AIDSTAR-One Sex Work and Life with Dignity: Sex Work, HIV, and Human Rights Program in Peru


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In Peru, where cultural norms emphasize women's subordination and the importance of masculinity, programs with a focus on gender—particularly those involving sex workers—are often underfunded and underrepresented. This case study (one of nine in a series) describes how three organizations focused on sex workers and transgendered and transsexual people have joined together to advance the rights of sex workers. The Sex Work, HIV, and Human Rights Program uses a democratic and participatory approach in order to raise awareness of human rights and advocate for sex workers' rights on both national and local levels.

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AIDSTAR-One Sex Work and Life with Dignity: Sex Work, HIV, and Human Rights Program in Peru

  1. 1. AIDSTAR-One | CASE STUDY SERIES September 2011Sex Work and Life with DignitySex Work, HIV, and Human Rights Program in Peru T he classroom in Pucallpa, a provincial city in Amazonian Peru, is nondescript, with desks, chairs, and a blackboard, the simple furnishings of classrooms everywhere. In sharp contrast, the discussion taking place today inside this room is vivid and riveting. It is the second half of a two-day workshop for sex workers on human rights, sexual health, HIV, and gender- based violence (GBV), led by facilitators who also are or have been sex workers. The group of 14—composed of female, transgender, Manuel Contreras and transsexual people1—is talking about the violence each experiences, from clients, pimps, the police, and even their own intimate partners. For many, this is the first time they have ever talked about the pain, fear, and isolation they encounter nearlyFacilitators/participants of thetrainings. every day of their lives. This groundbreaking workshop in Pucallpa, sponsored by the U.N. Population Fund (UNFPA) and the Sex Work, HIV, and Human Rights Program, represents a rare opportunity to address the needs of sex workers in four Peruvian provinces: Ucayali, Arequipa, Piura, and Junín. All four regions are known for their high levels of social stratification and poverty. Pucallpa, in Ucayali, is Peru’s gateway to the Amazon River, with many transient workers and much commercial activity. It is also home to a group of women, transgender people, and transsexual people who engage in different types of sex work. For sex workers in these regions, HIV risk is high. This workshop gives sex workers a space where they can talk about their experiences and concerns, ask questions,By Manuel Contreras learn about their rights, share their dreams, and interact in a peaceful and 1 Transgender indicates all people who live, or desire to live, a large part of their adult life in the role and dress of the gender group that is considered opposite of their sex as designated at birth. A transsexual is a person who is intending to undergo or is undergoing sex reassignment treatment (Whittle 2002).AIDSTAR-OneJohn Snow, Inc.1616 North Ft. Myer Drive, 11th Floor This publication was produced by the AIDS Support and Technical Assistance ResourcesArlington, VA 22209 USA (AIDSTAR-One) Project, Sector 1, Task Order 1.Tel.: +1 703-528-7474 USAID Contract # GHH-I-00-07-00059-00, funded January 31, 2008.Fax: +1 703-528-7480 Disclaimer: The author’s views expressed in this publication do not necessarily reflect the views of the United Agency for International Development or the United States Government.
