A challenge that could prevent health care for Bangladeshi sex workers

From IRIN, a story about a political fight in Bangladesh that might prevent sex workers from receiving HIV prevention health care.

Civil society is preparing to challenge a recent government decision in Bangladesh to exclude “prostitution” as a profession on new voter cards on the grounds it effectively blocks sex workers’ access to HIV prevention and life-saving health care.

On 17 August the Bangladesh Election Commission (BEC) announced “prostitution” would be recognized for the first time as a profession on new voter ID cards. But pressure from conservative religious groups led the BEC to reverse its decision, according to Shahnaz Begum, president of Sex Workers Network (SWN), a local NGO that works in half of the nation’s 64 districts.

Election commissioner Sohul Hossain told IRIN the term “sex worker” was omitted in order to prevent commercial sex work, in line with Article 18(2) of Bangladesh’s constitution, which states that “gambling and prostitution” should be “discouraged”.

But activists are seizing upon Article 40 of the constitution, which gives citizens the right to “enter upon any lawful profession or occupation”, arguing that women, therefore, can choose sex work as a profession.

This decision is “ripe for a public interest challenge”, said Khaled Chowdhury, a lawyer at the Supreme Court. “Sex work is not illegal, but as moral and social issues are involved, it is not encouraged. The decision of the EC [Electoral Commission] may have an impact [on the acceptance of sex workers], as voter ID cards are now essential in many aspects of a citizen’s life.”

ID cards are necessary to open a bank account, apply for a passport, and to register property. While not required for health services, almost all other government forms require an ID card as proof of identity.

Limited legality

When the government tried to shut down two large brothels in Dhaka, the capital, a decade ago, 100 sex workers fought back - and won. As a result, sex work is now legal for women over 18, pimps and brothel owners.

But the ruling offers sex workers little protection, as police still frequently harass them, which, according to Begum, can lead to unsafe sex practices. “Clients are often taken to a dark alley and the sex workers have to rush because they are on the lookout for police. If sex work was properly recognized they could take the time to convince their clients to use a condom.”

To make matters worse, a sex worker in Dhaka who gave her name and age as Tania, 28, said police often demand half her average daily earnings of US$7. And without police protection, she has little recourse when clients are abusive. “Yesterday a client gagged and beat me. I don’t want to live this life any more.”

Health care

The government has offered no-cost health care to sex workers at designated clinics around the country since 1978, but the Health Ministry reports that only 2,000 sex workers used these services in 2009 (0.5 percent of the 400,000 sex workers the NGO SWN estimates are working nationwide).

Begum said the government’s mixed messages about sex work are hurting the fight against HIV because sex workers who seek medical treatment are often turned away on the grounds they are “bad women”.

A consistent government stance on sex work would help prevent such discrimination, she added. “The legal framework for sex workers exists, but it is not implemented. The mixed public health messages from the government and Election Commission are undoubtedly harmful for reducing the spread of HIV.”

NGO clinics

There are dozens of NGO-run drop-in centres nationwide that provide free HIV counselling, condoms and medicines, and a referral system for HIV testing to sex workers and their clients. IRIN spoke to 10 sex workers: All said they preferred to visit NGO clinics due to the conservative attitudes of public health staff.

In 2007, 67 percent of sex workers reported using a condom with their most recent client, according to the UN General Assembly Special Session (UNGASS) 2008 Progress Report.

According to the Joint UN Programme on HIV/AIDS (UNAIDS), in 2009 estimated HIV prevalence among Bangladesh’s 160 million people was less than 0.1 percent. The rate for sex workers was about 1 percent, according the Global Fund to Fight AIDS, Tuberculosis and Malaria.

However, the Global Fund warned that a highly mobile population, coupled with poverty and a low level of awareness about HIV, threaten to increase prevalence.

And until the law can protect sex workers and guarantee their access to health care, civil society leaders taking their case to court say that Bangladesh's status as a low HIV prevalence country may change.

“HIV is not spreading at an alarming rate, but I believe it would decrease further if the government gave [it] full recognition,” said Begum.

Legal protection is one of the issues to be addressed at the first UNAIDS consultation in Asia on sex work and HIV to be held 12-15 October in Pattaya, Thailand.