The Case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean: Recognising their sexual and reproductive health needs and demands
Author: Miguel Corral AMSTERDAM: AIDS FONDS Translator: Margaret Stewart Minnich Design: pupilo.com.mx / Luis Del Toro Published by: Aids Fonds, 2016
Recommended citation: Corral, Miguel. The Case of Adolescents and Young People Who Autonomously Engage in Selling Sex in Latin American and the Caribbean: Recognising their sexual and reproductive health needs and demands. Amsterdam: Aids Fonds: 2016.
A LOT FO TIME WE CAN'T EVEN ACC
AUTOMATICALLY THINK WE'RE PI
MINOR, IT'S BETTER TO NOT GET IN
CAN GET YOU INTO TROUBLE. TH
CONDITIONS, GUARANTEES, REGU
TO CLIENTS, BEYOND THINKING
DAMAGE OR HARM REDUCTION, B
PEOPLE, INCLUDING MINORS, SHO
RATHER, IF THEY DO, PROVIDE TH
COMPANY A MINOR BECAUSE THEY
IMPS. PEOPLE SAY, ‘OH THEY'RE A
NVOLVED’. JUST BEING WITH THEM
HERE IS A NEED FOR DIGNIFIED
ULATIONS TO BE ABLE TO PROVIDE
G ABOUT HOW TO MITIGATE THE
BEYOND THINKING THAT YOUNG
OULDN'T ENGAGE IN SELLING SEX.
HEM WITH A LEGAL FRAMEWORK. -Young transgender woman, Colombia
“IN ARGENTINA THERE'S STILL A LOT OF STIGMA AND DISCRIMINATION AROUND ENGAGING IN SELLING SEX, GENDER AND SEXUAL ORIENTATION”
–Comments from youth participants at the Regional Consultation "Egalitarian Health for All" held in Bogotá, 07/2015.
TABLE OF CONTENTS
Acknowledgements
II
Introduction
VI
Methodology
VIII
YOUNG PEOPLE AUTONOMOUSLY ENGAGING IN SELLING SEX, AND HIV
01
Section 1. - Public policies and legislation on sexual and reproductive health and sex work in Latin America and the Caribbean, and how they affect adolescents and young people who autonomously engage in selling sex.
03
1.1 International protocols
04
1.1.1 International Conference on Population and Development (Cairo, 1994)
05
1.1.2 Montevideo Consensus on Population and Development (2013)
06
1.1.3 Ministerial Declaration “Prevention through Education� (2008)
06
1.1.4 Declaration of Commitment and Policy Declaration of the United Nations General Assembly on hiv/aids (ungass) (2011)
06
1.2 Current Panorama
10
1.2.1 Why is it difficult to find information about young people dedicated to sex work?
18
1.2.2 Causes and reasons for adolescents and young people to become involved in selling sex
20
1.2.3 Spaces in which young people engage in selling sex in Latin America and the Caribbean
22
1.2.4 Autonomous, neither victims nor pimps
30
Section 2. - Access to sexual and reproductive health services: focus of hiv.
35
2.1 Access to prevention methods
37
2.1.1 Experiences using condoms with clients, and others, whether use is forced or not
38
2.1.2 Diagnosis and treatment of sexually transmitted infections (stis) and hiv.
39
2.2 Health and health services
42
2.2.1 Experiences of young women with family planning and maternal care
42
2.2.2 Experiences related to hormone treatment of young transsexual women
43
2.3 Access to hiv treatment and hiv care 2.3.1 Access to care
46 47
Section 3. - Experiences of discrimination, stalking and abuse by police and health care providers.
53
3.1 Problematic issues beyond health services
55
3.2 Experiences with the police
56
Section 4. - Conclusions and recommendations.
63
4.1 What needs to be done in order to improve access to sexual and reproductive health, including hiv services
65
4.2 Recommendations for decision-makers from young people who autonomously engage in selling sex
67
4.2.1 Regional Consultation on Diverse Adolescents and Young People Who Autonomously Engage in Selling Sex in Latin America and the Caribbean Annexes
67 XII
—Documents and treaties that serve as support for the promotion of education and the sexual and reproductive health of adolescents and young people
XII
—Bibliography
XIII
“IN BRAZIL WE NEED BETTER CONFIDENTIALITY IN HEALTH SERVICES PROVIDED TO THOSE WHO ENGAGE IN SELLING SEX”
–Comments from youth participants at the Regional Consultation "Egalitarian Health for All" held in Bogotá, 07/2015.
Acknowledgements Our most sincere and heartfelt thanks go first to
each and every one of the young people who decided to go on this journey with us and who, on the way, shared their experiences, their emotions, and their ways of thinking about being engaged in selling sex. Without a doubt, the most valuable contribution is made by them and without them none of this would have been possible. We also want to let them know they are not alone and that their struggle is shared by the research team. Meeting the participants was possible due to the efforts made by our partner and ally organisations who served as a bridge and showed commitment, connecting us to the young people; without their support, patience and understanding, we simply would not have been able to reach them. The Network of Women Sex Workers in Latin America and the Caribbean deserves a special mention because, thanks to their work, we were able to conduct fieldwork in different countries. To Diana Terres we owe recognition for her fantastic job reviewing the legal framework, policies and international treaties on sex work in Latin America. Thanks a million to Diana!
* Stepping Stones is a project that aims to improve the security, dignity and livelihoods of young people and minors engaged in selling sex or vulnerable for, affected by, sexual violence or exploitation. Dutch ngo's Aids Fonds and icco Cooperation (icco) work together with local organizations to implement innovative interventions. These interventions empower young people and minors engaged in selling sex, prevent and end sexual violence or exploitation.
