalization. Misguided support for end-demand models (i.e., partial legalization in which clients continue to criminalized) and the conflation of sex trafficking and sex work both impede policy advancement.
In 2018, sex workers continue to be invisible within the global HIV response, despite ambitious targets and increasingly advanced biomedical tools. Without more comprehensive research and a concrete commitment to address structural factors like criminalization, there is little likelihood of meaningful improvements in the health and rights of sex workers.