Pesky cultural norms


In many countries, cultural norms contribute to stigmatization of sex workers, limiting their ability to seek or obtain care. PEPFAR is working with governments to ensure that access to health care and social services is not denied because an individual is a sex worker.

This is what PEPFAR, the US Government’s global HIV and AIDS programme, says about working with sex workers in its 2009-2013 strategy.  The use of the term “sex worker” is progress, as is the commitment to doing anything at all (after years of scaring implementers away from even discussing sex work).

However, having just sat through a week of sex workers reporting on the myriad abuses they face – violence and rape from law enforcement officers and security guards; either being turned away or abused in health care facilities; being systematically stigmatised in their communities, right down to pastors refusing to baptise their children (to list a few examples) – I really struggle with the label “cultural norms”.  To use this term seems like a miserly concession… maybe, just maybe, there are some situations where sex workers are treated differently and well, maybe programmes can try and get round these situations in the interests of making sure sex workers can get HIV tests and treatment…

The thing is, these “cultural norms” (or systematic abuses of human rights, if you prefer), do a whole lot more than stop sex workers in many developing countries getting HIV services.  They force them to work in riskier situations, and to live in fear; they don’t just stop them getting HIV services, but all manner of health and social services.  The idea that you can fix or tweak the situation just enough to hit your HIV programming targets fails to recognise how complex and entrenched the discrimination against sex workers is.  It also fails to recognise that the programme managers and outreach workers who are running programmes with sex workers often partial to a bit of prejudice and discrimination themselves.  And expecting people to stick to a treatment programme when all this other stuff is going on is at best naive and at worst insulting.

But what gets me most is the description of the problem as “cultural”.  In the world of aid and development, human rights are something you challenge, but culture is something you’ve got to respect. I guess the problem is that if it was called human rights, that would involve considering sex workers to be human.

Although PEPFAR still don’t get it, they don’t have the monopoly on this… the text from the PEPFAR strategy reminds me of the Lancet editorial from last year which suggested that where the rights sex workers are concerned, AIDS programmes merely need to find ways round criminalisation and systematic abuse in order to get them onto treatment programmes. It isn’t unusual to hear similar language from UN agencies.  There’s a long way to go.


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