World Health Organization (WHO)
"Young people who sell sex are often marginalized and disengaged from services due to fear of legal sanctions."
This technical brief aims to catalyse and inform discussions about how best to provide services, programmes, and support for young people who sell sex. It offers an account of: current knowledge concerning the HIV risk and vulnerability of young people who sell sex; the barriers and constraints they face to accessing appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build the strengths, competencies, and capacities of young people who sell sex. They are among the key populations at higher risk of HIV that also include men who have sex with men (MSM), transgender people, and people who inject drugs. Young people who belong to one or more of these key populations - or who engage in activities associated with these populations - are made especially vulnerable to HIV by widespread criminalisation, discrimination, stigma, and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage - willingly or not - in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs.
In the area of HIV risk and vulnerability, the brief examines: inconsistent condom use; use of drugs or alcohol; transitions in adolescence; violence; social and economic marginalisation; frequency and location of sexual exploitation/selling sex; lack of comprehensive sexual and reproductive health education, information, and services; and trafficking. In the area of legal and policy constraints, the brief examines: sexual exploitation; mandatory reporting; consent requirements; and criminalisation. In the area of service coverage and barriers to access, the brief examines: availability and accessibility; restricted access to support; poor service quality; discrimination; and competing priorities. Throughout, quotations by young people around the world who sell sex are included. In addition, one section of the brief provides concrete examples in the form of text boxes illustrating promising programmes for and with young people who sell sex that are being implemented by governments, civil society organisations, and organisations of sex workers or young people themselves. Strategies examined focus on: training health providers on the needs of young key populations (Link Up, International HIV/AIDS Alliance, Asia and Africa); peer-led outreach with young people who sell sex (SHARPER Project, FHI 360, Accra, Ghana); contacting hard-to-reach adolescent males who sell sex (River of Life Initiative (ROLi), Philippines); sex-worker-led outreach to young people who sell sex (Aids Myanmar Association Country-wide Network of Sex Workers, or AMA); youth-led advocacy to opposing discriminatory policing practices (Streetwise and Safe (SAS), New York City, United States); and youth-led initiatives to prevent the sexual exploitation of children (ECPAT's Global Youth Partnership Project).
The brief next outlines considerations for programmes and service delivery, stressing the importance of designing and delivering services in a way that takes into account the rights and needs of young people who sell sex according to their age, specific behaviours, the complexities of their social and legal environment, and the epidemic setting. Sample suggestion: "Provide developmentally appropriate information and education for young people who sell sex, focusing on skills-based risk reduction, including condom use and education on the links between use of drugs, alcohol and unsafe sexual behaviour. Information should be disseminated via multiple media, including online, mobile phone technology and participatory approaches." Finally, there is a list of considerations for law and policy reform, research, and funding. Sample suggestion: "Work towards the decriminalization of sex work, same-sex behaviours and drug use, and for the implementation and enforcement of antidiscrimination and protective laws, based on human-rights standards, to eliminate stigma, discrimination, social exclusion and violence against young people who sell sex based on actual or presumed behaviours and HIV status." An annex examines the United Nations Convention on the Rights of the Child (1989).
This technical brief is one in a series addressing 4 young key populations (see Related Summaries, below). It is intended for policymakers, donors, service planners, service providers, and community-led organisations. This series was led by the World Health Organization (WHO) under the guidance, support, and review of the Interagency Working Group on Key Populations with representations from: Asia Pacific Transgender Network; Global Network of Sex Work Projects; HIV Young Leaders Fund; International Labour Organization; International Network of People who use Drugs; Joint United Nations Programme on HIV/AIDS (UNAIDS); The Global Forum on MSM and HIV; United Nations Children's Fund (UNICEF); United Nations Development Programme (UNDP), United Nations Office on Drugs and Crime; United Nation Educational, Scientific and Cultural Organization (UNESCO); United Nations Populations Fund (UNFPA); United Nations Refugee Agency; World Bank; World Food Programme; and WHO.
UNDP website, January 23 2017. Image credit: © UNICEF/NYHQ2013-0782/Asselin