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Chi Mgbako

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Sex Workers in Greece Face Forced HIV Testing, While Those in Malawi Fight Back

Posted: 06/11/2012 2:51 pm

Greece has been a mainstay in the international press as it endures harsh austerity measures in the face of the global economic crisis. But recent news reports have also focused on another disturbing reality: At the end of April, Greek police began systematically arresting sex workers, forcing them to undergo HIV testing, and posting the names and photographs of those who test HIV-positive on official police websites. The sex workers face criminal charges of intentionally causing serious bodily harm, even though there is no evidence they were aware of their HIV status.

The Joint United Nations Program on HIV/AIDS (UNAIDS), Amnesty International, the Global Network of Sex Work Projects and the Global Network of People Living with HIV/AIDS, have all condemned the Greek authorities' actions as incompatible with human rights and discordant with proven public health measures to prevent HIV transmission. State-sanctioned forced HIV testing of sex workers also occurs elsewhere, including in the southern African country of Malawi. But in Malawi, something inspiring has happened -- sex workers are fighting back.

It began in 2009, when police officers in southern Malawi raided a bar, arresting male patrons and female sex workers. The police later released all of the men but took the women to the district hospital where they forced them to undergo HIV tests without their consent. The sex workers who tested HIV-positive were charged with "spreading disease dangerous to life," and before sentencing, a judge read out their HIV status results in open court. During this period, other Malawian sex workers reported similar instances of forced HIV testing to human rights groups.

The Malawian sex workers involved in these cases could have returned to their homes and swallowed the bitterness of these indignities. Instead, fourteen sex workers decided to sue the government and challenge the constitutionality of forced HIV testing. The legal case, among the first of its kind, is making its way, slowly but hopefully, through the Malawi courts.

The human rights organization representing the Malawian sex workers requested help from the human rights legal clinic I direct; my students and I contributed to the case by conducting international and comparative law research on the human rights implications of forced HIV testing. The results were clear: Because forced HIV testing is physically invasive in nature, it violates the right to bodily integrity and security of the person. Because it's a coercive and stigmatizing measure that discourages people from seeking voluntary counseling, testing, and treatment, it violates the right to the highest attainable standard of health. And "outings" of individuals' HIV status without their consent, as was done in open court in Malawi and on police websites in Greece, violate the rights to privacy and dignity, especially because such revelations can lead to stigma, discrimination, and even violence.

Greek officials have attempted to justify the forced HIV testing of sex workers by stating that they're protecting public health after an increase in AIDS cases in the country in the past year. This logic feeds into the stigmatizing notion of women as the main source of sexually transmitted infections and the misguided idea of female sex workers as "vectors of disease" from whom we must protect the general population. Rights-based public health measures should seek to protect all people from HIV infection, and provide those who are HIV-positive with the tools to live healthier lives.

As UNAIDS and the Office of the United Nations High Commissioner for Human Rights have argued, coercive measures in the fight against HIV/AIDS, including forced HIV testing, produce bad public health outcomes by alienating at-risk groups. Mandatory HIV testing breaches medical confidentiality and facilitates stigma and discrimination against people living with HIV/AIDS, therefore discouraging vulnerable groups from seeking out what we know works to stem the tide of HIV transmission -- voluntary and confidential counseling, testing, and treatment. Discriminatory state action like the forced HIV testing of sex workers drives further underground some of the people most in need of public health services that facilitate HIV prevention. It also alienates groups, like sex workers, who make fantastic peer educators on HIV.

Our eyes should remain on Malawi as this band of defiant sex workers takes a brave step to affirm their rights and the rights of all people, especially the marginalized, to live free from coercive practices that do not safeguard public health.

Sign the online petition to Greek authorities to stop the forced HIV testing of sex workers.

 

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Syllogizer
Barely Left of Pobedonostsev
10:57 AM on 06/12/2012
It is NOT 'discrimination' to force "sex-workers" to get HIV tests. It is bad enough that that line of work is tolerated at all, but if it is, then since they put themselves at such high risk, the state is well within its rights to insist that they be tested rather than put themselves at risk AND become a major public health problem.

To object to this is as bad as those in San Francisco who resisted closing the bath houses which at that time were hotbeds of promiscuous activity spreading the virus.
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HUFFPOST BLOGGER
Chi Mgbako
03:49 PM on 06/12/2012
Unfortunately, it's exactly this sort of stigmatizing rhetoric that hampers HIV prevention efforts. As UNAIDS wrote in their May 10 letter condemning the Greek authorities, "There is no evidence that punitive approaches to regulating sex work are effective in reducing HIV transmission among sex workers and their clients." Indeed, there are countless studies that confirm that sex workers are able to safeguard their health and the health of their partners when they are empowered, not when they are demonized. For those who are interested in research studies that point to this (and they are countless) start by checking out the "Resources - Health and HIV/AIDS" section of the Global Network of Sex Work Project website at http://www.nswp.org/ which houses numerous reports from varied sources on HIV prevention efforts in sex work settings. For those who are interested in understanding more about the accepted global health and human rights stance on the dangers of mandatory HIV testing, I encourage you to read the International Guidelines on HIV/AIDS drafted by UNAIDS (see. pp. 31 on prisoners, 36 on children, 37 on vulnerable groups, 55, 82, 84 at footnote 41, 86-87 on sex workers and pregnant women, 90 on refugees, 102 on potential employees, 103 on prisoners). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf. These guidelines have long been one of the most influential documents on this subject among global health and human rights experts.
Syllogizer
Barely Left of Pobedonostsev
12:50 PM on 06/13/2012
Chi, you are misusing statistics. The Guidelines do not justify your confusing absence of evidence with evidence of absence either.

