Sex Work and HIV: Toward Understanding and Global Solidarity
XI International AIDS Conference, Vancouver, July 9, 1996

Andrew: I'm here to introduce the panel on sex work. My name is Andrew Sorfleet and I moved here a year and a half ago and started working with the Sex Workers Alliance of Vancouver. I'm very pleased to be able to have all the Network members who were able to make it to the AIDS conference here and to be able to welcome them.

Cheryl: I'm Cheryl Overs. I coordinate the International Network of Sex Works Projects, which is an informal group of networks, rather than a single network. We have put together this round table with a view to hearing from some people who've been around for a long time, and who may be able to give us an overview of where they think things are going, where we've been, and the way we should be thinking about the pandemic and sex work, specifically, I think, in relation to what kinds of programs are funded, why they're funded, how they're funded, how they're evaluated. So I look forward to a panel of people who all have very different perspectives.

The first is Elizabeth Reid, a fellow Australian and director of the UNDP AIDS Program, whose topic is Deconstructing Sex Work.

Elizabeth: Thank you, Cheryl. I'm really talking towards understanding and global solidarity, which is the subtheme of this meeting. Sex workers have played an important role in response to the epidemic. Yet in the discourse of the epidemic they have been assigned a passive and distant role, as an epidemiological category, rather than a charismatic role as teachers and exemplars of how social change can come about.

Because of that, I want to revisit the discourse on sex work, whose concepts of core transmitters, vectors, and reservoirs created moral distances based on "them and us." I want to try to explore and expand the concept of "us" until it embraces "them" in a way that may deepen our understanding of the social and sexual dynamics of the epidemic and provide a strategic basis for solidarity.

From whence did our discourse come? From the onset of this epidemic, the gay community resisted the location of its epicentre outside of their own communities -- amongst, from example, men-to-men prostitutes -- and claimed it as an exclusive, endogenous concept embracing all men who have sex with men, and so creating the possibility of solidarity amongst those who identify themselves as such.

But there's been no such resistance in the heterosexual community. The discourse in these categories has been value-laden, alienating and excluding from the start. And the start was 1984: the first mission into a country -- Zaire -- where the epidemic predominantly was spreading in the heterosexual community. Within a few days, that mission had clinically identified 80 HIV-infected people: 41 men and 39 women.

They went back and took sexual histories. They discovered in both men and women very frequent sex with multiple partners. She was called a prostitute. He was called, during that mission and afterwards, virile.

This established the analytical discourse and its categories and its noncategories. It was a discourse which, if it had been spoken in its country of origin, Zaire, would not have been understood. The category of "prostitutes," or "prostitution," did not exist in its languages. There was an extraordinary variety of forms of transactional sex, and most had their own descriptive concepts, but there were no oppositional, binary categories of "prostitutes" and "us." Life is much too complex and messy, and untamable into such categories. And yet this created category-dominated analysis, funding and program development from then on. Why was it so seductive?

The extension of this analysis in recent years to the discourse on women's vulnerability to infection has created further noncategories. If, previously, men escaped from the analysis because they're virile, are they now escaping because they're invulnerable? And, if so, invulnerable to what? Analysis? Research? Strategies?

Now, how can this simplistic analysis and discourse be deepened? I spent some time recently talking to some women about the epidemic. They were quick to talk, and the confidentiality they required from me in return was to not to tell their husbands what we had been saying. Here's what we talked about.

They told me that this was a very conservative but typical pattern of sexual and social dynamics. I'm not going to spend to long on it, because it's relevant to everything. But it says here that the sort of sexual and social dynamics that occurred in their society, and the nature and type and basis of the relationships.

What we have here is a wife, and that relationship is characterized here: Stable, but of course, as she reaches 40-plus, she'll probably, or believes she will be, substituted by a younger woman. A working woman is characterized here: educated, employed; she's taken out, not kept at home. She's kept. The rent is paid, and clothes bought, etc. But she's powerful and she's independent. There's a girlfriend: a young schoolgirl. Transient. She'll come and she'll go, and be replaced by another. There's a village girlfriend. Every weekend, or whenever he goes home -- once a month -- she's there, and has been for a long time. There may be a married woman, and this will probably a married woman who wants a child and can't have one by her husband. She may not have good relationship, or she might be in need of financial support.

There may or may not be a sex worker involved in this sexual and social dynamic. But, according to the women, this is how they characterized the sex workers in their community: They're known. They're lucky. They have regular medical check-ups. They're in good health. And they don't have to ask permission to go and have it.

