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HIV prevention strategies within the Australian sex worker population - an overview of successful implementation

Presentation by Rachel Wotton, International Spokesperson, Scarlet Alliance -the Australian Sex Workers’ Association, XVII International AIDS Conference, 3-8 August 2008, Mexico City, Mexico “Universal Action Now”

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Sex Workers are always linked to HIV but more often than not we are viewed as a part of the problem rather than the solution. We are researched, spoken about as mere statistics, poked, prodded, quantified, written about, expected to participate in drug trials without question, blamed, stigmatised, vilified and discriminated against, all around the globe.

So today I would like to thank the organisers of the International AIDS Conference for allowing the voice of sex workers to be heard. For in order for HIV prevention strategies to truly be successful, there needs to be ongoing support and recognition of the positive and successful contributions sex workers have made so far. For individuals, organisations, governments and funding bodies to take an evidence-based approach and learn from these successes, really listen to what sex workers have to say and build upon and implement these strategies in your own country.

Today I will share with you a brief overview of Scarlet Alliance – the Australian Sex Worker Association as well as outlining a number of recent projects implemented by Scarlet Alliance, within the Australian sex worker population.

In the 1980's Australian sex workers responded very quickly to the threat of HIV infection. This occurred through increased condom use and peer led education campaigns. Other contributing factors to the Australian "success story" of HIV prevention for sex workers include: funding of sex worker organisations, legislative reforms and inclusion and consultation of sex workers in policy development – at both local and national levels.

To date, there is no known case in Australia of a sex worker transmitting the virus to a client or vice versa. This is formally acknowledged by the government within the National HIV/AIDS Strategy.

Overview of Scarlet Alliance

Scarlet Alliance, the Australian Sex Workers Association, was formed in 1989 following the first national sex industry conference. It is a completely autonomous sex worker organisation with all paid and unpaid positions, voting delegates and elected office bearer roles in Scarlet Alliance held by former or current sex workers. This includes the CEO and every member of the Executive Committee.

As the national peak sex worker organisation, Scarlet Alliance represents its membership of Sex Worker Organizations, Projects, Networks and Groups - as well as individual sex workers - throughout Australia. This includes male, female and transgender sex workers.

Four key strategies inform the work of Scarlet Alliance: community engagement; community development; health promotion and peer education. Through our objectives, policies and programs we aim to achieve equality, social, legal, political, cultural and economic justice for past and present workers in the sex industry, in order for sex workers to be self-determining agents, building their own alliances and choosing where and how they work.

Direct sex worker participation including: e-lists, working parties, community forums, media, public forums, marches, demonstrations and an Annual National Conference. Our magazine, ProVision, is also published twice a year for sex workers.

Scarlet Alliance recognises that there is a need for the affected community to be a part of the response. For this reason Scarlet Alliance has representation on a number of boards and committees, and is a member of the Australian Federation of AIDS Organisations (AFAO). Other roles that Scarlet Alliance fulfils include:

  • Providing a voice for National issues effecting Sex Workers via the Australian and International media.
  • Providing training and education to other Organisations and Government Departments on issues relating to the Australian Sex Industry and the migration of sex workers into Australia (often referred to as the trafficking of women for the purposes of sexual servitude).
  • Presenting up to date information on Sex Industry issues at International and National forums of Health, Law, Research, Human Rights, Feminist, Community Education, Immigration and Global Issues.

In the last few years Scarlet Alliance has increased its capacity to deliver diverse and relevant HIV prevention projects to sex workers across Australia. These projects include the National Training Project, Chlamydia and Sexual Health project, the Scarlet Men website and a HIV positive sex worker needs analysis project.

National Training Project

Peer Education, where people with knowledge of, and experiences in, the sex industry are employed as peer educators, has proven to be the most successful model of service delivery to sex workers. Scarlet Alliance and our member projects and organisations have supported staff throughout Australia to participate in an on-going process acknowledging the high level of skills held by peer educators. This process of documenting and defining the specific and highly diverse skills of peer educators has resulted in the development the Scarlet Alliance National Training Project.

This project is supported by resources in a National Training Package which continues to be utilized by peer assessors in every state when needed. To be eligible for assessment, a sex worker needs to fulfill the following requirements:

  • you are working in a peer educator role or you are volunteering in a peer educator role and
  • you have at least 12 months experience in your role, and
  • you are working/volunteering at a Scarlet Alliance member organisation, project, network or group

The Diploma includes 18 units of competency (14 compulsory and 4 elective). Eleven of these have been adapted specifically for peer educators working with sex workers. The competencies have been grouped into five "work function areas" that relate to the many tasks carried out by Sex Worker Peer Educators.