What is clear is that you are the one doing the demonizing here, not me. It is certainly not 'demonizing' to call "sex workers" what they really are -- prostitutes. Nor it is 'demonizing' to point out that states do have the right to make their line of work illegal -- and should do so.

But both you and your UN Guidelines are pretending that you have proved the opposite, that it should be legalized, that that is the only way to curb the spread of AIDS is to 'empower' people to practice depravity. It should be obvious that such a thing would be very difficult to prove (if possible at all), and neither you nor UNAIDS nor NSWP have got close to proving it.

Learn some real statistics, not the fake statistics you have been using to date. I suggest you start with http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269/ for a basic correction to your current erroneous attitude, and then move on to http://www.statsoft.com/textbook/

Both you and NSWP are doing the very thing John Ioannidis describes: "At every step in the process, there is room to distort results, a way to make a stronger claim or to select what is going to be concluded,” -- and this is exactly what you, NSWP and UNAIDS did: select your conclusion.
10:45 AM on 06/12/2012
I couldn't, in a thousand years, have said it better.
07:31 AM on 06/12/2012
Mandatory HIV testing for sex workers certainly seems like a good idea. It should certainly be done within a context of the law. It seems like the answer would be to license health workers and require mandatory periodic testing for HIV (and other STDs) as a condition of maintaining their license. The question then would become what to do with sex workers who try to work outside of the legal (licensed) framework. That should be criminalized, and consequences up to and including incarceration should follow. HIV is a terrible problem in Southern Africa, including Malawi. The judicial system needs to go after male sexual offenders as well - especially sugar-daddies having sex with underage girls.
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HUFFPOST SUPER USER
Parade Keegan
I Can Hear You
11:12 PM on 06/11/2012
While I don't agree with publicizing the names of infected individuals I think testing for sex workers makes a lot of sense. We test our food supply to protect the public. It would be foolish to believe that most people would willingly engage in unprotected sex with an HIV positive person.
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HUFFPOST BLOGGER
Chi Mgbako
01:08 AM on 06/12/2012
Hi Parade Keegan, author here, thanks for your comment. The issue is not whether HIV testing is a good idea, the issue is whether a coercive measure like forced HIV testing without consent helps prevent HIV transmission and is in line with human rights standards. It's not. We know that coercive measures like forced HIV testing don't work - to stem the tide of HIV people must have de-stigmatized access to voluntary and confidential HIV testing, counseling, and treatment. We've seen favorable results in HIV programs where sex workers are meaningful and voluntary participants and leaders in HIV outreach efforts, where they are viewed as rights-bearers, not as potential transmitters. Sex workers, and all marginalized, at-risk populations, are part of the "public" of which you speak. International public health and human rights officials have long been in agreement on how coercive measures like forced HIV testing only fuel stigma, and stigma is one of the biggest drivers of the HIV epidemic. See the United Nations International Guidelines on HIV/AIDS and Human Rights for more on the futility of mandatory HIV testing: http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf
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HUFFPOST SUPER USER
Parade Keegan
I Can Hear You
01:53 AM on 06/12/2012
Thank you for such an informative reply, I really do seek more information on "forced" testing as I'm "on the fence" about it. Without knowing about the societal repercussions it is difficult to form an opinion. Can you tell me, if a sex worker is forced to test and the results are not made public what would be the repercussions be? I realize that those who test positive could "accidentally" be "outed", is that the fear of force testing? When I use the term "public" I do take into account all the public, even those who are "marginalize" and see the biggest population at risk of infection being these same said people.
Syllogizer
Barely Left of Pobedonostsev
11:15 AM on 06/12/2012
It is obnoxious, Chi, to post an entire report claiing it supports you on a specific point, without giving a more precise reference, e.g., a page number in that report.

Especially when, as here, not only is the report written in that stifling bureaucratic language the UN loves too much, but also it is easy to find material in it that does NOT support you.

I have in mind specifically p27, which says, "Exceptions to voluntary testing would need specific judicial authorization, granted only after due evaluation of the important considerations involved in terms of privacy and liberty"

So contrary to your claim, they ARE admitting exceptions to the rule that testing be voluntary.
HUFFPOST SUPER USER
realitytrumpsbull
Two 'alves of coconut!
09:58 PM on 06/11/2012
Enter Sex-Bot, the 100% hypoallergenic artificial sexual gratification aid. How do you stop AIDS, herpes, syphilis, and all the other wonderfulness that can be spread by sexual contact? By pointing that thing somewhere else. Monogamy may get a lot of criticism in our modern age, but it does cut down on the crotch crickets. For that matter, so does an annual subscription to Hustler. Or, a different hobby.