The women who drew this dynamic said that only a certain class of men go with them. And the women here said that they're lucky because they're in touch with one another. They're lucky because they're less economically dependent. They're lucky because the current and future social sanctions are very weak. And they're lucky because they're better able to protect themselves from HIV infection.

The story, of course, goes on. The women told me that this woman may have other relationships, because this man is not always with her. She may have one, two, three -- or whatever -- others. They might be stable or transient. This young girl will probably have other relationships more serially, but she and her brother may possibly have had sexual relationships with people within their family. This woman has other relationships because this man is only around intermittently. She may have a stable or transient relationships. This woman has at least one other relationship. These women have other relationships. And this woman, because she knows that when she's 40 or more she may well be replaced, often has other relationships as security, a safety valve, investment in the future.

So the story goes on. And I want to make the point, from the onset, that it means I could have put anybody here. I could have put any one of these women, or a single man. But I was actually interested in intensity. Because we somehow have been seduced by that concept of intensity as well. All of the women have children. Now, this alone illustrates the difficulty of basing any analysis on a created category of prostitutes

The women who spoke to me said, "We are all living in this situation and we all know it." "Do the men know it?" I asked. "Yes, but they sometimes pretend that it's not happening. They have the idea that they can do what they want because they're men. If this {sorry, Andrew, I seem to have missed something here (I discovered during spellcheck) and I think it will be faster for you to fill in the blank than for me to search through the tape for this bit.} "How can protection come about?" I asked. "All women," they said, "should have access to condoms. But only the working woman has the power to insist that he use them. So any solidarity among women can change the men." "Why not work with the men," I asked, "to help them change themselves?" And the women answered, "They won't. They don't want to. But," they told me, "the economic crisis is changing them. Men cannot go to the chicken parlour with a different woman every night anymore. Money is difficult, and now they must save and put their children through school."

Now, the interesting thing about this discussion was that, in the women's analysis, their strategies are addressed to themselves. They're not even prepared to discuss the issue of male sexual behaviour with their husbands. they feel it would be easier to learn to talk to and support each other in their own society, in order to develop a strategic, protective alliance amongst women. Now this would be a strategy of collective empowerment. A strategy whose effectiveness has already been proved by collectives of sex workers, but one that the women think is much easier to achieve amongst sex workers than amongst these women.

The final step in the globalization of such an alliance, if they could create this alliance amongst these women, would be the alliance that included all of these women. Through the coming together of all of these sexual partners, the rejection of the boundary between women who work as sex workers and other women.

A first small and exciting step towards this is occurring in Zimbabwe, where a counselling centre in Harare is running a support group which brings together married women and sex workers. The moral divide which literally, physically separated these women on either side of the room when they started has long since been dismantled. A story going around recently was of one group member saying to the husband of another group member, "But, Mr. X, why are you down here looking for someone when your wife is at home waiting for you? Shame on you!"

I draw on this discussion because there have been few systematic studies of sexuality -- or more importantly, societal attitudes towards male sexuality -- in the developing world. There is no Gary Darset yet for the developing world and, as yet, Gary Darset has not started to create the capacity to do this sort of work. It's almost as if the anthropologists and social scientists have colluded with, or bought into, social norms that suppress such discourse. And strategists for social change have similarly intervened elsewhere.

However, the women's answers to my questions prompted me to reread some extremely interesting work done by Professor [?] from [?] State University in Nigeria. In a study of the cultural, social and attitudinal contexts of male sexual behaviour in urban Southwest Nigeria, Professor [?] showed that much of the premarital and extramarital sexuality in this area also was not with prostitutes, but diffused much more widely, and on a sufficient scale to maintain and HIV epidemic. He concluded that the best chance of halting the epidemic and mitigating its impact was a change in male sexual behaviour.

The study shows that there is evidence that the Nigerian system of extramarital sexual relations operates as it does, not so much because almost half the society thinks that the male need for sexual diversity is uncontrollable, but because a much larger proportion of society believes that wives have no right to comment upon, or even to take note of, their husbands' absences at night, or the fact that they are probably involved in sexual activities.

The research shows how little control the wives have over their husbands' extramarital sexual activities, and how rarely they try to exert over control over them. And that's true for educated wives as much as any others. To do so would be to strike at the heart of family and social systems. In this society also, wives are more aware of the situation than their husbands say and believe. The research concluded that, even though wives' ignorance of their husbands' extramarital relations is largely ritual and pretense, the fact is that they do not inquire about or often discuss these matters with their husbands, let alone protest.