II
The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
We would also like to thank Biljana Vidovic, the current Program Officer-Sex Work Projects of Stepping Stones, for her thoughtful commentaries and the sensitive companion she made of this project from the very beginning. Without her enthusiasm, support and orientation -even in the most extremely disadvantageous circumstances-, we would not have been able to create bridges between communities and the global agenda. Biljana, you are not only a great professional but a wonderful human being. And finally, we thank The project Stepping Stones* of aids Fonds who, from the start, believed in our work and were enthusiastic, providing the necessary funds to carry out this research. Many thank for their attentiveness to our work and for helping us to develop tools that, we hope, will serve to benefit many young
people, not only in Latin America and the Caribbean, but worldwide. Preliminary Note: An appeal to use more appropriate terminology During the First Regional Consultation implemented by the hiv Young Leaders Funds** “Health Equity for All” held in Bogota, Colombia in 2015, young people engaged in selling sex discussed the most appropriate way to refer to them with representatives from different countries. They emphasized that while they recognize the approach and efforts made by governments, international organisations, and other social and political actors, and while a serious human trafficking and child sex trade problem exists in Latin America and the Caribbean –which affects thousands of children and adolescents–, not all adolescents and young people are victims of trafficking or sexual exploitation. When sex work in the region is addressed, it is usually done from an adult perspective. It happens because of the risk faced by organizations that may
be accused of being pimps. This implies that there is a wide gap between sexual and reproductive health programs for sex work professionals –the target population they work with– and young people engaged in selling sex, and this can mean their vulnerability rate for contracting hiv and other sexually transmitted infections or having unplanned pregnancies increases. Young people participating in the regional consultation emphasised the need to recognise that not all young people are victims and that under certain circumstances they decide, independently, to engage in selling sex. Because of this, it is crucial to differentiate between those young people who autonomously decide to engage in selling sex and those who are sexually exploited
**The hylf was a youth-led funding mechanism that enables youth leadership in the hiv response by providing small grants and technical support to youth-led initiatives worldwide working with and for young people most affected by hiv, including young people living with hiv and young people from key populations.
Aknowledgements
III
Respecting their opinions, we use the term “diverse adolescents and young people who autonomously engage in selling sex”, to emphasize the autonomy in decision-making; it recognises their diversity in regards to sexual orientation and gender identity, nationality, race, and hiv status, among others. We believe that healthcare providers should adopt a vocabulary that respects them and that doesn't turn them into victims or imply any kind of negative connotation associated with their activity. Therefore, this definition doesn't include adolescents and young people who are victims of human trafficking and sexual exploitation. This definition implies the exchange of sex for economic goods, materials, hospice, or other resources made by these young people. In this document “young people engaged in selling sex”, is sometimes interchangeable with “adolescents and young people who autonomously engage in selling sex”. However, when other texts are cited, the original way of referring to this population will be respected. Also, it's important to mention that when we refer to adolescents or minors, we are referring to young people between the age of 15 and 19. This segmentation corresponds to the five-year focus on the subdivision on adolescence proposed by the
United Nations1 . Other organisations suggest that adolescence is comprised of three stages: earl and late2 (unicef, 2011). The age range considered here corresponds to late adolescence. Excels the fact that starting from late adolescence, significantly increases the capacity for analytical and reflective thought; also, the ability to evaluate risks and make informed decisions (unicef, 2011)3 .
1 World Health Organization, "La salud de los jóvenes: un desafío para la sociedad". (report presented at the who study group about young people and 'Health for All by the year 2000', Geneva, Switzerland, 1986), accessed December 10, 2015, http://apps.who.int/iris/bitstream/10665/36922/1/ WHO_TRS_731_spa.pdf 2 United Nations Children's Emergency Fund, Estado mundial de la infancia 2011. La adolescencia, una época de oportunidades (New York, United Nations Children's Emergency Fund: 2011), accessed Febraury 15, 2016, http://www.unicef. org/mexico/spanish/SOWC-2011-Main-Report_SP_02092011. pdf 3 Ibid.
IV
The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
“THE FOCUS ON SEXUAL AND REPRODUCTIVE HEALTH HAS BEEN IN COLOMBIA'S CITIES, BUT HASN'T REACHED THE SMALL TOWNS YET”
–Comments from youth participants at the Regional Consultation "Egalitarian Health for All" held in Bogotá, 07/2015.
Introduction This work is the result of the investigation “Health
Equity for All� that is part of the strategic actions carried out by the Stepping Stones of Aids Fonds, with the support of the hylf, an organisation of and for young people that provides technical and financial support to projects led by young people affected by hiv. When we talk about adolescents and young people engaged in selling sex, it's common to automatically imagine the victims of human trafficking and sexual exploitation. However, those involved in the prevention, detection, care and treatment of hiv, recognise that, in contrast to that scenario, there are some people who, due to precarious economic conditions, choose to engage in selling sex, even before the age of 18. The complexity of this issue requires us to understand the phenomenon before us. While it is true that countries have an obligation to ensure the protection of young people who have been victims of human trafficking and commercial sexual exploitation, they also should have adequate health regulations so that those who choose to sell sex, including minors, have access to health services, particularly sexual and reproductive health services. A big concern is that not one of the countries in the region has comprehensive laws on sex work. The lack of legislation on the issue means constant submission to the interpretation and arbitrary discretion of different social actors who often violate their rights: police, educators, health service providers, among many others. The aim of this investigation was to achieve a greater understanding of the needs and problems faced by adolescents and young people under-18 engaged in selling sex in Latin America and the Caribbean, particularly needs and problems related to sexual and reproductive health services, access, with a special focus on hiv. A human rights and gender perspective led the entire process.
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The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
This research was developed in three phases: 1) Reviewing the available literature on the subject in the region, especially policies and regulations; 2) Conducing focus groups in Brazil, Colombia, Honduras, and the Dominican Republic were conducted with young men, young women, and trans4 youth engaged in selling sex; 3) A consultation with youth representatives engaged in selling sex5 from various countries and representative of different key populations. This document includes three sections. At first we present an introduction to the methodological strategy: who was part of this research, when and where it took place, and how the data was collected. Furthermore, the analysis of the information is presented in three sections: a.) Public policies and legislation on sexual and reproductive health and sex work in Latin America and the Caribbean, and how they affect adolescents and young people who autonomously engage in selling sex. In this section you can find the documents related to sex work most relevant to the issue that we touch on here (policies, regulations, international treaties, and etcetera.), the goal is to give and idea of the overview of the situation in various countries of the region.
how they are attended and by whom, barriers and limitations to accessing services and finally, how they manage to overcome these dynamics and challenges. c.) Experiences of discrimination, stalking, and abuse by police and health care providers. The content of this section is particularly saddening, as, while not claiming to be exhaustive, the violence experienced by these adolescents and young people committed by the police or health service providers occurs repeatedly. Both this and the preceding section are those that justify the need for urgent actions, in order to safeguard the integrity of adolescents and young people who autonomously choose to engage in selling sex. Finally, we present the findings and next steps, regarding what needs to be done in order to improve the living conditions of the young people who autonomously engage in selling sex in Latin America and the Caribbean. This report is just a first step on the long road that organised civil society, governments, and aid agencies need to take to ensure a healthy and violence-free life for these young people, from a gender perspective and a human rights framework.
b.) Access to sexual and reproductive health, with an emphasis on hiv. Here young people engaged in selling sex express their emotions, thoughts, perceptions, practices, and their individual dynamics. Specifically, the section covers common experiences with regards to sexual and reproductive health services from their point of view: types of services that they are offered, including 4  When the word trans is used in this document, it refers to female transsexual and transgender individuals and transvestites 5  Althought the specific purpose of this consultation was to develop recommendations for decision makers, the contributions of the participants also enriched this research.