  2. 2. AIDSTAR-One | CASE STUDY SERIES respectful environment without fear. Three organizations implement the PEPFAR GENDER program: the Institute of Health, Sexuality and Human Development Studies STRATEGIES (Instituto de Estudios en Salud, Sexualidad y Desarrollo Humano [IESSDEH]) ADDRESSED BY BY of the Cayetano Heredia Peruvian University (Universidad Peruana Cayetano IESSDEH, REDTRANS, Heredia [UPCH]); the National Network for the Rights of Transgender People, AND MILUSKA Transvestites, and Transsexuals of Peru (Red Nacional por los Derechos de las Personas Travesti, Transgénero y Transexuales del Perú [REDTRANS]); • ncreasing gender equity in HIV I and the Miluska Life and Dignity Sex Workers Association (Asociación de programs and services Trabajadoras Sexuales Miluska Vida y Dignidad). • educing violence and coercion R • ncreasing legal protection. I According to the Joint U.N. Programme on HIV/AIDS (UNAIDS), sex workers are one of the populations most vulnerable to HIV (UNAIDS 2002). In Peru and many other parts of the world, this population experiences increased risk and vulnerability due to lack of empowerment and ability to negotiate condom use as well as high levels of exposure to violence and marginalization. The structural violence experienced by sex workers commonly begins at an early age and persists into adulthood with high levels of frequency. Violence perpetrated by clients, law enforcement agents, and pimps or partners is a common occurrence (CARE 2009). This case study documents the program and examines how it integrates gender strategies into its activities. It is based on interviews with program directors and the staff implementing the program, sex workers (women, transgender people, and transsexual people), and facilitators of training courses. Also interviewed were donors, national and local health and educational authorities, members of parliament, and representatives of international organizations. Focus groups with sex workers, as well as participant observation in workshops for the program’s beneficiaries, were also part of the information-gathering process. HIV and Most-at-Risk Populations in Peru Approximately 0.5 percent of the adult Peruvian population lives with HIV, which in 2007 represented 76,000 individuals (UNAIDS 2010). Sexual transmission is the cause in an estimated 97 percent of cases (Ministry of Health [MOH] 2010). To date, close to 5,000 people are believed to have lost their lives to AIDS-related diseases in Peru. According to different sources, vulnerability to HIV in Peru is concentrated primarily among most-at-risk populations (MARPs), which include men who have sex with men and transgender people, some of whom also engage in sex work. HIV prevalence among men who2 AIDSTAR-One | September 2011
  3. 3. AIDSTAR-One | CASE STUDY SERIEShave sex with men is 13.7 percent, and between Among the MSP’s goals are reduction of HIV among32 percent and 45 percent among transgender high-risk populations, including sex workers (U.S.people (MOH 2010; UNAIDS 2010). The urban Agency for International Development/Peru 2010).areas of Lima and Callao have the highest HIV The MSP has not been evaluated, so at present it isprevalence, along with certain regions of Amazonia, difficult to know how well it has been implemented.2including some areas in which the program iscurrently operational. However, there appears to However, in recent years the government hasbe less accuracy in HIV prevalence estimates for limited its response, particularly in prevention,the Amazonia region, as in the case of Pucallpa, because of the global economic crisis and aparticularly among MARPs. new presidential administration (U.S. Agency for International Development/Peru 2010). While theCivil society, academic, and international MOH continues to carry out HIV programming,organizations have responded vigorously to HIV in other public health issues, such as maternal andPeru; these include nongovernmental organizations, child health and malnutrition, have received muchuniversities and research institutions, organizations more attention. Funding for MARPs programs isof people living with HIV, and organizations for especially limited; some believe that stigma and theMARPs, such as REDTRANS and Miluska. overall situation of gender inequality are some ofU.N. agencies, primarily UNFPA and UNAIDS, the reasons why sex workers are not included as aalso provide support. The majority of funding priority in the political agenda.for HIV is from the Global Fund to Fight AIDS,Tuberculosis and Malaria, which has provided a Legal issues: The Peruvian constitution mandatestotal of approximately U.S.$60 million to Peru’s HIV equality for women and men. The governmentresponse, and U.S.