It is this which allows husbands to believe, or at least to keep up the pretense that they believe, that their wives do not know of their extramarital relations, and so are not disturbed by them. They themselves are disturbingly sanguine about their extramarital relations, and underestimate the number of other partners that their women have. Far more women are engaged in some form of transactional sex than are usually thought of as sex workers or prostitutes.

It should be noted that this analysis also, no matter how sensitive it is, remains essentially binary -- an analysis that draws on the relationships between husbands and wives. Yet Yoruba society is characterized by having separate, rarely intersecting female and male worlds. It is a social system in which husbands and wives retain strong links with their own families, which influence values and behaviour.

In this research, as an outcome, two strategies for changing male sexual behaviour are proposed. The first is that men will need to be helped to understand that multipartner sex is unnecessary and dangerous. That they do not have an ungovernable, biologically based sexual appetite. Secondly, women will have to be helped to believe that their husbands' sexual affairs are their business, and that they must intervene to saves their health and marriages.

These may seem difficult challenges, but let me tell you about what I've seen recently in [?] Zaire. In the last decades, patterns of social and sexual dynamics are very similar to what we have here. In recent months, what is happening -- when I was there, I had somebody come to me and tell me that he had been married for 45 years, and was very proud of that. When I asked him if he took his wife out with him, he told me, yes.

And I found there many men talking to other men about going straight. "Do not go like this and like this," they say. "Go straight. Otherwise, you won't survive." This is an extraordinarily significant in social behaviour, sexual dynamics and social norms, the like of which I haven't seen elsewhere. How did it come about? I don't know. But I'm sure that there will be many in that society who have reflected on that question and will have many insights and observations to contribute to answering it. We must, therefore, go and listen to them.

Thank you.

Andrew: Our next speaker is Joseph [?]. He's an independent commercial development worker in West Africa. He's not an independent commercial sex worker. Either are we.

Joseph: Thank you. This is a round table discussion, and I'd like to keep it as informal as possible, even though this table isn't very round. I am an independent consultant, or commercial development worker, and sometimes a client of prostitutes.

I think it's time that we take possession of these issues. Before we start on this discussion, we will always have to take possession. I've been in too many discussions about prostitution where, after a whole day of workshops, we found out at the end that we have not agreed on the very basic principle of what we actually think about prostitution, and what we feel about prostitution.

It may be unnecessary to say this here, but I don't think prostitution is a problem. It is one form of transaction in sex. It is sex in exchange for something. Transactional sex is extremely common everywhere, all the time. Prostitution is the most explicit and most overtly commercial form of this exchange. Within the category of prostitution there is a whole range of human interactions, ranging from the professional and equitable to the very abusive and degrading.

My quick presentation here will focus on visits to five different countries: Nigeria, Benin, Ghana, Cote D'Ivoire and [?], which I conducted from April to June 1996, on contract for two different agencies: International Family Health in London and Universite[?] Laval in Quebec. Both of these contracts were essentially design missions for programs targeting prostitutes. A report for the mission for Laval, by the way, is available on the website of the CCISD Laval.

I found little things that were not surprising. There is of course a very large diversity in the forms of sex trade in these countries. There is also an ever-changing profile of the sex trade. But I think what is really surprising, and what really stunned me, was the rapidity of the change that is taking place in the present time. Let me give you a very sketchy description of the situation.

There are of course many traditional forms of transactional sex in West Africa. But prostitution in its modern form, as we understand it, is really a colonial phenomenon. It's a phenomenon that started in the colonial era. The migration of women for prostitution, and the subsequent dominance of certain ethnic and national groups, is a relatively recent phenomenon, which started in the 1940s.

Initially, the most dominant group throughout West Africa were Nigerian women, who established a pattern of practice which is still known as the two-two line. The name "two-two" comes from the price which was charged per act, which was two shillings and two pence. The women settled in colonies, which were rows of rooms, or courtyards of rooms (the rooms were closed off with a curtain, and they're still known in [?] as the two-two rideau), or in large buildings, mostly two- or three-story buildings, with 100 to 200 prostitutes in them. And these were known as two-two etage, and they're still called that in [?].

The women rented these rooms. They lived there. And they worked as independent entrepreneurs. They had a more or less tight social organization, with a chairwoman, and some kind of a mutual aid society.

