Sex Work and Life with Dignity: Sex Work, HIV, and Human Rights Program in Peru

"The program helps open up a topic this society generally considers taboo. The barriers are slowly breaking down. This is a definite advantage." - Peruvian government official

This case study explores the experiences of three organisations focused on sex workers and transgendered and transsexual people that have joined together to advance the rights of sex workers in Peru. In this country, "cultural norms emphasize women's subordination and the importance of masculinity, programs with a focus on gender - particularly those involving sex workers - are often underfunded and underrepresented." This case study is part of the Gender Strategies in Concentrated Epidemics series published by the United States Agency for International Development (USAID)'s AIDSTAR-One (AIDS Support and Technical Assistance Resources, Sector 1, Task Order 1).

As detailed here, the Sex Work, HIV, and Human Rights Program uses a democratic and participatory approach in order to raise awareness of human rights and advocate for sex workers' rights on both national and local levels. Three organisations implement the programme: the Institute of Health, Sexuality and Human Development Studies (Instituto de Estudios en Salud, Sexualidad y Desarrollo Humano [IESSDEH]) of the Cayetano Heredia Peruvian University (Universidad Peruana Cayetano Heredia [UPCH]); the National Network for the Rights of Transgender People, Transvestites, and Transsexuals of Peru (Red Nacional por los Derechos de las Personas Travesti, Transgénero y Transexuales del Perú [REDTRANS]); and the Miluska Life and Dignity Sex Workers Association (Asociación de Trabajadoras Sexuales Miluska Vida y Dignidad).

Some of the core activities of the programme include:

• Preparing, reviewing, discussing, and disseminating information on a proposed bill supporting sex workers' rights on a national and regional level, with the active participation of sex workers and their leaders.
• Facilitating dialogue in regional workshops among key stakeholders - local authorities, civil society associations, and sex workers - on the rights of sex workers and HIV prevention. For example, regional consultations among 202 representatives from 69 local and regional institutions and from civil society associations in all four regions have been conducted with the aim of raising the visibility of sex workers and their needs.
• Mapping locations where sex workers work and conducting a survey of the socioeconomic characteristics in the regions where the programme is implemented. The information has been used to fine-tune programme strategies. A document titled Final Report on the Situational Mapping and Socio-demographic Survey of Sex Work in Four Cities in Peru (Salazar and Silva, 2009) has been published.
• Training sex workers - both leaders and beneficiaries - on gender, human rights, sexual diversity, self-esteem, and HIV, based on a peer education approach. The workshops that ensue include a theoretical and practical session that introduces the concepts of gender, human rights (with particular emphasis on sexual and reproductive rights), gender-based violence (GBV), sexuality, and sexual identity. The workshops also include sessions about self-esteem and leadership. Hands-on activities include painting, writing, and role play.
• Training of regional and municipal government officials on sex work, human rights, HIV, and legislation regarding sex work. As of this writing, more than 40 regional and municipal officials in the 4 regions and 28 law enforcement agents have been trained. A new curriculum is being developed for online workshops with these groups; the goal is to improve knowledge, skills, and attitudes, as well as the capacity to respond to cases of GBV against female, transgender, and transsexual sex workers.
• Supporting sex workers by providing information on health services available to respond to violence and HIV.

According to this case study, what has worked well in this endeavour include:

• "Horizontal" programme implementers with different strengths: IESSDEH is experienced in terms of research and evidence-based programming on gender. REDTRANS and Miluska, on the other hand, are experienced in working at the ground level with female, transgender, and transsexual sex workers in different parts of the country. The United Nations Population Fund (UNFPA) provides technical assistance to the programme to ensure integration of the gender perspective.
• Direct participation of sex workers in programme design, implementation, and decision making.
• Multilevel work: By working at the policy, community, and individual levels, this programme is comprehensive and thus more likely to make an impact.
• Ongoing advocacy efforts at the national, regional, and local levels.

Recommendations offered here include:

• Monitor the progress of the programme.
• Support the development of sex workers' abilities (e.g., computer and internet skills) so that local sex worker organisations will be fully capable of running the programme independently.
• Involving men (clients, pimps, bartenders, law enforcement and public service agents, etc.). "Changing attitudes and behaviors require long-term advocacy and training on human rights, gender, and masculinity issues, which must be based on peer education strategies with special emphasis on leaders and young staff members. A holistic intervention should also go hand-in-hand with reforms to institutional norms regarding the treatment of sex workers by duty bearers and service providers, with sanctions for those who commit abuses."
• Improve services that address violence and sexual and reproductive health needs.
• Collaborate with other sectors.
• Advocate for the approval of the sex work bill, which includes the need to respect the rights of sex workers and punish those who perpetrate violence against them.