Sex workers who use drugs

Sex workers and people who use drugs are subject to widespread violations of their human rights, which, for the most part, go unchallenged. Globally, these groups are subjected to repressive and discriminatory laws, policies and practices. These policies and practices fuel stigma, discrimination, widespread violence, and significantly increase the risks and vulnerabilities of both populations to sexually transmitted infections and blood borne viruses, notably HIV and hepatitis B and C. In settings that have detrimental and punitive drug and sex work laws and policies, sex workers who use drugs1 2 experience interconnected layers of risk and vulnerability, caused by the compounded effects of criminalisation, stigma, and discrimination.

Sex workers and people who use drugs – specifically, people who inject drugs – are now recognised as key populations in the global HIV response. However, this recognition often fails to translate into funding commitments of appropriate scale and reach, and at times results in health programmes that are not implemented from a rights-based perspective.

Furthermore, there is a worrying lack of recognition of the intersections between various communities. Sex workers who use drugs are often overlooked, crudely categorised as being within one community or the other. This approach fails to engage with people’s nuanced realities.

In a context where services are designed and implemented through the targeting of one key population or another, there is a substantial risk of sex workers who use drugs’ needs going unmet. This group is rendered invisible in research, epidemiological statistics and policy discussions, which results in invisibility in policy and programming. This invisibility was highlighted by sex workers who use drugs at the International AIDS Conference in Melbourne 2014, where conversations reflected the frustration of this community. Notably, sex workers who use drugs (particularly those who inject drugs) experience stigma and discrimination from within sex worker communities and communities of people who used drugs. Even among sex workers who use drugs, some non-injecting sex workers actively distance themselves from the stigma of injection drug use.

These discussions resulted in the development of this joint INPUD and NSWP briefing paper.

This joint briefing paper highlights the specific needs and rights of sex workers who use drugs, as a community that spans two key populations. This document provides an overview of some of the most endemic and substantive ways in which sex workers who use drugs face double criminalisation and associated police harassment, intersectional stigma, compounded marginalisation and social exclusion, heightened interference and harassment from healthcare and other service providers, infantilisation, pathologisation, and an associated undermining of agency, choice, and self-determination.

This paper also examines how compounded stigma and discrimination, as well as issues specific to sex workers who use drugs, place this community at heightened risk of negative health impacts and human rights violations.

This paper uses case studies that highlight efforts to meet the needs, and advocate for the rights, of sex workers who use drugs. These case studies draw on in-country examples of joint work between sex worker and drug user networks/communities. These case studies were developed from INPUD and NSWP consultations for the purposes of this document. Alongside references to secondary sources, these case studies demonstrate the positive outcomes of partnerships meeting the intersectional and overlapping needs, and advocating for the rights of sex workers who use drugs.

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