In the 1960s and 1970s, the Nigerian women gradually disappeared, and were replaced by Ghanians. The reason is quite clear; it has to do with the economic situation of the two countries. Nigeria experienced its oil boom; Ghana was dying of hunger

The Ghanians continued the style of practice of the Nigerians, but with a much higher level of social organization. They based the structure on ethnic lines. In each courtyard there were queen mothers -- an Ashanti queen mother, a [?] queen mother, a [?] queen mother -- according to ethnicity -- who responded to the traditional Ghanaian chiefs, who exist in all West African cities.

Numbers are very difficult, but there was an estimate in the early 1980s that there were 10 to 12 thousand professional prostitutes in [?], of whom at least 70% were Ghanians. And this was the situation when HIV came along. Consequently, virtually all Ghanaian two-twos became infected with HIV.

Also, the HIV prevention projects that became established there were designed to fit the type of organization seen with the Ghanaian women. Which means there were daytime education sessions in the courtyard. There was involvement of the traditional Ghanaian chiefs. There were peer education networks using Ghanaian women who exist in Benin, in [?], in all the countries.

What we are seeing now, in 1996, is that the Ghanaian women are disappearing from the scene at an incredibly rapid rate. [?], which at one time counted 70 to 80% of Ghanaian prostitutes, now has 20%. In Ghana itself, the two-two settlements are disappearing. What we're seeing in Ghana is more and more street prostitution and bar prostitution, practised by Ghanians, but in a different style.

In the other countries as well, street and bar prostitution is becoming the more common form of prostitution. The women are very often local women. They're very heterogeneous. They're usually much younger. And they're quite clandestine. They never identify themselves as prostitutes. They do not live where they work. And they have much lower HIV infection rates.

In all the prostitution programs that exist in West Africa, the HIV prevalence of the women is dropping very rapidly. Two years ago it was still 80 to 90%. Now it's barely 50%. This is because a different group of women are entering the profession. And the existing peer prevention programs do not reach these women at all.

There are two reasons for this change, both equally tragic. The first is that the women are dying of AIDS. If you go into the Ghanaian settlements in Ghana now, you see sick women everywhere, and it's really quite sad to see that. But the second reason is equally tragic -- the sedentary prostitutes have become victims of AIDS prevention programs.

Throughout the region, prostitutes -- and primarily foreign prostitutes -- have been blamed for the epidemic. They have been chased out of town. They have been killed. And they have had their houses burned. They are suffering the consequences of the AIDS prevention messages that we have introduced into these countries.

AIDS education has made the difficult lives of these women much more difficult, and most of them know it. So those who continue to collaborate, as peer educators or in similar roles, really deserve a tremendous amount of respect.

There is a danger here: that because of institutional inertia, that because programs have been set up, we will just continue our project as before. We'll use the apparently falling HIV prevalence rate to declare success for various interventions, and we will repeat the very sad and extremely shameful spectacle -- namely, of observing a number of cohorts of female prostitutes getting infected by HIV while we sit around and publish papers about them.

There is an urgent need to rethink our approach to targeted programs. Of course we have to continue to provide services for the sedentary prostitutes. Primarily their need is for health and social supports. Remember, most of them are infected with HIV. But we also have to develop programs for younger street prostitutes.

In all these countries -- particularly in Benin, but also in [?] and Ghana -- these women suffer severe persecution by the police. Under no circumstances should a targeted program or project be developed for these women until some sort of agreement can be reached with the police for the process of order.

Also, our approach has to change. The models of working with illegal, clandestine, highly stigmatized groups -- as for instance IDUs or female prostitutes in North America, or male prostitutes in South America -- are suddenly becoming very pertinent and very interesting to the work in West Africa.

Thank you.

Andrew: Next I'd like to introduce Claudia Fischer. She's a member of Madonna, a German sex worker organization, and of the International Community of Women Living With HIV/AIDS.

Claudia: I would like to present a very small example of [?] solidarity project, which is a harm reduction project for IV drug-using prostitutes, which we started in Germany in 1994. When we started this project, the situation was really very critical. So-called professional prostitutes and drug-using women working in prostitution faced a lot of problems. In general prostitutes were stigmatized and discriminated against as vectors of transmission, which was very hard for professional prostitutes to deal with, because they face a really low prevalence rate. And so therefore they started to blame drug-using prostitutes, and there was no solidarity at all.