Introduction
VII
Methodology For the preparation of this report it was necessary to use various sources outlined below:
a) Literature about sex work in Latin America and the Caribbean: reports were reviewed of the Joint United Nations Programme on hiv/aids (unaids) and the International Labour Organisation (ilo) where they have worked on the subject, when it is mentioned. Research papers and recommendations documents made by civil organisations such as the Network of Sex Workers in Latin America and the Caribbean (RedTraSex) were reviewed. Research papers on sex work in different countries in the region were also reviewed. These help to understand the big picture on the issue in the region. In as far as possible, the idea was to accumulate relevant data related to young people engaged in selling sex, however, because most studies focusing on human trafficking and commercial sexual exploitation, the issue of selling sex by young people is only touched upon briefly. The lack of data and understanding of young people engaged in selling sex is the complex framework which the current report tries to grasp. b) Focus Groups: Focus groups were conducted with young women, men, and transgender people. Brazil, Colombia, Honduras, and the Dominican Republic. To that end, we contacted civil society organizations with community-based work to access participants. Overall, 99 people participated in the groups: 31 young women, 36 young trans women, and 32 young men. While this number is not intended to be representative of the population of young people engaged in selling sex in Latin America and the Caribbean, it allows us learn about the realities and experiences they live every day. In each of the four focus groups there were four themes discussed: access to sexual and reproductive health, with an emphasis on hiv; other health services; information and education; and, other issues, primarily issues of stigma, discrimination and violence.
VIII
The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
c) Regional Consultation: The First Regional Consultation on Diverse Adolescents and Young People who autonomously engage in selling sex was held in September, 2015 in Bogota, Colombia. The event included the participation of 15 young people from Argentina, Brazil, Colombia, Costa Rica, the Dominican Republic, Guatemala, Mexico, Panama, and Paraguay. The purpose of the visit was to connect young people from different countries in a space where they could dialogue, discuss, organise, and propose courses of action. The result was the development of five recommendations for decision-makers. In many ways, it was an opportunity to hear the perspective of leaders and stakeholders.
Taken altogether, the focus of collecting data and information from focus group discussions, reports and research rests on the following 3 themes: 1) Public policies and legislation on sexual and reproductive health and sex work in Latin America and the Caribbean, and how they affect adolescents and young people who autonomously engage in selling sex; 2) Access to sexual and reproductive health services, with an emphasis on hiv; 3) Issues of discrimination, harassment, and abuse by police and health care providers.
DOMINICAN REPUBLIC women 10 trans 11 msm 8 HONDURAS women 7 trans 7 msm 7
BRAZIL
COLOMBIA
women 7 trans 8 msm 6
women 7 trans 10 msm 11
Methodology
IX
“IN RECENT YEARS, LAWS AGAINST HUMAN TRAFFICKING HAVE BEEN APPROVED IN MEXICO AND HAVE LED TO THE PERSECUTION OF MANY PEOPLE ENGAGED IN SELLING SEX BY AUTHORITIES ACCUSING THEM OF BEING PIMPS”
–Comments from youth participants at the Regional Consultation "Egalitarian Health for All" held in Bogotá, 07/2015.
Young people autonomously engaging in selling sex, and hiv.
SECTION Public policies and legislation on sexual and reproductive health and sex work in Latin America and the Caribbean, and how they affect adolescents and young people who autonomously engage in selling sex.
According to the Joint United Nations Programme on hiv/aids, 36.7 million people were living with hiv worldwide in 2014 –during this year, about 2 million people were newly infected with hiv and 1.2 million died of aids-related causes6 –. Of these, 1.7 million live in Latin America. Of these, it is estimated that about 100,000 are young people between 15 and 24 years, including 40,000 girls and young women7. The hiv epidemic in Latin America and the Caribbean is concentrated primarily in some populations. Identi6 “El sida en cifras 2015”, unaids, accessed December 10, 2015, http://www.unaids.org/sites/default/files/media_asset/ AIDS_by_the_numbers_2015_es.pdf 7 unaids, How aids Changed Everything. MDG 6: 15 years, 15 lessons of hope from the aids response (Geneva, Joint United Nations Programme on HIV/aids: 2015), accessed December 10, 2015, http://www.unaids.org/sites/default/files/media_asset/ MDG6Report_en.pdf
4
The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
fied key populations in the region mostly sex workers and men who have sex with men (hereinafter, msm). hiv prevalence among sex workers is less than 10%, unlike msm, which exceeds this percentage8 . One of the main difficulties recognised to creating effective strategies for prevention, diagnosis, care, and support for hiv aimed at adolescents and young people autonomously engaged in selling sex in Latin America and the Caribbean is the lack of laws governing sex work and protecting human rights of those engaged in selling sex. Even when homosexuality is not criminalised in any country in the region, homophobia and transphobia are present as a generalised cultural phenomenon that affects adolescents and young people who autonomously engage in selling sex, which increases vulnerability for contracting hiv. 8 Ibid.
1.1 international protocols There are various international treaties and proto-
cols in Latin America and Caribbean designed to guarantee the rights and sexual and reproductive health of the population, emphasising the importance of reaching young people. However, policies and programs aimed specifically at young people engaged in selling sex do not exist. This section presents the most relevant regional documents related to the topic. A list of other documents relevant to the topic of young people who autonomously engage in selling sex and sexual and reproductive health can be found in Annex A.
1.1.1 International Conference on Population and Development (Cairo, 1994) The chapter on reproductive health and rights states that reproductive health involves the ability to have a satisfying and safe sex life, without childbearing risks, and the freedom to decide whether to have sex or not, when, and how often. In addition, it notes that in this definition sexual health is included, as life and personal relationships and not just counselling and care related to reproduction and sexually transmitted infections9 . In this report, a special emphasis is put on adolescents’ situation, which it describes as “particularly vulnerable due to lack of information and access to relevant services”10 . The same chapter incorporates a title on sexually transmitted infections and hiv, which mentions the need to pay special attention to women and youth in terms of access to hiv prevention and care services11 . As one of the measures 9 United Nations Population Fund, “Report from the International Conference on Population and Development”, (report presented at the International Conference on Population and Development, Cairo, Egypt, 1994). 10
Ibid, 38.