These work functions areas include:

  • Communication, Community Development,
  • Project Management,
  • Public and Community Education, and
  • Working with sex workers.

After successful accreditation, the peer educator can then receive the nationally recognised Diploma of Community Education. This is an important recognition of the professional competencies of peer educators, and allows their work to be understood alongside other national competencies and standards. This Diploma can also be used towards gaining entry or extra credit points towards university or other forms of higher education courses.

CASH project

The Scarlet Alliance Chlamydia Awareness for Sex Workers Health Project, otherwise known as the CASH project, has been running for two and half years. The project included both national and local components around Australia.

The national component involved developing a training manual for peer educators called the Chlamydia Education Training Package. The three local components included the development and distribution of three key resources within the local sex work community in Tasmania, sex workers in Adelaide and sistergirl sex workers in Darwin.

Core information from the Chlamydia Education Training Package was identified and adapted in consultation with members from the local sex work community and builds upon the success of the National Training Project. This information was shaped into the set of key messages centred around Chlamydia:

  • improving knowledge amongst sex workers about the STI;
  • increasing information on testing and treatment;
  • skills utilised by sex workers to prevent STIs;
  • and sex workers as safe sex educators of their clients.

Community development approaches and the involvement of local sex workers were vital to the strength of the resources and their appropriateness to sex workers and sex work settings. While the brief was the same, each sex worker community involved in the project determined their own needs and adapted the information according to their needs, creating completely different resources from one another:

  • The sistergirl sex worker community in Darwin developed a t-shirt,
  • the Tasmanian sex workers created a board game, and
  • the Adelaide sex workers created a resource folder for every brothel that can be updated constantly by brothel workers and outreach staff.

The final phase of the project includes the development of feasibility for up-scaling report and the final evaluation of the project.

Scarlet Men website : www.scarletmen.org.au

Male sex workers have always played an important and high profile role in sex industry advocacy, lobbying and representation in Australia. They have volunteered their time, knowledge and skills to ensure that male sex work issues are heard by policy makers, politicians, and the community.

Unfortunately funded peer education projects for male sex workers are rare in Australia and it is genuinely difficult to access services and support for male sex workers. The Scarlet Men website is an initiative of Scarlet Alliance and is a site about health, services, and other issues important to male sex workers in Australia. It also links to the Scarlet Alliance Male Sex Worker information pages which include an archive of articles, information, interviews, stories, artwork and research by and for male sex workers in Australia.

HIV positive sex worker needs analysis project

Scarlet Alliance was recently funded through the Elton John AIDS Foundation grant, administered by the AIDS Trust, to conduct a one year HIV Positive sex worker needs analysis project.

Aims of the project was to capture the self identified issues facing HIV+ sex workers, barriers to accessing services, and the impact of discrimination, stigma, policy and laws.

The last report on the needs of HIV positive sex workers in Australia was around fifteen years ago so this project was long overdue. The subsequent reports and recommendations will assist the entire HIV sector and all sex worker organisations and services to better meet the needs of HIV positive sex workers.

The project includes:

  • a steering committee that meets regularly to provide input into the project.
  • a National Association of People with AIDS (NAPWA) advisory position (www.napwa.org.au)
  • a literature review of available documentation and current laws
  • a needs analysis of self identified issues for HIV+ sex workers
  • contributions by HIV positive sex workers to be published in the Scarlet Alliance ProVision magazines, and
  • employment of a part-time project officer

The project has created two reports, the first being a comprehensive needs assessment of HIV+ sex workers, the second assessing the legal frameworks currently regulating HIV+ sex workers in Australia and the impact these regulations have had on both their work and private lives. This has recently cumulated into a half day forum, to deliver the recommendations of the project to the HIV sector.

These projects show the range and diversity of strategies that can be utilized, allowing the voices and needs of sex workers to be authentically represented in policy development, service delivery and HIV education. Ongoing consultation and support of sex workers by government will ensure that the ongoing success of HIV prevention strategies within the Australian sex worker community can continue.

Conclusion

These strategies can be utilised for sex worker communities around the world. Failed approaches to HIV prevention need to be addressed and replaced with an evidence-based approach to what does work. Recently Scarlet Alliance has helped facilitate the development of Friends Frangipani Association - the new Papua New Guinea sex worker organisation and has forged strong ties with Mongolian sex workers. I am also very happy to announce that we have recently been successful in gaining funds to allow us to partner with sex workers in Fiji and East Timor to support them to also develop their own autonomous sex worker networks and associations.

It is hoped that through such positive initiatives and acknowledgement of the success of the Australian response, sex workers in other locations can also be supported in relation to HIV prevention strategies.

Always remember: Nothing about us, without us.