"Stigma against sex workers is a huge negative influence on mental health," Karma said. She has an excellent vantage point. Unlike Bellavue, she lives in a state where prostitution is decriminalized. Because she works in a legal brothel, Karma says she's in in a fairly safe environment—but she understands the risks of the trade very well. "The fact that it is legal and legitimate creates less room for intolerance," she said. She thinks she deals with less judgment from others, including friends and acquaintances, because her work has not been made criminal. That's a big deal because social rejection plays a significant role in marginalization, which isolates people from the resources meant to protect them. For many sex workers, the stigma of the sex industry prevents them from accessing adequate health care—which puts them at increased risk of contracting HIV/AIDS.It's been more than three decades and the epidemic of HIV/AIDS is far from over. The UNAIDS 2015 fact sheet states that 36.9 million people were living with HIV at the end of last year, and that 25.3 million have died from AIDS related complications since the year 2000. Less than half of those living with the disease are currently accessing antiretroviral medication. But new infections have dropped 35 percent in the last fifteen years, giving hope to leaders in the fight to end AIDS.For many sex workers, the stigma of the sex industry prevents them from accessing adequate health care.
Catherine Hanssens is the founder of The Center for HIV Law and Policy (CHLP). Her organization works for the rights of people affected by HIV. Hanssens told Broadly, "It isn't possible to make a full life possible for people living with HIV, let alone end HIV, until stigma and its reflection in biased laws and policies are eliminated." Since CHLP formed, the organization has focused on "the conditions and discrimination imposed on young people in detention and foster care facilities, and the horrific injustice and pubic health inconsistency of HIV criminal laws," Hanssens said. "If anything, we have increased our focus on the intersection of HIV, the criminal justice system, and the social/political capital of affected populations. That is where the rubber hits the road, in my opinion."It isn't possible to end HIV until stigma and its reflection in biased laws and policies are eliminated.
Sex workers are a key population for HIV transmission risk. Stigma, marginalization, and risk exist wherever punitive laws against sex work are in place.
According to a study released by UK medical journal The Lancet in 2014, in areas where sex work is recognized as a legitimate profession, the likelihood of acquiring HIV is reduced by 32 percent. Criminalization raises HIV risk in sex work populations in part by discouraging as much as one third of sex workers from carrying protection: In some regions, condoms constitute evidence of illegal sex work.The risks facing sex workers vary drastically from region to region, as well as between the different forms of sex work that people engage in. While Karma works in a legal brothel, many sex workers in the world do not have that choice. "Only about 20 percent of sex workers in the United States are street-based," Rodriguez said. "Most sex workers see clients in massage parlors, brothels, shared housing, or hotel rooms, often connecting and arranging meetings with clients online." Rodriguez explained that people who practice sex work on the street are subject to a higher incidence of violence both from their clientele and abusive law enforcement. "Further, risk reduction strategies, such as screening clients during price and condom use negotiations, are jeopardized, since fear of law enforcement crackdowns compel sex workers to move quickly and cut these negotiations short. This diminishes sex workers' ability to screen out clients with whom they may not feel safe."If a client does become violent, street-based sex workers don't have the protection that others might. Rodriguez says that these risks "may be fueled by clients' knowledge that sex workers often have no legal recourse." And this doesn't just put sex workers at a risk of physical violence. As Rodriguez noted, "As many as a quarter of street-based sex workers report feeling pressured to have sex with a client without using a condom. This is exacerbated in jurisdictions with 'condoms as evidence' policies and practices." Judging by the statements of CHLP, and Karma's experience, systems of law are not serving sex workers. Their lives are put at risk because they are criminalized and stigmatized, pushed far from the resources the rest of society relies upon.As many as a quarter of street-based sex workers report feeling pressured to have sex with a client without using a condom.
"I've only walked out on a couple of bookings," Karma said. "One, because the client repeatedly tried to kiss me on the mouth despite not paying the additional fee. Another because he was just really rude and disrespectful. I realize I'm very lucky to have not had to deal with a forceful client, because many other girls have had bad experiences with this. I have never felt in danger at work. The establishment offers security. There are cameras everywhere but inside the rooms, a security guard on duty and an intercom in every room. I've have not contracted an STI since I started working in this industry."Mayo Schreiber is an expert in criminal law and the Deputy Director of CHLP. According to him, "there are many well-known and documented factors that coalesce causing HIV/AIDS to persist." They're not outside of us, or somehow foreign to the way we live. "These factors we as a society created and sanctify," Shreiber said. "They are the result of national and local political decisions for which we are responsible: HIV criminal laws that stigmatize and harshly punish people who take the responsibility to get tested or sex workers who carry condoms, a lack of syringe exchange programs, a lack of sexual health programs or condoms in prisons and jails, the failure to provide affordable health insurance and housing for all our citizens, the failure to provide comprehensive sexual health literacy programs (particularly for young people), parental refusal to accept adolescents' sexual orientation or gender identity that force them onto the streets, etc."These factors have the greatest impact on those in our nation with the least amount of political and economic capital—the young, the impoverished, people of color, men who have sex with men, transgender people, persons who overuse drugs, sex workers, prisoners. It is primarily they who bear the brunt of the political decisions allowing HIV/AIDS to exist. But it is everyone in this country that pays the price."There are many well-known and documented factors that coalesce causing HIV/AIDS to persist. These factors we as a society created.