What came up in internal discussions -- and it was very hard discussing it -- was that not all professional prostitutes don't do drugs. That there's a lot of drug use as well. And, on the other side, that IV drug-using women don't always work in an unprofessional way. So therefore we said, "We don't want to divide these two groups -- like, there are the professional prostitutes and on the other side are the so-called unprofessional, IV drug-using women.

We have to look at the patterns of behaviour. We have to look for the conditions under which prostitution takes place, and whether the practice of prostitution is recognized as a survival strategy to meet particular needs. This is of major significance.

So we started this project. Several problems appeared with the approach to the target group of IV drug-using women. There was their self-image, the perception by professional counsellors, the violence they faced, and the high rates of STD and HIV prevalence. Difficulties are also posed by the emotional and spiritual distance IV drug-using women have towards prostitution itself.

But, on the other hand, the more the professional control of the scenario, the less the client determines the situation, which very often includes forced sexual practice, rape and violence. The more of being able to practice what should be learned as a professional, there is less mental disorders, they are less confronted with physical violence, and there is less necessity to prostitute. And a high grade of professionalism also corresponds with a lower rate of infection with HIV and STDs.

Our methodological approach is based on the attempt to strengthen self-defensive potential through means of professional tutoring and guidance. What we really found out is that IV drug-using women -- there is so much research going on about them. But what they really need is concrete and practical help and support.

What we do is that we offer a trainer for a period of a minimum of two to four weeks, to drop-in centres, and to advise various medical health centres and institutions that ask us. The trainer is always a former sex worker. This is obligatory. Sex workers are professional about preventing STDs and HIV. They are professional about preventing physical violence during working hours. And they are professional about practice harm-reduced sexual techniques.

So the criteria for the trainers are: profound knowledge in sexual techniques and of harm reduction practices; accurate knowledge of STD/HIV prevention and transmission and practical measures; a high sense of sociability and social competence; and an uncritical relationships towards consumers of illegal drugs.

How does it work practically? The trainer is integrated in the daily counselling business. She is introduced by the centre staff as a former sex worker. This approach makes it much, much easier for drug-using women to come over. Because at that point the stigma of prostitution is with the former sex worker, who's present and open about it.

The trainer offers, on a one-to-one basis, practice in sexual techniques, teaching and prevention methods, [?] techniques, and self-defence strategies. In our experience, IV drug-using women do not accept classical counsellor-client settings. Therefore the trainer has to create an adequate atmosphere and offer her advice in a collegial way.

Time, place and the whole context is always determined by the IV drug-using women. The trainer gets as much time for training as needed -- it's up to the women. The trainer is paid by Madonna, but it's through a special social welfare program which women can apply for when they want to stop working in prostitution. Travel, accommodation and food expenses are always paid by the requesting institution. Since the project started, in 1994, 400 women have been trained so far.

Finally, I would like to mention two problems which face the project. It is difficult for us to find trainers who accept drug use. And, on the other side, it is very difficult for us to break the relative ignorance of professional counsellors towards prostitution.

Thanks.

Andrew: Next we'll have Paulo Longo, from Pegasao, a support program for male sex workers in Rio de Janeiro, Brazil.

Paulo: Pegasao is a project for male sex workers in Brazil. Pegasao is gay slang -- it means cruising, or looking for someone. When we go to the street to search for a client, we're doing pegasao. So that's the name the boys gave to the project.

I was supposed to speak about something with a very big title: Policy and Funding Priorities that are Most Effective in Preventing HIV and STDs in sex workers. But, instead of that, I prefer to tell you a story and let you draw your own conclusions.

Thanks to those who came again -- I don't know how you can stand again to come and talk about sex work after all these years.

We started this project in 1989. I was really quiet, being a psychologist. I said I would not go to the sex workers' movement anymore. I finished my university. So I came to the International AIDS Conference as a psychologist. So everything seemed to be changing in my life.

The first paper I saw in the abstract book was a paper from a Brazilian doctor: Dr. Edouard [?] -- I can say his name -- which showed that in Brazil, we had 43% of Brazilian hustlers (male sex workers) infected by HIV. It was really shocking for me -- how could someone conclude that 43% -- almost half -- of Brazilian hustlers were infected with HIV.

I read the paper carefully. It was quite an important paper, because it was later published in the New England Journal of Medicine. And, in this paper, I could see that it was a study done with 33 boys from a certain area of Copacabana. He found eight boys who were infected, and he said that 43% of us were infected by HIV. Which really made me very upset.

