As noted previously, no national survey estimates are available regarding the number of HIV infections among sex workers in the U.S. But the research that has been done in specific cities is telling.
Among street-based, drug-using women selling sex in Miami, 22.4% were HIV positive in a study published in 2006. In a recent study of male sex workers in Houston, 26% tested HIV positive. And the rates among transgender individuals tend to be even higher: In a 2009 study of male-to-female transgender sex workers in Boston, one third had HIV. The CDC reports that HIV infection rates among transgender populations range from 14% to 69%, with the highest prevalence among male-to-female transgender sex workers.
The lack of public health attention to sex workers in the U.S. is clearly not due to the fact that their HIV rates are too low to warrant it. Rather, the limited available data strongly suggest that this population is, in fact, fundamentally "like the others" and is just as deserving of the attention and dedicated support of HIV prevention advocates as are MSM and IDU.
As always, the most persuasive case is made by those whose story it is. "People are not aware of sex workers and what they go through ... or why they are in the work that they're in," observed a sex worker named Patricia, who was interviewed for the Sex Workers Project's 2005 report. "When they were growing up, they didn't say, 'Oh, you want to be a ballerina? I want to be a hooker.' It didn't work that way."
Will Rockwell, a sex worker and youth officer for the global Network of Sex Work Projects, told National Public Radio in 2008 that, "[in] a culture in which sex work is criminalized, this sort of work is invisible, and so is the police harassment, the legal abuse, the client violence" that sex workers face. According to Rockwell, sex workers need "affordable housing and heath care, along with a legal framework that takes into account reproductive rights, labor rights, [and] immigrant rights -- and considers sex workers human beings."
These are not impossible goals if advocates are willing to make the noise, generate the data and demand the representation to achieve them.
Anna Forbes is a writer, organizer and women's health activist who has been working full-time in HIV/AIDS since 1985. She is currently an independent consultant and is learning sex workers' rights advocacy from some inspiring teachers.
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