$10 million was approved in passed a law in 2000 that criminalizes gender-Round 10 with a focus on MARPs. based discrimination, with penalties requiring offenders to provide 30 to 70 days of community service (Organisation for Economic Co-operationGovernment leadership: The MOH and other and Development 2011). Peru has adopted legalgovernment agencies have taken a leadership frameworks against gender discrimination, seen theposition in the response to the epidemic, primarily emergence of progressive legislation on reproductiveby providing such services as testing, counseling, rights, and established national strategies for equaland medical treatment. Particularly important in opportunity. There is also significant progress in theguiding the response is the National Health Strategy institutionalization of policies against Prevent and Control STDs and HIV, originallydeveloped in 2004, which includes strategies for However, in Peru, as in other Latin AmericanMARPs in prevention, treatment, care and support, countries, society is still based on a structural contextand formative and operational research. Other of gender inequality characterized by women’ssectors that work within the strategy are the Ministry subordination in all spheres of social, cultural, andof Education, the Ministry of Justice, the Ministry of economic life. Gender discrimination is even moreLabor, and the Office of Public Defense (MOH 2010). pronounced when it comes to reproductive rights and protection from violence, especially for specificA milestone at the government level has been the groups of women: the indigenous, the poor, youth, andMultisectoral Strategic Plan (MSP) to Prevent and migrants. Findings from a World Health OrganizationControl STD-HIV/AIDS 2007–2011, which providesguidance for Peru’s response to the epidemic. 2 For more information about the plan, see Sex Work and Life with Dignity: Sex Work, HIV, and Human Rights Program in Peru 3
  4. 4. AIDSTAR-One | CASE STUDY SERIESmulticountry study of violence against women show international organizations, such as CARE and thethat violence against women in Peru remains a United Nations. The MOH, IESSDEH, REDTRANS,serious problem (García-Moreno et al. 2005). For and Miluska coordinated the event.example, 51 percent of ever-partnered women in Limaand 69 percent in Cuzco had experienced physical or Throughout the consultations, conferencesexual violence by a partner. participants identified key priorities for the target populations and possible mechanisms to respondThe Peruvian constitution and legal system do not to their needs. The major achievement comingcriminalize voluntary male, female, transgender, out of this event was the partnership of IESSDEH,and transsexual sex work. However, there are no REDTRANS, and Miluska, created to coordinate andregulations in place that protect the rights of sex implement the Sex Work, HIV, and Human Rightsworkers. Because most sex workers in Peru enter Program in work at an early age, they live in marginalizedconditions most of their lives, have limited social The program’s goal is to contribute to the nation’ssecurity, and have grown up in an environment that response to the HIV pandemic by responding to theoffers few opportunities for education or development needs and vulnerabilities sex workers face, from aof skills for employment (Salazar and Silva 2009). It perspective that respects their human rights andis within this context that civil society associations, involves sex workers in planning, implementation,together with United Nations agencies, have strongly and all other programming levels. At the individualadvocated for putting sex work on human rights and level, the program’s primary objective is to strengthenpublic health agendas. the capacities of sex workers to understand and exercise their rights.The Sex Work, HIV, and At the community level, the focus is on strengthening the organizational skills of local transgender,Human Rights Program transsexual, and female sex workers’ groups, as well as raising awareness about human rights amongCurrent HIV activities for sex workers in Peru regional and municipal officials and civil servants,originate mainly from two sources: the MOH’s especially the rights of sex workers. Improving theprogram efforts, including peer education-based quality and efficiency of health services for sexprevention in brothels, and organizations of sex workers is also a key community-level objective.workers that focus on protecting human rights andimproving access to health services. At the legal and political level, the program seeks to incorporate the specific needs of the sex workerIn 2007, sex worker organizations sponsored a population into the 2011–2015 National Strategicnational conference in Lima on sex work, human Plan. Advocacy for approval of a sex work bill thatrights, and HIV. This gathering was inspired by other guarantees that population’s human and labor rightsinternational events on HIV and sex work carried is also a key objective.out both in Latin America and globally. Participantsincluded 98 representatives from sex worker IESSDEH: IESSDEH was created in 2007 asorganizations, 130 transgender persons, and 69 an agency of the Health, Sexuality and Humannational and local authorities (Salazar and Villayzán Development Unit, part of the UPCH School of Public2010). Other participants included members of Health. IESSDEH responds to the need to promotecivil society associations, academic circles, and and implement evidence-based activities for groups4 AIDSTAR-One | September 2011