When I came back to Brazil, I went back to Copacabana Street -- where I'd sworn never to return -- and we started to talk to the boys. We said, "OK, let's show these people that it's not the way it must be. No one can just come here, talk to some boys, take blood from 33 boys, have eight infected boys, not tell anyone that they're positive, go to an international conference, and publish this as if it proves that most Brazilian hustlers are infected. Come on. Let's give an answer to this person.

That's how Programme Pegasao started. We decided to give an answer, so we started to create our own project. That meant talking to each other about safe sex. Because we had no idea about what it was. It's true. We just knew that condoms should be used, but that was all. So, let's create our project.

We had meetings and talks. We had no idea about the methodology. We didn't know what we were doing -- if it was workshops, if it was outreach -- we had no names for that. We just knew that we had clear ideas about our needs. Our needs were: to be educated, to have access to condoms, to have access to STD clinics, to have access to testing IF we want to be tested.

We had no idea about funding, either. It was quite a new idea for us. We didn't know how to get funding for this kind of strategy. For us it would be enough to be talking to each other. And if someone gets three condoms, we can share it. And if someone gets two condoms, we can still share it. We cannot share one condom, unfortunately. But sometimes that's all they give us.

This project started to grow. It was really increasing. We had lots of contacts; lots of people coming. We got training and all this sort of stuff. And lots of very interesting people started to approach us, like prisoners, gay people, transvestites and transsexuals, even deaf people. All these people who nobody wanted to work with started to come together to us. And it was really interesting, because then we had an organization. Which is like [?] army. But it was really funny.

This organization is now named NOS, which in Portuguese sounds like "us." It's [?]. I can never translate it. It's something like "nucleus of orientation in social health care," maybe. We had all these people coming and developing several different projects; new projects being developed. And [?] started to be more professional. So we could define our methodology. Define our purpose. Define our objectives.

Suddenly, we started to have what people called wonderful results of an intervention project. So we received international attention. We had people coming from different settings. We were on BBC TV. We were in international newspapers. We were invited to international conferences. We had an external evaluation by the WHO Global Program on AIDS, and they said that we were one of the 15 most effective interventions in world.

Well! It was really exciting. This very small project of male sex workers in Rio de Janeiro, Brazil, was suddenly a very important international thing. And it was already three years that the project was running. So we thought, finally! We will get this thing that they call funding.

Nothing.

We were really expecting this, and nothing came. Strangely, some people started to approach us with very good offers. Like, "We will support your project." And we'd go, "Oh! This is the person!" Like, it was five visitors a week, with everyone saying that they would sponsor our project. Strangely, these people came and said, "OK, we will fund your project." And we said, "OK, we need this and this." "No, no! We will not fund what you need. We need you to give us this and this. So we will not give you funding for --"

It was really strange. I always remember this phrase. It's like a nightmare for me, still. No salaries. No rental. No infrastructure. No food. No outreach expenses. No this. No that. It was always this same speech. And that was all we needed. They said, "No, we will not give you salaries, because we don't want to create a relationship of dependency." Yes, it's true! "We will not give you the rental, because we do not fund infrastructure. But we can give you a computer." We had five computers already.

"We will not give you this and that. But we can sponsor publications." And we said, "But half our group are illiterate! We don't need publications." And they said, "We can fund a video." "OK, you can fund a video. But most of our boys do not have where to watch the video. So it's not a priority for us."

Some people came with alternative funding proposals, like, "We can sponsor your project, but you have to do something. You put your boys to be working as interviewers for my research. So then they will have a good salary for the outreach expenses, and they do the research for us." And we said, "Oh, good." So we started to do that, in some research that really interested us, like the sociodemographic definition that had been presented some conferences ago.

It was good. But we had to take 80% of our time, you see, just to do the research. And in the 20% of the time that was left, we were exhausted, after filling all these questionnaires and everything. So the outreach work was really going out. We got tired of working with all this research, and we decided to start our own, alternative funding.

We started by selling T-shirts and badges and things, as everyone has done once in their life. Finally,

{side of tape ends here}

We had to close, because the government said we had no licence to sell food. So our wonderful source of resources, which was enough to pay one salary and rental of the house -- this money is gone, because the government does not give us a licence to do that. Meanwhile, we're getting more and more wonderful results, invitations to more consultations. And no money, see?

I've been approaching people here at the Network of Sex Worker Projects. And I can tell that it's not just in this part of the world, in developing countries, that sex workers face difficulties. It's all over. We've got 200 projects connected to this network, and most of us have to face these difficulties. We have to work like hell, and are reduced to selling cards and badges and T-shirts. And, again, the same old stuff. Ten years after the beginning of this pandemic.