11
Ibid, 44.
Public policies and legislation on sexual and reproductive health and sex work in Latin America and the Caribbean
5
proposed, it states that “countries should eliminate, where appropriate, legal, regulatory, and social barriers to the provision of information and reproductive health services to adolescents”. Finally, it establishes that programs should involve and train all who are able to provide guidance related to adolescents sexual and reproductive behavior”12 .
1.1.2 Montevideo Consensus on Population and Development (2013) It underlines the need for approaches that are “friendly”, and emphasises “a gender perspective, human rights, and are intergenerational and intercultural”13 . In addition, it emphasises the importance that adolescents and young people make free, responsible, and informed decisions regarding their sexual and reproductive lives and the exercise of their sexual orientation. Adding to this, it states that sex workers are one of the groups that suffer more stigma and discrimination and that this remains a challenge in the prevention and detection of hiv/aids; it also recognises that adolescents and young people are among the most vulnerable groups.
tive of “positioning prevention as a central concept in order to respond in an effective manner to hiv/ aids”15 particularly with adolescents and young people. The declaration was ratified by 30 ministries of health and 26 ministries of education in Latin America. In its content it emphasises that “unequal gender relations and between age groups, socioeconomic and cultural differences, and individual sexual orientations and identities, when associated with risk factors, create situations of increased vulnerability for hiv infection and stis”16; it also notes that “a significant percentage of young people start their sexual life at an early age and in most of these sexual encounters no protection is used to prevent sexually transmitted infections”17. Also among its objectives is “ensuring that health services are youth friendly and delivered with full respect for human dignity and, under the laws of each country, attend the specific sexual and reproductive health needs and demands of adolescents and young people, considering sexual orientation and identity diversity. It also establishes appropriate referral mechanisms within the health sector”18 .
1.1.4 Declaration of Commitment and Policy Declaration of the United Nations General Assembly on hiv/aids (ungass).
1.1.3 Ministerial Declaration “Prevention through Education” (2008)
It seeks the combined efforts of governments, civil society, international organisations and other relevant stakeholders in the fight against hiv/aids. It was
Additionally, we find the Ministerial Declaration “Prevention through Education”14 , with the objec-
an, 2008). Accessed December 10, 2015, http: //www.censida. salud.gob.mx/descargas/declaramin.pdf
12
Ibid, 47, 48.
15
Ibid, 1.
13
“Report from the International Conference”.
16
Ibid, 3.
17
Ibid, 3..
18
Ibid, 5.
14 ssa, “Declaración Ministerial ‘Prevenir con Educación’” (report presented at the First Meeting of Ministers of Health and Education to Stop hiv in Latin America and the Caribbe-
6
The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
signed in 2001 and together with the political declaration of 2006 (updated in 2011) is the most consistent instrument for combatting hiv at the global level. The Declaration of Commitment establishes from its first pages that prevention strategies should specifically target young people. In addition, it is recognised that the full participation of this sector of the population “is crucial to the development of effective responses to the epidemic”19 . In addition, in paragraph 53 it indicates the need for the young people to have information and education about hiv, such as necessary services to develop wanted skills to reduce their vulnerability to hiv infection. A brief review of these documents makes it clear that the sexual and reproductive health of adolescents and young people is a priority issue on the international political agenda, and that through the years new elements that strengthen strategies 19 United Nations, “Declaración de compromiso en la lucha contra el vih/sida” (report presented at the United Nations General Assembly, New York, United States, 2001), accessed December 10, 2015, http://www.unaids.org/sites/default/ files/sub_landing/files/aidsdeclaration_es.pdf.
and mechanisms have been added. These documents give evidence that screening programs, prevention, care, treatment, support, and human rights directed towards young people represent a cornerstone to stop the spread of the epidemic. In addition, these reports and statements argue that adolescents and young people play a leading role in responding to hiv and related to their sexual and reproductive health issues and emphasises that providers of health services should be trained to address their problems and needs, reducing the stigma and discrimination of which they are usually a target. Regarding sex work, the Political Declaration on hiv/aids ungass and the Framework for Action for monitoring the Programme of Action of the International Conference on Population and Development, beyond 2014, addresses the issues related to sex work, in terms of reducing vulnerability related to hiv, stigma, and discrimination. They also call for states to decriminalise sex work, or to promote legislation that protects their rights. In theory the content of these documents, which are the reason for the design and development of poliPublic policies and legislation on sexual and reproductive health and sex work in Latin America and the Caribbean
7
cies and programs to protect and guarantee the sexual and reproductive health of adolescents and youth people in Latin America and the Caribbean, should also impact those who autonomously choose to engage in selling sex. While we already know that adolescents are having sex at this stage of life20 , there is a need to recognise that in addition to initiating a sexual life at that stage, they receive different economic goods, materials or other things that they may need. However, recognising this reality is complex due to the great problem of human and sexual exploitation that cuts across Latin American and Caribbean societies. However, denying the fact that there are youths who autonomously choose to engage in selling sex only complicates and worsens the health and safety conditions that they face daily. In the next section, we will give a closer comprehensive vision of how sex work policies in the region are impacting adolescents and young people, and addition we will put them into perspective before the reality of human trafficking and sexual exploitation.
20 Juan Manuel Contreras and Ralph Hakkert, “La sexualidad y la formación de uniones”, in Diagnóstico sobre salud sexual y reproductiva de adolescentes en América Latina y el Caribe, ed. United Nations Population Fund (Mexico City: United Nations Population Fund, 2001), accessed December 10, 2015, http://lac.unfpa.org/sites/lac.unfpa.org/files/pub-pdf/diagnostico_adolescentes.pdf
8
The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
NO. IN MY COUNTRY LAWS ABOUT SEX WORK DON'T EXIST. –Response from youth representatives from different countries during the Regional Consultation on Adolescents and Young People Who Autonomously Engage in Selling Sex.
