Pye Jakobsson, a Swedish sex worker activist, set the record straight for health care providers and policymakers attending the International Harm Reduction Association (IHRA) conference last week in Beirut. In her plenary speech, Pye stressed that sex work is not inherently harmful and that sex workers are not a hard to reach community. The real problem is that programs aimed at sex workers are often designed without the input of sex workers themselves.
Like Pye, many sex workers have embraced the term “harm reduction” to describe a variety of actions taken to promote the health and safety of sex workers. However, they consistently emphasize that the “harm” associated with sex work is not sex work itself, but repressive, criminalized environments where sex workers lack access to appropriate services and face widespread human rights violations.
The harm reduction framework was originally developed to minimize the negative effects of drug use on people’s health and well-being. Harm reduction meets drug users “where they are at” in relation to their drug dependence. It focuses on reducing harm through efforts such as syringe exchange and substitution treatment rather than promoting the abolition of drug use itself. Public health evidence overwhelmingly favors harm reduction as an effective strategy for reducing health risks for drug users, including HIV infection.
Many health care providers have employed a similar approach in designing services for sex workers: reducing the risk of HIV and other sexually transmitted infections through empowerment, peer education, and condom distribution. Sex worker rights groups at the conference stressed that while these types of activities are important, they only go so far. Given the negative impact that laws and policies criminalizing sex work have on the lives of sex workers, effective harm reduction programs must also address the legal and policy environments that affect sex workers’ health and human rights. A number of harm reduction organizations have broadened their programming accordingly to include legal services and advocacy to decriminalize sex work.
In a panel on "street lawyers" and harm reduction, Hajdi Shterjova Simonovikj, a lawyer from the Macedonian organization Healthy Options Project Skopje (HOPS), said that after several years of providing health services for sex workers, she and her colleagues realized that it wasn’t enough. Sex workers had condoms and information about HIV, but they still faced harassment and arrest by police, who would confiscate their condoms and money. Upon release from prison, many resort to having unprotected sex in order to earn enough money to get home. HOPS now provides legal services to sex workers, and advocates against police harassment and violence as part of its harm reduction strategy.
HOPS is supporting 13 sex workers in a lawsuit against Macedonia’s Ministry of Internal Affairs for human rights violations perpetrated by police during a November 2008 raid. Hajdi believes that legal support, especially court litigation, encourages empowerment, self-organizing, and community mobilization among sex workers to promote and protect their rights. Hajdi has noted a decrease in the number of arrests of sex workers in Skopje since the 2008 raid, though it is not clear if this is a direct result of the ongoing lawsuit.
Like many marginalized groups, sex workers are often referred to as a “hard to reach” community. Pye and other activists challenge this notion, calling it an excuse for poorly designed programs that fail to effectively engage sex workers in their development and implementation. If sex workers aren’t reached with services, service providers must ask themselves what they need to do differently. It’s a lesson sex worker activists wishing to collaborate more closely with the harm reduction community have successfully employed. As Pye recalls, sex worker engagement at the 2008 IHRA conference in Barcelona fell largely outside the main conference agenda. Though there was notable interest in the two sex work-focused sessions, she said it was as if the activists present were on a “small boat,” floating disconnected from what was happening in the larger program.
Over the last several years, sex workers have worked collaboratively with IHRA to deepen their partnership and more meaningfully integrate sex work-related topics into the meeting. In Beirut, 17 presentations by sex worker rights activists from more than 12 countries were woven into the conference program, sparking dialogue on sex work throughout the conference.
In her remarks during the closing session of the conference, Pye triumphantly proclaimed: “Sex workers are here, and it’s about time!”