At this very moment that I am speaking to you, our organization is moving. We could not pay the rental anymore. We had to go out of the house. And I've been thinking about why people do not want to sponsor sex workers' projects. Sometimes they say, "You make a lot of money selling your bodies." But we make much less money selling our bodies than they do selling us medicines and condoms.

I guess that's a very good reason for sex workers' projects to be sponsored -- to be funded -- that in most cultures men learn their sexual initiation with us. We are sex experts. This is a very good and obvious reason for sex workers' projects to be funded. And whoever is responsible for defining policies and priorities for sex workers' projects -- please forgive me. But you are really doing wrong.

Thank you.

Cheryl: Thanks, Paulo. Paulo had an enormous struggle to raise the funds to come here and, I think, just earned every cent of that very hard extracted airfare that got him here. Even that is an enormous drama for people in sex work projects. I think at this conference there's less of us than ever. And those of us who have gotten here are just those same old faces that are very good at working the system. We're very aware as we're here at this conference that there are some wonderful initiatives developing all through the world. At our booth, we have lots of letters from people saying, "We're so sorry we're not there. Everybody but us is there." Only that's not the reality. Very few are here.

I'd like to make an appeal for, I think, my fifth or sixth AIDS conference, to people who work in agencies: Try to bring somebody. Next year, perhaps. How many times do we have to say this.

I now open the floor to questions. I'll take the luxury, while people are going to the microphone, of asking the first question. Elizabeth, in your presentation you almost seemed to conclude, quite rightly, I think, that if anything major is to happen around the paradigms of sex work it's around the demand side, rather than the supply side, of the equation. I absolutely agree with that. I get tired of hearing about how eliminating women's poverty will eliminate prostitution. There are prostitutes in Luxembourg and Switzerland. How rich does a country have to get before you eliminate prostitution? So I think this idea of eliminating poverty as a way of eliminating prostitution is just ridiculous. There's demand; there will be supply. So I agree with you about that.

But this idea of the message that diverse sex is unnecessary and dangerous -- that grazing, as it were; having a number of partners -- is for men unnecessary and dangerous -- and that women should participate -- it is women's business what their husbands extramarital lives are -- I wonder if the end result of that would be that, if that were successful enough, these women you were speaking with -- if the end of that would be the abolition of prostitution. And how in fact that fits, in terms of AIDS policy, with the observations Joe was making about women who are dying of HIV disease and AIDS.

Elizabeth: I wasn't trying to argue for the elimination of prostitution at all. The two strategies that you just quoted were actually the conclusions of that particular research, that was concluded by the research team. I actually have trouble with them. I think perhaps I didn't make that clear enough. What interested me -- when I sat back and thought about either of those two strategies, what came to my mind was the images of the men I spoke to in Zaire, and the significant changes that occurred. I don't know how you bring about those changes. I don't think it is by those strategies. But there are people who've changed, and who do know how those changes came about.

So it was relatively difficult trying to say what I wanted to say. I'm not sure I've done it well. I didn't want to argue, obviously, either against sex work or against funding for those working in it. Nor to take away -- in fact, what I wanted to say was that we have lots of lessons to learn from what's been happening within that community and amongst those people, that we should be applying much more widely. That what's been really harmful has been the creation of epidemiological categories called "sex workers," and the use of language like "core transmitters," "reservoirs," "vectors," and so on. But what I was trying to show in the slides was that the social and sexual dynamics of sexuality are extremely diverse. And we can't capture by those sorts of categories. We have to look at processes of social change, and start working with them, and with the people who are changing within them.

Pia: I work in an organization of prostitutes, and we are working on an information and AIDS prevention project for prostitutes. I don't have questions, but I appreciate what Paulo said. And I want to say something about this. Because it's very nice to be able to say, in such a large conference, how many are the doctors or the researchers who offer to the prostitutes just to be studied, and they never offer money. I feel very close to you about the story you told, because in Italy we have the same situation. There is a very important doctor -- Dr. Tirelli -- and he studied two African prostitutes, one HIV positive, one not. And then he published a very important study in which he said that 50% of African prostitutes in Italy were HIV positive!

The only thing I suggest is that we should be paid every time we speak. This is the problem. There are so many researchers and doctors and everybody who want know things from prostitutes; we should sell every word we tell them.