1.2 Current panorama Sex work is an issue that has raised debate in the
academic, political, and civil society fields as well as in the media, due largely to political and ideological content that is poured into the exercise of sexuality21. But the debate is not restricted to this issue and it's important to take into account concerns related to human rights, labor, health, and other relevant fields. The Commission on hiv and the Law states that “some governments implement anti-trafficking laws that are so general that the voluntary consensual exchange of sex for money is often confused with the exploitative, coercive, and oftentimes violent, trafficking of people (principally women and girls) in order to use them for sex”22 . We must distinguish between sex work, prostitution, and sexual exploitation. Sex work contrasts with the other terms as its categorisation as work is linked to the fact that it is carried out with the full consent of the person who exercises it23 , thus distinguishing it from sexual exploitation; the term prostitution on the other hand, can be pejorative and contribute to the criminalisation of people involved in sex work24 . However, various sources use both terms generically. 21 Roxana Morales, et al., “Patriarcado y trabajo sexual en el imaginario social de la Costa Rica del siglo xxi”, La Ventana, 38 (2013): 122-163. 22 United Nations, “Risks, rights and health” (report of the Global Commission on hiv and the Law presented at the United Nations Development Program, New York, United States, 2012), accessed May 20, 2015, http://www.hivlawcommission. org/resources/report/FinalReport-Risks,Rights&Health-SP.pdf 23 Misael Tirado, “El debate entre prostitución y trabajo sexual. Una mirada desde lo socio-jurídico y la política pública”, Revista de Relaciones Internacionales, 6 (2011): 127-148, accessed May 20, 2015, http://www.redalyc.org/articulo. oa?id=92722560005 24 Rosío Córdova, “Identidades sexuales y prácticas corporales entre los trabajadores del sexo de las ciudades de Xalapa y Veracruz”, Nueva Antropología, xxi, 69 (2008): 83-103, accessed May 20, 2015, http://www.redalyc.org/pdf/159/15912420005.pdf
10
The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
Montoya states that another aspect of the discussion is related to the courses of action to be taken related to this activity25 . While on one hand there are positions that seek to eradicate sex work, others are inclined to regulate it, and still others opt to consider this activity a job that the state must protect. In all cases the overall discussion of what should be considered trafficking and sexual exploitation is always present, implying that important aspects of the life and health of people autonomously engaged in sex work are involved. One of the major difficulties is that sex work has historically been stigmatised, with stigma being understood as “to label, point out, judge”26 . This, coupled with the precarious conditions in which the people carry out this work and the violence against sex workers, has been strongly linked to an increase in stis, as well as mental health disorders and other medical conditions, as described in a study of sex workers in Mexico City27. This is supported by Tirado, who also notes that recognising the risks that sex workers are exposed to doesn't always contribute to progress in prevention, treatment and care, but rather has resulted in medical and legal discourse that hinders a more comprehensive view of the phenomenon, serving as a basis for abolitionist arguments about consensual sex work28 .
25 Valentina Montoya, “¿Trabajadora sexual o ‘víctima perfecta’? Límites en el acceso a la justicia ”, Prisma Jurídico, 1 (2012): 143-161, accessed May 20, 2015, http://www.redalyc. org/pdf/934/93426128008.pdf 26 Adalgiza Amaya, et al., “Estigmatización de las trabajadoras sexuales: Influencias en la salud”, Colombia Médica, vol. 36, 3 (2005): 65-74, accessed, May 20, 2015, http://www.redalyc.org/articulo.oa?id=28310109. 27 Ingrid Mercedes Bohórquez, et al., “Factores asociados a síntomas depresivos en trabajadoras sexuales”, Anales de la Facultad de Medicina, vol. 71, 4 (2010): 277-282, accessed: May 21, 2015, http://www.redalyc.org/articulo.oa?id=37919982012 28 Misael Tirado, “El debate entre prostitución y trabajo sexual”.
In a 2003 note on hiv and sex work, unaids considers sex work a universal phenomenon that is usually considered illicit and therefore illegal. In addition, there are many reasons why people engage in selling sex and it depends on the community and also of what sub-population they belong to. They are women, men and trans people, some of whom are young people. Many people enter sex work for economic reasons, while others may choose to do so29 30 . In Latin America, there are laws criminalising human trafficking and sexual exploitation of adults and minors, but no country has legislation governing autonomous sex work31.
29 “Trabajo sexual y vih/sida”, unaids, 2003, accessed May 21, 2015, http://data.unaids.org/publications/irc-pub02/ jc705-sexwork-tu_es.pdf 30 unaids, Notas de orientación onusida sobre vih y el trabajo sexual (Geneva, Joint United Nations Programme on hiv/ aids: 2009), accessed May 20, 2015, http://www.censida.salud. gob.mx/descargas/biblioteca/documentos/orientacion_del_ ONUSIDA_VIH_y_Trabajo_sexual.pdf 31 Network of Sex Workers in Latin America and the Caribbean (RedTraSex) states that “sex work is not recognized as such and therefore there are no specific laws on it”. “Situation of human rights of female sex workers in 15 countries in the Americas”, RedTraSex, 2015, accessed August 20, 2015, http:// www.redtrasex.org/publicaciones/cidh_resumenejecutivo_ disenado1/index.html Public policies and legislation on sexual and reproductive health and sex work in Latin America and the Caribbean
11
Life Story: Young Woman Sex Worker (Paraguay)
Diana is 25 years old and has been enga many women engaged in selling sex in L because of stigma, she feared her family are no laws or regulations around sex makes access to sexual and reproducti the police as one of the top public inst work, even though it isn’t criminalised in raising campaigns aimed at youth are n that the government protect the rights o protect and respect individ
aged in selling sex since she was 18. Like Latin America and Caribbean countries, y would find out. She explains that there work in her country and believes this ive health programs difficult. She sees titutions hindering the exercise of sex n Paraguay. She believes that awareness needed, as well as advocacy to demand of all people, and laws and policies that duals dedicated to sex work.