  5. 5. AIDSTAR-One | CASE STUDY SERIESthat are at a social disadvantage. Its multidisciplinary organization goes beyond the individual andwork is very well known in the fields of health and community levels to engage in advocacy efforts on asexuality, as is the support it provides to strengthen political level.efforts to develop vulnerable communities. IESSDEHpromotes evidence-based interventions that focus The Sex Work, HIV, and Human Rights Program ison improving public policies; the group works with based on a democratic and participatory approachdifferent civil society associations and players that in which members of the three institutions andinclude artists and activists, among others. beneficiaries contribute equally in a joint process. The managers of the three institutions haveREDTRANS: REDTRANS is a national network established mechanisms to communicate thethat was legally incorporated in 2006, although different developments of the program on a regularits work dates back to 2000. A member of the basis. Also, they try to ensure that beneficiaries’larger Latin American and Caribbean Network voices are taken into account.of Transgender People organization, it focuseson promoting the human rights of transvestite, IESSDEH plays the role of main coordinator of thetranssexual, and transgender people by supporting program and also provides technical assistancecommunity interventions and exercising political to REDTRANS and Miluska to strengthen theirinfluence in the fields of health, education, and programmatic and monitoring and evaluationjustice. It also conducts research and raises capacities. IESSDEH also facilitates the dialogueawareness about these populations. between the three organizations, providing a physical space for the planning, debating, and coordinatingMiluska: Founded in 2002 as a sex worker efforts. REDTRANS and Miluska provide managementassociation, Miluska responds to violations of sex and leadership of the program at the grassroots level.workers’ human rights, primarily on the issue of The three organizations participate equally in theviolence. It also conducts a wide array of activities design and implementation of the program and havethat include legal, financial, and psychological the same level of decision-making for sex workers, and it trains sex workersabout human rights, health, HIV, gender, GBV, Both UNFPA and UNAIDS have supported thesexual and reproductive health, and stigma. The program since its inception with technical and financial assistance. These agencies and other institutions believe that the program—with its gender perspective and HIV components—is a new way to defend the human rights of Peruvian sex workers. Although it is a new program, it has demonstrated great commitment in responding to the varying needs of sex workers, such as health, safety, and education, in different regions across the nation in a short period of time. Manuel Contreras Program Activities Some of the most important activities of the programREDTRANS and Miluska staff. during its initial years include: Sex Work and Life with Dignity: Sex Work, HIV, and Human Rights Program in Peru 5
  6. 6. AIDSTAR-One | CASE STUDY SERIES• Preparing, reviewing, discussing, and and Miluska continue lobbying for the bill and more disseminating information on a proposed bill generally for sex workers’ rights through campaign and supporting sex workers’ rights on a national and advocacy efforts. regional level, with the active participation of sex workers and their leaders. Peer education: One of the most important components of the program is a peer education• Facilitating dialogue in regional workshops among approach that enhances the capacity of sex workers key stakeholders—local authorities, civil society to assert their rights. In the first phase of the associations, and sex workers—on the rights of program, sex worker leaders from all regions where sex workers and HIV prevention. For example, the program is implemented received training to regional consultations among 202 representatives become facilitators for workshops for sex workers. from 69 local and regional institutions and from These leaders now facilitate two-day workshops in civil society associations in all four regions have different venues. At present, at least 79 sex workers been conducted with the aim of raising the have been trained. visibility of sex workers and their needs. Different key actors—researchers, policymakers,• Mapping locations