‘I have seen and experienced how difficult it can be to talk about a disease that is transmitted the way that Aids is. But if we are going to beat Aids, we can’t afford sensitive conversations and we can’t fail to reach the people who are at the highest risk’. These are the words of US Secretary of State Hillary Clinton at the International Aids Conference held in Washington DC, USA from July 22 to 27th July 2012.┬á Clinton’s new committal to sex workers comes as part of a set of new programs dedicated to three risk groups, i.e. Female sex workers, injecting drug users (IDU) and Men who have sex with Men (MSM).┬á
┬áIt is important to note that at the time when the Global Aids Community had converged in Washington DC from July 22 to 27th, calling for decriminalization of sex work, the world’s prostitutes were not in attendance at the conference primarily because of a US antiÔÇô prostitution and travel ban on sex workers that contorts the mission. Many of the sex workers had no way of reaching the July 22-27th conference in Washington DC because foreign sex workers are still denied entry into the US. Interestingly, the sex workers also held their international conference in Kolkata India during the same period. At their conference, the sex workers marched through the streets of Kolkata with balloons and red umbrellas demanding decriminalization of sex work and prostitution worldwide, raise Aids awareness and protest against their exclusion because of VISA restrictions from the international AIDS Conference in USA.
 In some European cities red lights districts are a common site where sex work is regularized and practiced legally. In Thailand for instance sex tourism is promoted while in South Africa, there are a lot of sex joints in downtown Johannesburg where patrons including those from Botswana regularly visits these places and exchange money for sex. However, in Botswana sex work is prohibited and criminalized. It is in fact viewed with great suspicion, stigmatized and perceived as disgust and embarrassment to those practicing it.  Yet still, it continues to attract many clients and society is in denial including the buyers themselves, from ministers (politicians) to garden boys, from pastors/priests to CEOs, academia to lawyers, economists to accountants, medical doctors to engineers, from the journalists to police officers and soldiers.
Sex work has long been controversial; it has become even more contested and society shy away to openly discuss it, but it exists in various forms. There is high class corporate sex work; there is sex work in the church, in offices and almost everywhere. The most common one however, is the one in the streets where sex workers engage in sex for money and their clients pay for the services rendered. It is all too often assumed that disempowerment leads women to sell sexual services as a last resort, as the ultimate step before destitution and out of coercion rather than choice.
Debates and discussions have been held on this notion; programs have been developed to rehabilitate the sex workers by way of setting up income generating initiatives. But do we clearly understand the profession such as carrying out the needs assessment; create an enabling environment etc. etc. In Sangli, India sex work is different.
Sangli presents a very interesting case study about sex work especially from a group of sex workers from an organization called Vamp.┬á They refer to their work as dhanda, meaning business and it is not something they did out of desperation. It is reported that on being interviewed in her profession one of them said ?. “If I’d been married, I would have been HIV positive by now,” reflecting that married women are far more vulnerable than she is as a sex worker, unable to insist on condoms with their husbands as she does with her clients. And her face breaks into a smile as she describes the life she leads: the freedoms she enjoys, her choice of clients, and the autonomy and empowerment she has. “I’m as free as a bird,” she says, the UK, Guardian, 2012.
The sex worker further stated that ‘some had been married and returned to sex work full of pity for those women who had to put up with the privations and lack of freedom marriage brings. Some had tried other jobs, and found them tiring, exploitative and badly paid. Sex work was, for them, an occupation they spoke of with pride, despite the stigma. And, they say, this is where the problem lies: the societal attitudes towards them, the violence, stigma and abuse of human rights they experience as a result.
After reading about the Sangli case study, some questions came into my mind and it is on the basis of this that I would want us to engage in a dialogue. The last few years have seen growing impatience on the part of national progress, international agencies and public health experts to make headway against the Global HIV epidemic. In the last decades the biggest problem in global health seemed to be the lack of resources available to combat the multiple scourges ravaging the world’s poor and sick. Today, thanks to a recent extraordinary and unprecedented rise in public and private giving, more money is being directed toward pressing heath challenges than ever before. But because the efforts this money is paying for are largely uncoordinated and directed mostly at specific high-profile diseases, rather than at public health in general, there is a grave danger that the current age of generosity could not only fall short of expectations but actually make things worse on the ground.
 The current new global health initiatives are on addressing the three risk groups; Sex workers, MSM and IDU. Africa finds itself in another unfortunate situation as it is being turned into a testing ground for new treatment and prevention methods. Who would forget Andrew Natsios the then Director of USAID. Natsios dismissed the idea of distributing ARV drugs in the formative years of HIV/AIDS, telling the House International Relations Committee that Africans could not take the proper combinations of drugs in the proper sequences because they did not have clocks or watches and lacked a proper concept of time, Laurie (2007). The issues that are now being raised are very sensitive and seen and perceived as evil and demonic and not in line with many African beliefs, culture and customs.
But are we in denial?????’Do we hide behind issues of morality, religion and culture???
┬áOne of the fundamental questions that I have also asked myself is that should sex workers be described as a worker even though money exchanges hands? Should sex work be treated as a behavior or occupation? Is the word sex worker properly worded or should it be “Male sexuality in the market place’. Does sex work enhance male sexual power? Can sex work clearly be described as one exercising the right to freedom or on how to use her body as and when she pleases?┬á
Clearly this is not a freedom. This is a desperate way of trying to make the best way of a desperate situation, despite what many sex workers will say including those in India. Are they merely trying to rise above the horrific realities that they face? If marriage is deemed as dangerous as stated in the Sangli, case, are they trying to restore marriage with dignity by selling sex? Is sex work based on woman being a commodity, thus a sex worker in India for instance who makes money as a prostitute is perpetuating the worldwide phenomenon of making women sexual conveniences?
The actual business that sex workers are running should not be idealized. Their strengths if any are to be admired; working in the sex industry should not. This is not solely any man or women should ever wish for anyone let alone close family members and siblings.
At the same time I also asked myself the following questions: I wondered why there is so much churns and emotions about sex work. Why is that women who are in sex work cannot even express what they feel? Why is it that their live experiences are discounted on grounds of false consciousness? Why is it that non sex worker are so confused about sex work when those in sex work are not at all confused. Discussions about sex work without sex worker representation result in an incomplete understanding of the social dynamics of the occupation. They are often seen as object of the programs rather than contributors to them.
Is it not time now for the toxic mist of pity, disgust and moral opprobrium that swirls around the figure of the sex worker be replaced by a willingness to put prejudice aside and listen to and learn from sex workers. They may be some surprises in store…you never know.
Seleke is a Fulbright Scholar currently serving as a Global Health Fellow, Geneva, Switzerland.  He writes here in his personal capacity.