Wallace (New York): I am a doctor, but I have a great deal of respect for the warmth and giving of sex workers. Even though we have a half-million dollar budget in New York to do outreach to streetwalking sex workers, we cannot do it from a place. Every neighbourhood has made a fuss if we try to locate a facility. So we have to do it with buses and little vans. So even in one of the richest cities in the world, we are hemmed in all the time by the prejudice against the word "prostitute."

Secondly, yesterday there was a CDC talk by a doctor from [?]. And she said twice, at the beginning and at the end of her talk, that prostitution fueled the epidemic in Africa. Can we please, again, try and get them to say that it's sexual behaviour which fuels the epidemic?

Caroline Ryan (University of Washington): I've just returned from treating commercial sex workers in Cambodia. I wanted to ask if any of the networks are working with human rights groups. Because I'm very concerned about the human rights problems in Cambodia with commercial sex workers. There are a lot of people being kidnapped and held against their will. The other thing I want to say is that, even in trying to change some of these young girls about AIDS prevention, condom techniques and negotiation, it is very difficult for them to negotiate with a drunk client who has a gun. There has to be a lot of education for clients as well. But I find it hard to see, there, any sort of solutions to the problems of these very young girls in Cambodia. I'm wondering if any of the panelists have suggestions or comments.

Paulo: I just would like to suggest that we think about the term "commercial sex workers," because I don't know any sex worker who is not commercial. We just say "sex workers." We don't say CSWs, but SWs. About the human rights thing -- it's one of the major concerns of the Network. We are really upset with the Burma representative at this conference, who's supposed to speak in a sex workers' session. We know that in this country sex workers are murdered easily. Not just sex workers -- most people are murdered easily in a country which keeps the president under arrest in her own house. You can imagine what they do to sex workers.

So we are going to do something about it. And we are connected to important human rights groups -- like Human Rights Watch; like Amnesty International, and all those groups -- to make announcements and take immediate action when something goes on.

The last part of the question --

Cheryl: Do you want me to do that? I have no idea how you can educate someone to negotiate with a person with a gun. [?] sell this idea. I think we should go to the next question. It's such an enormous topic.

[?]: I come from [?] drop-in centre in Kuala Lumpur, Malaysia. We work with drug users and sex workers. I just want to address this point to Paulo. It's about funding for sex worker programs. We in Kuala Lumpur also find it very difficult to get funding for our expansion programs for sex worker projects. One of the things we really find frustrating is the irony of funding -- especially government funding -- and I know this is not just in some countries. There are many countries that have this kind of funding.

When governments fund sex worker projects, the reason is that they have their own agenda as to what they want to do. Most times, they want to save the clients of sex workers from sex workers. They fund it because they want to save the rest of the public. They're not actually concerned about the health of sex workers.

The question is, when we do receive such funding, how can we be creative in using it to do health projects with commercial sex workers?

Cheryl: I'm sorry, that was too fast for Paulo. Anyone else want to say something about the creative use of funding? I'm afraid what I'm going to do over here is ask the two sex workers to go to the other mike. I'm sorry; we'll priorize questions from the two sex workers.

Beth Wolgemuth: My question is for Elizabeth Reid. I've read some of your research before. I'm still very concerned -- there is an element of occupation to sex work. That's why we call it sex work. I'm not sure it's really all that helpful -- maybe you can talk about -- blurring the lines, for instance, between "what is transactional sex?" I think it's time we recognize sex work as an occupation. Perhaps I'm misunderstanding, and you could clarify what you mean by blurring the boundaries?

The boundaries I was referring to were between women who are described as sex workers and all the other women there. The girlfriend, the working woman, the wife, the village girlfriend. What I was arguing was that there is complexity, and that they're all involved in sexual transactions of the sort that spread the epidemic. So if we're looking at how to characterize and understand the dynamics of spread of the epidemic, we need to understand that as well.

[?]: I wanted to respond to Dr. [?], who was talking about Cambodia, about human rights stuff -- the biggest impediment to sex workers being granted human rights is the criminalization of prostitution. And on a worldwide scale, the decriminalization of prostitution is the first way to go in granting sex workers their human rights.

A very quick question to Claudia Fischer: You talked about the fact that the people you were training had to be former sex workers. Does this mean that sex workers who are currently working aren't able to be part of this program?

Claudia: No. They would. They just don't earn the money they could earn in the same time in prostitution. Because they're only paid by the special social worker program, which is $400 per month. But if they want, they can, for sure.