3.1. Definition
Good practice recommendations are overarching principles derived not from scientific evidence but from common sense, ethics and human rights principles. These recommendations did not go through a formal GRADE process.
3.2. Background
Like all human beings, sex workers are entitled to the full protection of their human rights, as specified in international human rights instruments (39,40). Human rights include the rights to non-discrimination; security of person and privacy; recognition and equality before the law; due process of law and the highest attainable standard of health; employment, and just and favourable conditions of employment; peaceful assembly and association; freedom from arbitrary arrest and detention, and from cruel and inhumane treatment; and protection from violence (41).
Sex workers are essential partners and leaders in effective HIV and sexual health programmes, and for developing solutions that respond to the realities of the environments in which they live and work. Laws that directly or indirectly criminalize or penalize sex workers, their clients and third parties, and abusive law enforcement practices, stigma and discrimination related to HIV and sex work can undermine the effectiveness of HIV and sexual health programmes, and limit the ability of sex workers and their clients to seek and benefit from these programmes (41,42). Of particular concern is violence perpetrated against sex workers, as well as repressive police practices, including harassment, extortion, arbitrary arrest and detention, and physical and sexual violence. Also of concern are health-care settings where there is stigma, discrimination and denial of health care to sex workers. Since sex worker-led organizations are crucial for enabling sex workers to protect themselves from discrimination, coercion and violence, measures that prevent them from assembling and organizing themselves are also of significant concern.
Attention and resources are needed to prevent, address, report and redress violence against sex workers, especially by supporting sex workers' individual and collective self-organization and self-determination.
The promotion of a legal and social environment that protects human rights and ensures access to information, services and commodities related to HIV prevention, treatment, care and support, without discrimination, is essential for achieving an effective and rights-based response to the HIV epidemic and promoting public health, including in the context of sex work.
3.3. Good practice recommendations
Recommendation 1
All countries should work toward decriminalization of sex work and elimination of the unjust application of non-criminal laws and regulations against sex workers (19,43,101).*
Implications
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The police practice of using possession of condoms as evidence of sex work and grounds for arrest of sex workers should be eliminated.
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The wide latitude of the police to arrest and detain sex workers without cause, including the use of public order statutes to prevent sex workers from being in public spaces and police extortion should be eliminated.
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The fear and stigma faced by sex workers should be reduced, thereby facilitating them to seek and utilize health and other services.
Recommendation 2
Governments should establish laws to protect against discrimination and violence, and other violations of rights faced by sex workers in order to realize their human rights and reduce their vulnerability to HIV infection and the impact of AIDS.† Antidiscrimination laws and regulations should guarantee sex workers' right to social, health and financial services (41).
Implications
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Policy-makers, parliamentarians, religious leaders and other public figures should work together with civil society and sex workers' organizations to confront stigma, discrimination and violence against sex workers, and transform punitive legal and social norms and practices that stigmatize and marginalize sex workers towards ones that protect the rights of sex workers. Representatives of UN agencies should do everything possible to support these national processes.
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Programmes should be put in place to provide legal literacy and legal services to sex workers so that they know their rights and applicable laws, and can be supported to access the justice system when aggrieved.
Recommendation 3
Health services should be made available, accessible and acceptable to sex workers based on the principles of avoidance of stigma, non-discrimination and the right to health.
Implications
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Decriminalization of sex work should reduce stigma. Complementary actions should be undertaken to reduce stigma related to HIV and sex work in health-care settings and communities.
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Programmes should be put in place to sensitize and educate health-care providers on non-discrimination and sex workers' right to high-quality and non-coercive care, confidentiality and informed consent.
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Sex workers' groups and organizations should be made essential partners and leaders in designing, planning, implementing and evaluating health services.
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Essential health services for sex workers must include universal access to male and female condoms and lubricants, as well as access to comprehensive sexual and reproductive health services, and equitable access to all available health-care services including primary health care.
Recommendation 4
Violence against sex workers is a risk factor for HIV and must be prevented and addressed in partnership with sex workers and sex worker led organizations.
Implications
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Violence against sex workers needs to be monitored and reported, and redressal mechanisms established to provide justice to sex workers.
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Law enforcement officials, and health and social care providers need to be trained to recognize and uphold the human rights of sex workers, and held accountable if they violate the rights of sex workers, including the perpetration of violence.
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Support services need to be provided to sex workers who experience violence.
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See the Report of the Global Commission on HIV and the Law: Risks, Rights & Health, July 2012; Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, A/HRC/14/20, 2010; UNAIDS Guidance Note on HIV and Sex Work, 2012.
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See International Guidelines on HIV/AIDS and Human Rights, Guideline 5, para.22: “States should enact or strengthen anti-discrimination and other protective laws that protect vulnerable groups, people living with HIV and people with disabilities from discrimination in both the public and private sectors, that will ensure privacy and confidentiality and ethics in research involving human subjects, emphasize education and conciliation and provide for speedy and effective administrative and civil remedies.”