where sex workers work service providers, beneficiaries—involved in the and conducting a survey of the socioeconomic sex worker project piloted and validated a specific characteristics in the regions where the program methodology for the workshops. The workshops is implemented. The information has been used include a theoretical and practical session that to fine-tune program strategies. A document titled introduces the concepts of gender, human rights (with Final Report on the Situational Mapping and Socio- particular emphasis on sexual and reproductive rights), demographic Survey of Sex Work in Four Cities in GBV, sexuality, and sexual identity. It also includes Peru (Salazar and Silva 2009) has been published. sessions about self-esteem and leadership. Hands-on activities include painting, writing, and role play.• Training of sex workers—both leaders and beneficiaries—on gender, human rights, sexual The workshops address violence against female, diversity, self-esteem, and HIV, based on a peer transgender, and transsexual sex workers through education approach. different strategies that emphasize empowerment. They provide a unique, supportive space where sex• Training of regional and municipal government workers have the opportunity to learn, interact, and officials on sex work, human rights, HIV, and share their experiences with their peers, as well as legislation regarding sex work. discuss other strategies to advocate for their own• Supporting sex workers by providing information rights. In each workshop there are sex workers who on health services available to respond to violence and HIV.Legislative activity: The program drafted a bill for The program helps open up a topic thisa law that acknowledges the human and labor rights society generally considers taboo.Theof sex workers. The bill focuses on gender equality, barriers are slowly breaking down.This is areduction of stigma and discrimination, protection from definite advantage.violence, and labor rights. The Peruvian Parliamentdiscussed the legislation but so far has not been willing —government officialto pass the bill. Despite this, IESSDEH, REDTRANS,6 AIDSTAR-One | September 2011
  7. 7. AIDSTAR-One | CASE STUDY SERIESvolunteer to join the peer education program and to undergo training tobecome future facilitators. CHILDREN SUPPORT THEIR PARENTS’Educating gatekeepers and communities: The program also ACTIVISM EFFORTSorganizes workshops aimed at developing the capacity of duty bearers,rights holders, local authorities, and service providers in defending the Most participants mentionedrights of sex workers, particularly related to GBV. The workshops for that their children havethe security forces, including the police, are of particular value to the supported them as they engageprogram. At present, more than 40 regional and municipal officials in in leadership and trainingthe four regions and 28 law enforcement agents have been trained. activities. The program has helped raise awareness amongA new curriculum is being developed for online workshops with these the children of sex workersgroups; the goal is to improve knowledge, skills, and attitudes, as well as and educated them about theirthe capacity to respond to cases of GBV against female, transgender, mothers’ labor and humanand transsexual sex workers. rights. One of the sex workers said that she has a young sonThe local MOH offices have a group of young volunteers who carry out whose peers bully him becauseactivities to inform communities about these subjects, specifically about his mother is a sex worker;how and where they can access HIV services. IESSDEH, REDTRANS, however, he says he is proudand Miluska work to make sure sex workers are represented, both within of the efforts his mother makesthe group of young people and those who benefit from the program. as she strives to lead a betterThe program has succeeded in taking a first step to make visible the life and live in a more open andobstacles that sex workers face when they exert their rights and to include understanding world.gender in the agenda of local sex worker organizations. The programhas also raised awareness among officials about the need to respond tothe issues sex workers face. It has created a dialogue about how bestto respond to the needs of sex workers among regional and municipalofficials, law enforcement agents, civil society association representatives,and sex workers themselves. According to one government official: The program helps open up a topic this society generally considers taboo. The barriers are slowly breaking down. This is a definite advantage.On an individual level, sex workers involved with the program havelearned that they have rights that must be respected. They believe theyhave become more empowered to assert their rights, thanks to theactivities implemented by the program. They agree that this has helpedempower them to report violence from different perpetrators, even whenthe person responsible for the violence is an intimate partner. As oneprogram beneficiary said: This is helping some of the sex workers with abusive and violent husbands report these men, and even leave them. Sex Work and Life with Dignity: Sex Work, HIV, and Human Rights Program in Peru 7
