The devil is in the detail


It isn’t every day that the UNAIDS website carries a feature story about African sex workers fighting for their rights.  The feature in question was published shortly after March 3rd, which is International Sex Worker Rights Day, and described initiatives supported by UNAIDS in two countries: Kenya and Namibia.  It is great that the story is featured so prominently.

I was quite involved in the Namibia work, as I’ve explained here and here.  As a result I read the UNAIDS story very closely after seeing it on Twitter.  And then I wrote to UNAIDS: 

@UNAIDS It’s great you covered Namibia in your sex work story. However there are a couple of inaccuracies in the article. Can we discuss?

I also sent an email.  It’s been a couple of days since I contacted them so I think it is fair to explain here which parts of the story I take issue with.

Firstly, this sentence:

The publications noted that sex workers are disproportionately affected by HIV due to the nature of their work—most of the time they can not negotiate the use [sic] condoms with their clients.

(Emphasis added).

I’ve read every piece of research conducted with sex workers in Namibia, dating back to 2000. The quality of the research is, on the whole, very poor, based on unspecified methods and non-representative samples.  Nonetheless none of the studies says that most sex workers cannot negotiate condom use.  The participants in the community assessment research we set up in October didn’t say this was the case either.  To be sure, condom use is not systematic.  This may have something to do with negotiation skills, but as the assessment showed it is also affected by lots of other things, such as the attitudes of clients, with the fact that police officers use posession of condoms by sex workers as evidence of criminal activity, and lack of supply. It is inaccurate and stigmatising to imply the problem is just about sex workers.

Secondly, this:

The reports include recommendations for action by national and local stakeholders to address these challenges and protect the human rights of sex workers. Such recommendations include addressing violence, abuse and stigma towards sex workers as well as reducing legal and policy barriers that block their access to HIV services.

(Emphasis added).

When sex workers involved in the work asked for changes to laws and policies, they were not doing so on the grounds that it would help them get access to HIV services.  They were doing so because the laws and policies as they stand are one of the main reasons they are so vulnerable to violence, abuse and stigma.  Yes, HIV is a big issue for sex workers in Namibia.  But it is one of many issues.  That much was clear from what sex workers said throughout this project and during their interviews with several Namibian newspapers.  Indeed the quotes from sex workers that UNAIDS uses in its feature more accurately reflect the reality.

The reason I think this is important is because the whole idea behind the work we did in Namibia was to move away from the standard survey approaches which ask sex workers the same standard questions about condom use and access to services, and to give sex workers space to talk, among other things, about the issues that HIV programmes aren’t helping them with and maybe even won’t help them with.  We achieved this to an extent, so it is frustrating to see this message get homogenised into the same old narratives that we normally hear.  I’ve written before about the need HIV policy wonks have to only discuss things that have categorically been shown to have an epidemiological association with HIV.  That’s fine up to a point, but if we’re really committed to listening to communities, we’ve got to take what they are saying at face value.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s