In Rwanda and Cameroon, as well as in many other African nations, prostitution is criminalized and sex workers may face an extended prison sentence and high fines for their practices.
Female sex workers are considered an at-risk population due to their general isolation from society and their stigmatized profession. A survey conducted in Rwanda found that 51 percent of female commercial sex workers were infected with HIV; this is 17 times higher than the national average (3 percent).
The illegal nature of their work makes it difficult for females to access, receive, and maintain treatment for HIV infection. For example, prostitutes who are jailed are unable to adhere to their treatment regimens. Additionally, these marginalized women face open discrimination from their communities, families, and often, health workers who refuse to distribute adequate prevention or treatment methods.
Although Rwanda’s National Strategic Plan for HIV/AIDS (2009-2012) hopes to reach 60 percent of female sex workers with HIV prevention programs, it will be difficult to fulfill this goal if their practices continue to be criminalized. Sex workers are not likely to openly and actively engage in HIV prevention initiatives for fear of jail time or other punishment.
India has attempted to negate the social barriers to treatment and prevention through targeted interventions among female sex workers. By actively focusing HIV/AIDS interventions on this vulnerable population, an expected 3 million new infections can be averted between 1995-2015.
A study conducted by the World Bank evaluated the impact of this strategic approach on female sex workers in four districts with high HIV prevalence: Andhra Pradesh, Karntaka, Maharashtra, and Tamil Nadu. HIV prevalence declined by more than 50 percent (1.9 percent in 2001 to 0.8 percent in 2008), and was attributed to an increase in consistent condom use.
The interventions focus on providing contraceptives, offering treatment for STI’s, and raising awareness through peer education.
However, while this approach is gaining greater acceptance for females, male sex workers are entirely excluded from the initiatives, and therefore face even greater barriers to HIV prevention and care.
In many developing countries, such as Cameroon, homosexuality as well as prostitution is outlawed. The Cameroonian government does not recognize these men as an at-risk group, and therefore they receive none of the benefits offered to female sex workers through HIV prevention and control programs.
Male sex workers are often forced to lie in order to receive treatment from state hospitals. Additionally, their risky behavior and lack of awareness exposes them to an even greater risk of transmission. For example, many gay male sex workers feel that AIDS does not concern them, as spot advertisements on TV only show heterosexual couples. In order to broaden the audience of these HIV/AIDS awareness campaigns, Adonis Tchoudja, president of Aids Acodev, a sex workers’ association in Cameroon, advocates for the inclusion of lesbian, gay, bisexual, and transgender people in their messages.
The successes made by the national HIV/AIDS response may be undermined if men who have sex with men are not included in these targeted prevention and treatment initiatives, as the risk of transmission to the wider population remains high.