  8. 8. AIDSTAR-One | CASE STUDY SERIESSome of the sex worker facilitators also spoke about Ongoing advocacy efforts at the national,the personal satisfaction they have obtained from regional, and local levels: Advocacy effortstheir active participation in the program, even though have been key to gaining consistent support fromit can mean an extra effort in their daily lives. authorities at different levels, especially because they have provided evidence on the condition of I feel good about strengthening and helping my sex workers in Peru based on the mapping and co-workers. I feel happy because I learn and survey activities. teach at the same time. ChallengesWhat Works Well Sustainability: First, financial resources—manyThe different stakeholders agree that this is an provided by United Nations agencies—are limited.innovative program that establishes a strong For the time being, it will be difficult for the threefoundation in programming for sex work, HIV, and implementing organizations to generate sufficienthuman rights in Peru. funds for long-term maintenance of programming. One option is for national and local authorities to“Horizontal” program implementers with provide support; however, despite the work thedifferent strengths: IESSDEH is experienced in program has done on advocacy with policymakers,terms of research and evidence-based programming this issue does not appear to be a priority on moston gender. REDTRANS and Miluska, on the other agendas. The government’s budget for HIV-relatedhand, are experienced in working at the ground matters and MARPs remains extremely limited.level with female, transgender, and transsexual sexworkers in different parts of the country. UNFPA Second, the local base organizations need toprovides technical assistance to the program to raise the capacity of their members, not only inensure integration of the gender perspective. The terms of providing training on the subjects of HIV,three implementing organizations have equal gender, and human rights, but also of organizationalstanding in the decision-making process. management, generation of independent resources, and dissemination of their activities. Most of theDirect participation of sex workers in members have very low levels of formal educationprogram design, implementation, and and have had very few opportunities to develop skillsdecision making: The program is notable valuable for organizational work.because of its participative process, which involvesthe participation of several sex workers full-time (most Patriarchal gender norms: Patriarchal genderof whom are members of REDTRANS or Miluska). norms and stigma and discrimination are strongThis has been vital to creating a sense of ownership barriers that inhibit political leaders from supportingand facilitating the development and implementation sex workers and prevention of HIV among them fromof program activities. This builds the foundation for the a human rights perspective. Subjects related to sexsustainability of the program in the long run. work continue to be taboo and stigmatized in Peru, which creates barriers in responding to issues sexMultilevel work: By working at the policy, workers face. In fact, some officials interested incommunity, and individual levels, this program supporting the program do not necessarily take theis comprehensive and thus more likely to make gender perspective into account and maintain theiran impact. traditional and stereotypical views of sex work.8 AIDSTAR-One | September 2011
  9. 9. AIDSTAR-One | CASE STUDY SERIESThe general patriarchal context impacts the Support the development of sex workers’effectiveness of efforts to raise awareness and abilities: To guarantee sustainability, ongoingtrain public officials and staff. It is difficult to work is necessary to continually reinforce localtransform attitudes and behaviors based on organizations in the regions that are implementingworkshops alone, especially given the gender the program. This calls for developing capabilitiesinequality structure that continues to prevail in not only in terms of gender and human rights, butPeru. Ongoing training efforts to raise awareness also in areas that support the organizations, such asamong service providers, law enforcement agents, computer and internet skills; program administration,sex workers, and the community at large are coordination, and implementation; and financial andneeded to make changes that truly represent administrative and safety for sex workers. The program’s long-term vision is that local sexDemands on sex workers’ time: The program worker