| BR AZ IL
A AL M TE UA
ARGENTINA | BELIZ E|B
A | HONDURAS | MEX ICO MAIC I | JA AIT |H
K OR W
OL IVI A|
X
| NI CA R AG UA
A M NA
AY
|P A
A EL ZU E EN |V
HAVE LAWS ON SEX WORK
HUMAN TRAFFICKING AND/OR SEXUAL EXPLOITATION
RICA | CUBA | ECUAD OR OSTA C | | EL BIA SA M LV O L AD CO OR | E L |G I C RIM CH INA LIS ES SE
| PUERTO RICO | REP. D ERU OM I Y|P N I C UA AN AG A| AR U |P RU GU
Table 1. Countries with regulations on Sex Work and Human Trafficking in Latin America and the Caribbean32 33 34 35 36 . 32
Ibid
33 United Nations, “Global report on trafficking in persons. Human Trafficking, a crime that shames us all” (report presented at the United Nations Office on Drugs and Crime. New York, United States, 2009), accessed December 10, 2015, http://www.unodc.org/documents/Global_Report_on_TIP.pdf 34 “Trafficking in persons report 2015”, u.s. Department of State, 2015, accessed December 10, 2015, http://www.state.gov/j/tip/ rls/tiprpt/2015/index.htm 35 Constitution of the Commonwealth of Puerto Rico, “Para enmendar los Artículos 2, 3, 5, 7, 8, 11 y 58 de la Ley Núm. 246 de 2011, Ley para la Seguridad, Bienestar y Protección de Menores”, accessed December 10, 2015, http://www.lexjuris.com/lexlex/ Leyes2014/lexl2014225.htm 36 News Medical, “Jamaica will not decriminalise, regulate commercial sex work, Prime Minister says”, News Medical, June 26, 2008. Accessed September 20, 2015, http://www.news-medical.net/news/2008/06/26/39535.aspx
14
The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
IN THE CASE OF FEMALE SEX WORKERS, POLICE REMAIN ONE OF THE TOP INSTITUTIONS HINDERING THE EXERCISE OF SEX WORK FOR ALL OF US, EVEN THOUGH IT ISN’T CRIMINALISED IN PARAGUAY. –Young Woman Sex Worker (Paraguay)
This legal vacuum, in addition to the social stigma of sex work, means that many professional sex workers remain anonymous, making their access to health services and human rights protection more difficult. In the 2013 World Report, unaids suggests that the epidemic continues to cause a profound effect on this group, on men, women, and transgender people. It stresses that, in addition to the stigma, inadequate funding of hiv prevention programs for this population is a critical reason as to why coverage in this area remains so low, and, despite their high risk of contracting the virus, prevention programs for sex workers represent only a small part of the funding for hiv prevention worldwide37. Deficiencies in programs are usually mainly comprised of social and legal disadvantages that increase vulnerability and prevent people from getting the services they need, in the first place because there are no laws in most countries of the region regulating sex work, and secondly because sex workers are often vulnerable to harassment and abuse from the police. Therefore, access to needed services may be especially challenging for people who lack legal status and may be fearful of the impact that it could have by making their activity more visible to the authorities. There are many stereotypes and prejudices around those who engage in sex work, and added to the moral, justice, and legal arguments, it's important to consider health as one of the main aspects that impact the stigmatisation of sex workers. In the case of young people engaged in selling sex this is even more emphasised38 . This often happens because of 37 unaids, Informe Mundial. onusida, informe sobre la epidemia mundial de sida 2013 (Geneva, Joint United Nations Programme on hiv/aids: 2013), accessed December 10, 2015, http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Global_Report_2013_es_1.pdf 38 Nydia Ninna Valencia Jiménez, et al., “Percepción de riesgo frente a las infecciones de transmisión sexual de trabajadoras sexuales de algunos establecimientos de la ciudad de Monteria-Córdoba (Colombia)”, Investigación y Desarrollo,
16
The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
the link made with the commercial sexual exploitation of children (hereinafter csec). The International Labour Office (ilo)39 includes the following as csec: a) The use of children in paid sexual activities, in cash or in-kind, (commonly known as child prostitution) in the streets or inside establishments such as brothels, discos, massage parlours, bars, hotels, and restaurants, among others. b) Trafficking of children and adolescents for sexual exploitation. c) Child sex tourism. d) Production, promotion, and distribution of pornography involving children and adolescents. e) The use of children in (public or private) sex shows. The United Nations’ “Protocol to Prevent, Suppress and Punish Trafficking of Persons, especially Women and Children”, which complements the United Nations Convention against Transnational Organised Crime, coincides with ilo in the definition of sexual exploitation, and specifies that “child” refers to persons under the age of 1840 . Because of the complexity surrounding the issue, it is difficult to say that all young people immersed in selling sex are forced to do so. On one hand, the vol. 19, 1 (2011): 64-87, accessed May 21, 2015, http://www.redalyc.org/articulo.oa?id=26820752007 39 International Labour Office, Guidelines on the design of direct action strategies to combat commercial sexual exploita-tion of children (Geneva, International Labour Office: 2007), accessed December 10, 2015, http://www.ilo.org/ipecinfo/product/viewProduct.do?productId=8272 40 United Nations, “Convención de las Naciones Unidas contra la delincuencia organizada trasnacional y sus protocolos” (report presented at the United Nations Office on Drugs and Crime, New York, United States, 2004), accessed December 10, 2015, http://www.unodc.org/documents/treaties/UNTOC/Publications/TOC%20Convention/TOCebook-s.pdf
WHEN I FIRST GOT INVOLVED IN ENGAGING IN SELLING SEX I REMEMBER I WAS PUNCHED BY A CLIENT; I WENT TO THE OWNER OF THE HOTEL FOR HELP, I WAS BLEEDING A LOT. AND HE TOLD ME THAT HE WASN’T GOING TO HELP ME, BECAUSE IN HELPING A MINOR, HE WOULD BE ACCUSED OF SEX TRAFFICKING AND HE DIDN'T WANT PROBLEMS. –Young Woman Sex Worker (Colombia)
very definition of youth itself is complicated and susceptible to change, depending on the context. For example, although unaids recognises that youth sex workers exist, it specifies that the un body understands youth as those between 18 and 24 years of age. This contrasts with the terms of the Latin American Convention on Youth41, where it is determined that the terms “young” and “youth” refer to all persons, nationals or residents, of any country in Latin America, between 15 and 24 years old.
clude women 17 years old or younger. The limits on documentation of the issue create a blind spot that hinders a comprehensive vision of the phenomenon, limits their understanding, prevents a differentiation between autonomous sex work and human trafficking, and can even limit effective interventions with key populations when hiv is involved. b) Legal frameworks and standards regarding human trafficking (hereinafter, ht) and csec.
