In the course of our research on sex work at the Michael Kirby Centre for Public Health and Human Rights in Melbourne we have noticed that public health prosecutions and ‘naming and shaming’ of HIV positive sex workers occurs in cities and towns across the world, including in the UK and US. We are also observing a general increase in mandatory HIV testing and the emergence of various other links between medical procedures and law enforcement in the context of female sex work.
Nobody doubts that HIV testing is crucial, especially now that there is effective ARV treatment that also significantly reduces transmission of the virus. Nor does anyone doubt that these actions violate established and fundamental human rights. That includes the Greek authorities. They raise an age old discourse by claiming their actions subjugate human rights for valid public health considerations.
Successful HIV prevention is known to depend on a large portion of sex workers and clients using condoms and accessing STI and HIV treatment. The strategies for achieving this that have proven successful are reducing the burden of criminalisation and discrimination and providing respectful services including quality health care, information and social support. Crucially this has to apply to migrant sex workers too.
A randomised controlled trial may not be possible but there is sufficient research and experience to compare the results of ‘rights based’ approaches with heavy handed tactics like those used in Greece that have been shown to drive sex industries underground and reduce the number of sex workers reached by HIV prevention services. Thus it is clear that repeatedly testing a few ‘legal’ sex workers while alienating ‘illegal’ sex workers from services and testing them forcibly in the wake of sporadic raids is not good public health and it is a waste of resources that could be better used.
Sometimes medical ethicists grapple with complex cases that genuinely raise conflicts between human rights and public health. This is not such a case. The Greek health authorities and many other governments and local authorities that have taken similar actions against sex workers have both the human rights and the public health very wrong.
Senior Research Fellow. Michael Kirby Cente for Public Health and Human Rights
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