Minister, Distinguished Guests, Ladies and Gentlemen,
I thank you for the opportunity to speak here at the launch of WAD day in Sydney for 2014.
I acknowledge all those who live with HIV and acknowledge and remember all those whose lives have been cut short by the virus and especially I acknowledge and remember all my brother and sister sex workers who either live with HIV or have died as a result of HIV infection.
Less than six months ago I sat in the vast space of the Melbourne Conference Centre during the 20th International Conference on HIV/AIDS. There I listened to Justice Kirby while he spoke of the death, cruelty, suffering, loss, irrationality and hatred that had been forces in our lives every day in the over 30 years since HIV first appeared among us. And then he paused and said, “This is not a time for silence. It is not a time for silence nor has it ever been a time for silence.”
I am a current sex worker and am a sex worker who lives with HIV. The intersection of HIV and sex work is a difficult place. It is a place of great stigma and discrimination, a place of great responsibility and a place of learning and love.
HIV started with, and has long been defined by fear.
People living with HIV have been subject to so much irrational fear and prejudice in the past 30 years that there should be a name for it. Sex workers have been stigmatised and discriminated against for many centuries. Sex work is misunderstood and feared and sex workers have suffered a long and undeserved reputation as vectors of disease. Prejudice against sex work and sex workers has been occurring for so long and happens so often that sex workers do have a name for it.
We now stand at any important point in the history of the HIV epidemic with a range of new biomedical tools that can give us control over the virus. But we must remember the diversity of the populations affected by the virus and that biomedical prevention is not a “one size fits all” solution.
For sex workers peer based outreach, education and community development programs and particularly peer education and outreach supported by government have proved highly effective and successful long term tools in HIV prevention. No case of HIV transmission has ever been documented in Australia in a sex work setting, and Australian sex workers enjoy lower rates of HIV than non sex workers.
In NSW we are lucky enough to have sex work almost fully decriminalised, one of only two places in the world.
Decriminalisation of sex work is recognised best practice by all experts in the field including UNAIDs and is the legal framework demanded by sex workers everywhere. Decriminalisation allows sex workers control over both their work and their workplaces. Ground breaking research by the Lancet from AIDS2014, says that decriminalisation helps reduce HIV transmission 33-46%.
Whilst there is a constant battle to obtain decriminalisation around the world, here in NSW we battle to retain it against sensationalist media and calls or licensing and regulation where none is needed. Even when sex work is decriminalised stigma and discrimination remain; Stigma and discrimination are recognised powerful drivers of HIV transmission, and sex workers have no legal protections available to us based on the source of this stigma and discrimination; our occupation and work as sex workers.
Stigma and discrimination make sex workers a difficult population to reach and engage. A need that may become even more critical as the idea of HIV diagnosis equals death decouples in the public mind. This highlights the importance of the continued funding of peer based outreach and education programs, which must be supplemented by work to break down stigma and discrimination.
Sex worker health is only a small part of overall HIV funding. Some people believe funding is low because of sex worker successes in HIV transmission reduction, but that success was built on a great and continuous 30 year effort, often unfunded and unpaid and it would be dangerous especially in the current volatile, changing and often problematic HIV prevention landscape.
Biomedical prevention strategies such as treatment as prevention and pre-exposure prophylaxes will allow many to take control of existing HIV infections or assist them in protecting against infection. Sex workers, indigenous people and people who inject drugs have so far not been a significant part of the conversation around the issues arising from biomedical prevention. Biomedical prevention intersects with the lives of many sex workers already. Post exposure prophylaxis provides us with a fall back level of protection if barrier protection fails.
Sex workers living with HIV have been achieving undetectable viral loads and thus using TasP where they are able, since the Swiss statement in 2008 to provide an extra layer of protection behind their existing use of safe sex practices and barrier protection. A number of sex workers [mainly from within MSM populations} are already signing up to the PRELUDE demonstration study of Pre Exposure Prophylaxis announced last week by the Kirby Institute at UNSW.
Sex workers recognise that the focus and effect of TasP and PrEP are on HIV only. These interventions have no effect on other STIs and safe sex practices, and condoms remain our first line of defense both HIV and non HIV STIs.
Regular testing, rapid testing and home based testing underpin TasP and PrEP, and are designed to reduce perceived barriers to HIV testing. Sex workers voluntarily test regularly and concurrently for all STI’s including HIV.
Many sex workers, both positive and negative, have concerns about home based HIV testing which they see as uncontrolled testing. These concerns centre around the possibility of home based testing kits being misused once released from controlled clinical settings.
With HIV prevention at such an exciting but crucial point we need to ensure that we also have clear and true overall view of the multi-faceted and nuanced factors involved in its transmission in all populations, plus the political will, funding and legal reforms necessary to support the fight to end HIV and that in that struggle no one is left behind.
I thank the Minister for her dedication to this fight, which has been long standing and much appreciated…
And may I remind you that “This is not a time for silence”.
Cameron Cox
Published for Talkabout Online #183 – February 2015