1.2.1 Why is it difficult to find information about young people and adolescents who engage in selling sex? In addition to the above, the most common reasons for which there are difficulties in finding information related to adolescent engaged in selling sex under 18 are the following: a) Research on persons under 18 years related to sex work are generally classified under csec. In general, completed studies reflect and provide information on sex work that is performed by adults. Investigations on adolescents and minors imply that they are victims of exploitation by third parties. Therefore, at least in Latin America, it's not possible to locate research that provides statistical and qualitative data on those under 18 years old who are engaged in selling sex, without them being victims of csec, as thought it was not a social phenomenon that has historically existed in the region. Even research by the network RedTraSex42 does not in41 “Convención Iberoamericana de derechos de los Jóvenes”, Ibero-American Youth Organization, 2005, accessed December 10, 2015, http://www.unicef.org/lac/CIDJpdf%283%29.pdf 42 RedTraSex, “Estudio sobre estigma y discriminación en los servicios de salud a las mujeres trabajadoras sexuales en América Latina y el Caribe” (summary of the Regional Execu-
18
The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
The fact that organisations, governments, or any social or political actors may be accused to facilitate trafficking or exploitation is a main challenge. As in intend to limit this situation, more precise limits between the two activities could mean an improvement in the handling of cases of csec. The legal grounds from which the subject is dealt with are complex. On the one hand, we find that the criminalisation of autonomous sex work affects the possible support networks that those engaged in selling sex could have, including of course young people and adolescents. The briefing of the Global Network of Sex Work Projects43 , exemplifies those cases where individuals dedicated to sex work sought the support of their trustworthy clients in order to leave situations of abuse or exploitation, which, since the implementation of laws on human trafficking, has ceased to be an option because clients risk being arrested; in addition, in many cases it facilitates harassment from law enforcement authorities seeking “victims”.
tive Report, 2013), accessed December 10, 2015, http://www. redtrasex.org/IMG/pdf/resumen_regional_est_disc.pdf 43 “Sex Work is Not Trafficking Summary”, Global Network of Sex Work Projects, 2011, accessed December 10, 2015, http://www.nswp.org/es/resource/sex-work-not-trafficking-summary
c) The international references about youth are not always uniform.
access their rights, legitimise their work, and deconstruct traditional perceptions about gender47.
The definition of “youth”, “young people”, and “adolescents” varies depending on the country and it makes difficult to adopt a single unifying perspective on such matters. Although later on issues related to the development of the decision-making capacity of individuals will be reviewed in detail, it is necessary to point out that this vagueness plays a crucial role at the moment of defining, whether protocols and current legal regulations, to a person as a victim of human trafficking, an autonomous sex worker and/ or trafficker.
While the socio-cultural context will play a key role in the decisions of people, this doesn't imply that they don't have the opportunity to freely decide on what activities they want to engage in. The case of minors is more complex. While it is known that the contexts of poverty and family violence, lack of education and job opportunities are factors that may be related to the decision to engage in sex work in the case of adolescents under 18 years old, the act of not defining themselves as victims converts them almost automatically into the counterpart, that is to say, traffickers, making it so that when information is sought, they lie or omit data, for fear of being considered accomplices in pimping.
d) It is difficult to understand the specific reasons for which a person chooses to engage in sex work. Several articles mention some of the reasons why some people engage in sex work. In the case of Colombia44 , there is research that lists situations such as poverty as well as domestic violence, and a poor perception of affection. In Cordova’s article45 the labour market conditions in Mexico are considered causal. Other authors insist in the heterogeneity of the phenomenon and the different ways of starting, practicing and dealing with it since sex work is not a onetime event46 . Morales and his team argue that sex work is deeply linked to the human rights movement and even considers it to have given a significant boost to the labour rights movement. They (sex workers) address the importance of reflecting on this condition in order to have organising capacity that enables them to 44 Amaya, et al., “Estigmatización de las trabajadoras sexuales”. 45 Córdova, “Identidades sexuales”. 46 Michel Dorais, “Intimidad en venta: ¿cómo se llega a ser trabajador sexual?”, Desacatos, 16 (2004): 52-68, accessed May 22, 2015, http://www.redalyc.org/articulo.oa?id=13901604
e) Social and cultural rejection of the exercise of sexuality by people under 18. The 2008 Ministerial Declaration “Prevention through Education” addresses sexuality as “a dimension of human beings expressed throughout life”48 . The Organisation of American States (oas) notes that in several countries in the region most young people initiate sex during adolescence49 . Approximately 50% of women aged 15-24 years old have begun to have sex; among the youth population the percentage is higher in rural areas and among those with lower education levels; in the article by Allen et al, sex workers interviewed were, on average, 16.5 years old when they began to have sex50 . While the onset of a sexual life doesn't 47
Morales, et al., “Patriarcado y trabajo sexual”.
48 “Declaración Ministerial ‘Prevenir con Educación’”. 49 “Temáticas de la Juvenud. Salud sexual y reproductiva”, Organization of American States, accessed December 10, 2015, http://www.oas.org/es/youth/Salud_Sexual_y_Reproductiva. asp 50
Betania Allen, et al., “Afecto, besos y condones: el abc de
Public policies and legislation on sexual and reproductive health and sex work in Latin America and the Caribbean
19
mean the beginning sex work, it shows that, in Latin America and the Caribbean, young people are beginning their sexual life, consensually, before reaching the age of majority. One difference that we found is that some of them prefer to do it as an economic exchange or for other material goods. f) In general, no distinction is made with regards to promoting the sexual and reproductive health care of adolescents and young people engaged in selling sex, and not facilitating or promoting human trafficking and sexual exploitation. It will be difficult to integrate this population effectively into sexual and reproductive health prevention, detection and treatment strategies, especially those related to hiv, as long as selling sex is not yet recognised as an autonomous activity of some adolescents and young people. On the other hand, we must consider that childhood and adolescence are important stages to promote the development of people and countries, so it is necessary to provide quality education that includes comprehensive sex education as a human right as well as a strategy for current and future quality of life51.
