The Jonathan Mann Memorial lecture of the AIDS 2010 conference sets out  to honor Jonathan Mann the founder and first head of the World Health Organization’s Global Programme on AIDS.  This year’s selected speaker was Meena Seshu, General Secretary of Sampada Grameen Mahila Sanstha based in Sangli India, a champion and leader in the movement for sex workers’ health and rights in India.

In her speech that won a standing ovation, Meena highlighted the ongoing struggle for the rights of sex workers in accessing health care, in living with HIV, and the ongoing mistreatment of sex workers by health care providers and the state.  She also spoke to the diversity of sex workers and others who are marginalized by the health sector that have come to  her program for services.   Alongside the many women, others in marginalized sexual and gender diverse communities have turned to her program for information, care, and support.  Her strong statements for the need to focus on and support sex workers were supported by voices of other prominent leaders in the sex workers movement at the conference, including Mickey Meji of the African Sex Worker Alliance, Andrew Hunter of the Global Network of Sex Work Projects, and Cheryl Overs of the Paolo Longo Research Initiative.

A key barrier for sex workers to access care and services has been the laws and regulations that drive sex work underground, further stigmatizing sex workers and exposing them to violence and harm.  The attitude that we can ' rescue' sex workers has driven the inclusion of a range of provisions in anti-trafficking laws which impede access to health services for sex workers.  For example, despite purported assertions of saving women, the broad and unclear language of the anti-prostitution pledge, which acts to block U.S. dollars from supporting sex worker organizations, has limited the ability of sex workers to access life-saving care, prevented programmes from working with sex workers, and preventing programs from relying on the known leadership of sex workers in addressing the HIV epidemic. 

My own first work in HIV and AIDS was with street based sex workers in the townships surrounding Johannesburg.  I saw and experienced the impact of the law, criminalization, and stigma at first hand -  when health education sessions were disrupted because a police car had been spotted from afar, when I visited a young sex worker in a small room unable to move due to the pain of a sexually transmitted infection and no doctor who would see her because she was a sex worker and potentially HIV positive, and when police officers harassed those of us who brought male and female condoms and education to these sex workers.  This continues to be the case all over the world for marginalized groups including in Washington D.C. where sex workers are often harassed in prostitution-free zones instituted by the city that essentially limit legal protections for sex workers against search and arrest.

This ongoing marginalization of sex workers is blocking our ability to effectively respond to the HIV epidemic and preventing sex workers from getting necessary health services.  I hope that the high profile of advocates for sex workers at this conference has turned the attention of the international community squarely to the necessity of addressing  the role of the law in continuing to stigmatize, marginalize, and block access to life saving care.