The Healthy Hooker

new internationalist
issue 252 - February 1994

Health in your hands: the New Zealand Prostitutes' Collective produce their own poster.
The healthy hooker
Prostitutes are often blamed for spreading AIDS.
Catherine Healy and Anna Reed say they do the opposite.

A smartly-dressed couple check into a city hotel armed with red wine and condoms. In a building across the street a couple, who have just met, are putting on a condom. Down a lover’s lane, in the back seat of a car, two young people, high on dope, are removing one after finishing sex. Out in the suburbs a man puts one on before he has sex with his regular partner.

No, this is not a couple who are having an affair, nor are they people who have just met at a bar, nor teenagers after the school dance. And they are certainly not long-time lovers. They are all people who are part of the sex industry – sex workers and their clients.

Historically, sex workers have been blamed for passing on sexually-transmitted diseases. But in many parts of the world the facts are showing something quite different. It is our belief that sex workers know a great deal about the human side of sex, and have developed some experience relevant to the prevention of the spread of sexually-transmitted diseases. They know a lot about sex and the thoughts, behaviours and attitudes that go with it. And this makes them the ideal transmitters of safer sex practice.

In the shadow of the AIDS pandemic, many prostitutes are aware of the implications that the spread of the disease has, not only for their own lives and livelihoods, but also for their many sex partners, and in turn for the general population. Consequently, day and night they instruct their clients in safer sex practices before engaging in sexual contact with them. For those clients who protest the message is clear. To quote an imposing transsexual worker we know, it’s ‘No joe, no go!’

There is now near-universal use of condoms by sex workers in industrialized countries. This is having a far greater impact on sexual culture than all the chats in doctors’ clinics. We can’t prove it, of course, but it is probable that prostitutes have been more successful in safer sex education than all the television advertisements put together. After all, the best way for someone to learn something is to do it. So it follows, the best way for a man to start to feel OK about condoms is to have someone put one on him, and then proceed to give him a pleasurable experience.

Yet, somehow, it’s still the sex workers who are perceived by many to be a major reservoir of infection, the vectors for the transmission of HIV/AIDS into the general population. In the early days of AIDS it was inevitable that the sex industry would be scrutinized. The media in our own country – Aotearoa/New Zealand – ran stories that whipped up hysteria against prostitutes, with images of the ‘vengeful AIDS victim... a crazed hooker on revenge trip against all punters’. We have yet to hear about the crazed punter hell-bent on infecting prostitutes.

Some prostitutes do have unsafe sex. Sometimes they are badgered into having it by an obnoxious or drunken client or they may simply be offered more money to do so. Sometimes the workers are themselves affected by alcohol or drugs. But many prostitutes are badgered, are offered extra money, work under the influence of drink or drugs – and yet they don’t do anything unsafe.

Why not? Because they take care of themselves; because they have self-esteem. That is the key to stopping sexually-transmitted diseases. And the more control sex workers have over their lives the more likely they are to develop self-esteem. If they do not they are more likely to be careless and at risk from infections like HIV.

AIDS on the table: Brazilian prostitutes have formed their own organization and educate themselves about safer sex.

In 1986 there was an international health conference in Ottawa, which produced a charter calling for ‘all people to achieve their fullest health potential’. This includes ‘a secure foundation in a supportive environment, access to information, life skills and opportunities for making healthy choices’. It goes on to say that, in order to achieve such potential, people need to ‘take control of those things which determine their health’.

Policy-makers in our Department of Health must have paid attention to this important document, because they formed a contract with sex workers and supplied funding to peer educators to run AIDS-prevention programmes in the sex industry. The New Zealand Prostitutes’ Collective was born.

This funding has allowed us to set up a community drop-in centre, where sex workers can gather, receive support from others and information relevant to their health. Condoms and other safe-sex accessories are also made available. Outreach workers go around the country spreading the prevention messages and there are needle-exchange programmes for those prostitutes who need them. The success of these programmes has resulted in a low incidence of HIV/AIDS in the sex industry.

At one of our centres we’ve set up a medical clinic where we carry out anonymous HIV-testing for sex workers. Can you imagine how empowering it is for prostitutes to interview doctors and nurses to ascertain their suitability for staffing our clinic?

Obviously we are biased towards programmes run by sex workers, but the assistance of health professionals to complement our programmes is important. We don’t need their sympathy – just their empathy and their appreciation of the fact that sex workers need not be part of the problem of AIDS but part of the solution.

This is more difficult in countries where the economic or social situation of prostitutes makes it difficult for them to use or to purchase condoms. In countries where AIDS has impacted significantly on the sex industry there are few supports for prostitutes; they have had to organize and to educate themselves.

In Brazil, for example, the prostitutes’ organization in Rio de Janeiro is trying to teach its members about AIDS and safer sex. In Thailand the group Empower teaches sex workers to negotiate safer sex in English, the language most commonly used by tourists. And in Nepal a research project involving voluntary HIV-testing of sex workers resulted in the promotion of and increase in condom use. Sex workers subsequently set up their own support and education groups – the first organization of its kind in Nepal.

In Africa sex workers use condoms less than their counterparts elsewhere, and the incidence of AIDS among prostitutes has increased dramatically. In one study of prostitutes in Nairobi it was found that infection rates rose from 4 per cent in 1981 to 61 per cent in 1985. But education of both clients and workers can make a difference. One campaign in central Africa which combined education with the distribution of condoms reported that 75 per cent of the 596 prostitutes involved were now using them.

The World Health Organization says that: ‘In order to achieve... risk-reducing practices, it is essential to avoid discrimination against people engaged in prostitution, and to ensure their active participation in prevention efforts’. In China this clearly doesn’t happen: sex workers and their clients are arrested and sent off to re-education camps. Most countries deal with sex work by legislating against it. But this forces sex workers to hide, which also has the effect of cutting them off from society. There is little evidence to show that this affects the amount of commercial sex available. But it does affect the health, welfare and self-esteem of sex workers, which are in inverse proportion to the legal sanctions against them.

Prostitution law reform is good for health – and its beneficial effects could be considerably accelerated by giving sex workers the information, the international connections, the support and the resources they need.

We look forward to the day when the contribution that sex workers can make to the health of the whole community is recognized. Only then might the word ‘prostitute’ be replaced with the phrase ‘safe-sex educator’.

Catherine Healy and Anna Reed are members of the New Zealand Prostitutes’ Collective.

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