organizations will be fully capable of runningrequires the participants’ ongoing and long-term the program independently. Aside from developingdedication; however, many are unable to devote the organizational capabilities of sex workers,time and energy to training and facilitation. Earning it is also necessary to invest in the institutionalan income, caring for their home and children, and strengthening of the organizations by supporting theirmeeting other needs are some of the reasons why legal charters and creating a physical space for anmany sex workers cannot be more active in the operations center.program’s activities even if they would like to be. Working with men: Many interviewees stressed the importance of working with men, both withRecommendations those involved in the sex work industry (clients, pimps, bartenders, among others), as well as lawMonitor the progress of the program: enforcement and public service agents, who areThe program is an innovative approach for Peru often violently aggressive.that has the potential to achieve its objectives tosubstantially modify conditions for sex workers in There are currently several programs in Peru andthe regions implementing the program. However, it elsewhere in Latin America that are working tohas not yet been evaluated. Both the donors and the involve men in sex worker programming. Suchorganizations implementing the program are aware activities need to focus primarily on long-termof this and are starting to discuss the design of a efforts that include discussions on the importancestrategic monitoring and evaluation plan. The design of transforming established gender roles that haveof a rigorous evaluation design is recommended to a negative impact on both men and women’s lives.evaluate the process, outcomes, and impact of the These programs should include components thatprogram. The monitoring and evaluation plan will offer men the opportunity to reflect on the costs ofprovide more substantial information on the aspects hegemonic masculinity and gender inequality. Workof the program that work best and which aspects with men must also include an emphasis on HIVshould be modified. This information will be very prevention, as well prevention of teen violence.useful to the design of the program’s subsequentphases and the possibility of it being replicated in It is especially important to work with male officialsother regions, while attracting the government’s and security agents, including the police force.interest and possibly generating a stronger interest Short-term training and awareness efforts are notamong likely donors. sufficient. Changing attitudes and behaviors require Sex Work and Life with Dignity: Sex Work, HIV, and Human Rights Program in Peru 9
  10. 10. AIDSTAR-One | CASE STUDY SERIESlong-term advocacy and training on human rights, In the short- and medium-term, IESSDEH,gender, and masculinity issues, which must be REDTRANS, and Miluska plan to continuebased on peer education strategies with special implementing the program with the same strategiesemphasis on leaders and young staff members. to ensure stability and continuity in intervention areas.A holistic intervention should also go hand-in- To further strengthen the project, the organizationshand with reforms to institutional norms regarding will hope to establish permanent groups of young sexthe treatment of sex workers by duty bearers and worker leaders from different cities who can volunteerservice providers, with sanctions for those who part-time to coordinate different activities, includingcommit abuses. training. To strengthen capacity, peer educators will work within their cities and then move to other citiesImprove services that address violence where the program is implemented.and sexual and reproductive health needs:The program offers information and services for sex Implementers also envision increasing the scopeworkers on matters related to violence and sexual of their work by including activities to increaseand reproductive health. However, the program access for sex workers to income and productivedoes not directly provide services. These regions resources, including education or training ingenerally lack high-quality comprehensive services vocational skills. At the individual level, this willfor sex workers. These services must be offered enhance the capacity of sex workers to exert theirprimarily by the different government sectors but rights at an institutional level and will strengthenreceive reinforcement through technical support local sex worker organizations.provided by the program implementers. Finally, an evaluation of the program is planned,Collaborate with other sectors: Stronger which will provide valuable data before replication ininvolvement and collaboration with the educational other regions can be considered. gand legal sectors is necessary. Advocacy effortsmust target these sectors on national, regional,and local levels. The MSP should be used as the REFERENCESguideline for this process. CARE. 2009. Empoderamiento de las MujeresAdvocate for the approval of the sex work Trabajadoras Sexuales en el Perú y Prevención del VIHbill: All organizations interested in this field should y Sida [The Empowerment of Sex Workers in Peru and the Prevention of AIDS and HIV]. Estudio de Impactocontinue supporting the proposed bill. The bill Estratégico [Strategic Impact Study]. Lima, Peru: CARE.specifically includes the need to respect the rightsof sex workers and punish those who perpetrate García-Moreno, C., H. Jansen, M. Ellsberg, et al. 2005.violence against them. WHO Multi-country Study on Women’s Health and Domestic Violence Against Women: Initial Results on Prevalence, Health Outcomes and Women’s Responses.Future Programming Geneva, Switzerland: World Health Organization. Joint U.N. Programme on HIV/AIDS. 2002. Sex Work andThe program is poised to consolidate in the HIV. Geneva, Switzerland: Joint U.N. Programme on HIV/regions in which it is implemented and to AIDS Technical Update.become independently capable in planning andmanagement, and in procuring both medium- and Joint U.N. Programme on HIV/AIDS. 2010. Global Report.long-term funding. UNAIDS Report on the Global AIDS Epidemic 2010.10 AIDSTAR-One | September 2011
  11. 11. AIDSTAR-One | CASE STUDY SERIESAvailable at ACKNOWLEDGMENTS(accessed August 2011) The author would first like to thank the IESSDEH staffMinistry of Health. 2010. Informe Nacional Sobre los members for their support in preparing this case studyProgresos Realizados en la Aplicación del UNGASS and their great hospitality during the field work. A special[National Report on the Progress Made on the UNGASS thanks to Ximena Salazar, an IESSDEH researcher,Application. Period: January 2008–December 2009]. for her cooperation throughout the process. AnotherLima, Peru: Ministry of Health, Head Office for the Health special thanks to Jana Villayzán of REDTRANS for theof Individuals. support she provided during the field work stage andOrganisation for Economic Co-operation and her contributions while discussing the different subjects.Development. 2011. “Social Institutions and Gender Index: Thanks to Angela Villon of Miluska and Christina TangGender Equality and Social Institutions in Peru.” Paris, for their support in organizing the focus groups. AFrance: Organisation for Economic Co-operation and huge thanks to the Pucallpa workshop facilitators andDevelopment Center. Available at participants for allowing the opportunity to speak tocountry/peru (accessed August 2011) them about the program and attend the workshop. The author expresses appreciation for the time spent andSalazar, X., and A. Silva. 2009. Informe Final de Mapeo contributions made by the former program collaborators,y Encuesta Sociodemográfica del Trabajo Sexual en government and international agency officials, and theCuatro Ciudades del Perú [Final Report on the Socio- program’s service providers, as well as the beneficiariesdemographic Mapping and Survey of Sex Work in Four who participated in the interview processes. Thanks alsoCities in Peru]. Lima, Peru: Instituto de Estudios en Salud, to the U.S. President’s Emergency Plan for AIDS ReliefSexualidad y Desarrollo Humano, National Network for Gender Technical Working Group for their support andthe Rights of Transgender People, Transvestites, and careful review of this case study.Transsexuals of Peru, Miluska, and U.N. Population Fund.Salazar, X., and J. Villayzán. 2010. Outlines forMultisectorial Work with Transgender Populations, Sex RECOMMENDED CITATIONWork, and HIV/AIDS. Lima, Peru: Instituto de Estudios enSalud, Sexualidad y Desarrollo Humano, Latin American Contreras, Manuel. 2011. Sex Work and Life with Dignity:and Caribbean Network of Transgender People, and U.N. Sex Work, HIV, and Human Rights Program in Peru.Population Fund. Case Study Series. Arlington, VA: USAID’s AIDS Support and Technical Assistance Resources, AIDSTAR-One,U.S. Agency for International Development/Peru. 2010. Task Order 1.HIV/AIDS Health Profile. Lima, Peru: USAID/Peru.Whittle, S. 2002. Respect and Equality: Transsexual Please visit forand Transgender Rights. London, England: Cavendish additional AIDSTAR-One case studies and otherPublishing Limited. HIV- and AIDS-related resources. Sex Work and Life with Dignity: Sex Work, HIV, and Human Rights Program in Peru 11
  12. 12. AIDSTAR-One’s Case Studies provide insight into innovative HIV programs and approachesaround the world. These engaging case studies are designed for HIV program planners andimplementers, documenting the steps from idea to intervention and from research to practice.Please sign up at to receive notification of HIV-related resources,including additional case studies focused on emerging issues in HIV prevention, treatment,testing and counseling, care and support, gender integration and more.