1.2.2 Causes and motivations for adolescents and young people to engage in selling sex. The manual Making Sex Work Safe, of the World Health Organisation (who), explains that the motivations for people choosing to engage in selling sex are generally economic in nature. A fundamental point addressed by this manual, is that sex work is universally paid more than other occupations for many women, immigrants, or sexual minorities,
particularly those with little education. It also raises the point that, particularly in the case of trans people, discrimination in employment, rejection by their families and communities, mobility, tradition, and psychological factors are among their motivations to engage in sex work52 . Many of the people that engage in selling sex are living in poverty. unaids supports this argument commenting that individuals can engage in sex work full-time, part-time, or occasionally to meet specific economic needs, such as education expenses or in situations of family economic crisis53 . unaids also explains that entry into sex work can also have social roots that can be traced to traditions, beliefs, and norms that perpetuate gender inequalities and gender roles54 . In her investigation Sex workers: the stigma of political consciousness, held in Mexico City, Marta Lamas writes that there are prostitutes who have entered voluntarily and that many of them engage in this work as a way to earn an income or help with the family income55 . This statement is supported by Juliano in her research Sex Work in the Spotlight, which states that, in the face of poverty, in terms of attractive work possibilities, sex work is often viewed as the rough way to make money, but is more profitable than the other options that are available to poor women and/or women with little training, although it's also 52 Cheryl Overs and Paulo Longo, Haciendo el trabajo sexual seguro (Argentina: Cordoba National University, 2002), accessed December 10, 2015, http://www.ciudadaniasexual. org/publicaciones/Doc_Haciendo_el_Trabajo_Sexual_Seguro.pdf 53 unaids, Notas de orientación. 54 “Trabajo sexual y vih/sida”.
las prácticas sexuales de las trabajadoras sexuales de la Ciudad de México”, Salud Pública de México, vol. 5, 45 (2003): 594S607, accessed May 22, 2015, http://bvs.insp.mx/rsp/articulos/articulo.php?id=000452 51
20
“Declaración Ministerial ‘Prevenir con Educación’”. The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
55 Marta Lamas, “Trabajadoras sexuales: del estigma a la conciencia política”, Estudios Sociológicos, vol. 14, 40 (1996): 33-52, accessed May 22, 2015, http://codex.colmex.mx:8991/ exlibris/aleph/a18_1/apache_media/68H5YA9LBIU89SFIXRJBI9HDT7B7NY.pdf
recognised that in addition to the economic issue, there may be other reasons why men and women choose to engage in this activity. In her work Why Should Prostitution Be Sex Work?56 Patricia Britos explains that, in most cases, women end up prostituting because they lack financial means and sex work guarantees them an income and time schedule that allows them to care for their children57. Overall, the information available refers to cases of women and the studies presented agree that most of them begin to engage in sex work for economic reasons. As pointed out Dolais, male sex work is an issue less studied and this may be because it's more likely that young people who engage in selling sex do not identify themselves as sex workers or prefer to remain anonymous58 . This claim is also supported by Left, Ramirez and Perez, who argue that male sex work is universal but is usually an invisible phenomenon, although it seems that has been increasing in recent years59 .
56 Dolores Juliano, “El trabajo sexual en la mira. Polémicas y estereotipos”, Cadernus Pagu, 25 (2005): 79-106, accessed May 22, 2015, http://www.scielo.br/pdf/cpa/n25/26523.pdf 57 Patricia Britos, “¿Por qué la prostitución debe ser un trabajo sexual?”, A Parte Rei, 66 (2009): 1-12, accessed: May 22, 2015, http://serbal.pntic.mec.es/aparterei/britos66.pdf 58 Dorais, “Intimidad en venta”. 59 Giovane Mendieta, et al., “Prostitución masculina: una revisión narrativa”, Andina, vol. 17, 31 (2015): 13681389, ac-cessed May 23, 2015, http://www.redalyc.org/ html/2390/239040814008/index.html Public policies and legislation on sexual and reproductive health and sex work in Latin America and the Caribbean
21
1.2.3 Initiation age in sex work Table 2.
RESPONSES TO THE QUESTION: At what age did you begin to get involved in selling sex? Asked to youth participants of the consultation in Bogota, Colombia
Dom. Rep. | TRANS
Colombia | MAN
Colombia | MAN
Honduras | WOMAN
Colombia | WOMAN
Colombia | WOMAN
Costa Rica | WOMAN
Dom. Rep. | WOMAN
Dom. Rep. | WOMAN
Mexico | MAN
Argentina | WOMAN
Honduras | TRANS
Paraguay | WOMAN
Guatemala | WOMAN
Brasil | WOMAN
Brasil | TRANS
Of the 16 people consulted, only five mentioned that they began to engage in sex work after 18 years old. The age of initiation into sex work most often is 16 years old.
Many sex workers start at an early age. In this sense, age appears to be a decisive factor for entry into sex work, which is related to greater economic, biological, social and gender vulnerability issues60 . unaids em60 Florence Lise Théodore, et al., “El sexo recompensado: una práctica en el centro de las vulnerabilidades (sti/hiv/ aids) de las jóvenes mexicanas”, Salud Pública de México, vol. 46, 2 (2004): 104-112, accessed May 24, 2015, http://www.scielo.org.mx/scielo.php?pid=S0036-36342004000200004&scri pt=sci_arttext
22
The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
phasises that the lack of economic opportunity is a particularly decisive factor in the case of women and young people61. A study in the city of Monteria, Colombia, indicates that “mental constructs sex workers feel that they have more opportunities when you are young”62 .
61
“Trabajo sexual y vih/sida”.
62
Valencia Jiménez, et al., “Percepción del riesgo”.
“IN GUATEMALA WE NEED BETTER ACCESS TO HIV TESTING AND OTHER HEALTH SERVICES WITHOUT THE REQUIREMENT THAT ADOLESCENTS ENGAGED IN SELLING SEX BE ACCOMPANIED BY A PARENT OR LEGAL GUARDIAN”
–Comments from youth participants at the Regional Consultation "Egalitarian Health for All" held in Bogotá, 07/2015.
Life Story: Young Sex worker (Mexico)
When Juan Carlos was 17, he began eng who would give him gifts -a cell phone expenses- in exchange for sex. Then he state Tamaulipas where he began to en customers for services there. He says h his income, but that he didn’t necessa first he did it to buy things that he wan He lives that his studies will provide be does not deny that eventually he will e arises. To date, his family does not kn
gaging in selling sex. First he met a man e, clothes, shoes, or money for school e traveled to the capital city of his home ngage in selling sex in a bar. He charged his foray into selling sex was to improve arily have financial problems. While at nted, today he does it to pay for college. etter opportunities for development but engage in selling sex if the opportunity now that he is engaged in selling sex.
In what spaces do young people engage in selling sex in Latin America and the Caribbean? There are a variety of places where adolescents and young people sell sex. These places can be defined, first, as open or enclosed spaces, and can be classified as public, such as streets, shopping malls, or parks; or private, including brothels, saunas, nightclubs, restaurants, and hotels. These places can function either as a meeting point or destination for sexual intercourse63 . Male sex work in Latin America takes place mostly in closed spaces such as bars, discos, saunas, and pornographic cinemas. In second place public spaces were identified: plazas, parks, and streets. Finally, it is explained that with technological advances in recent years, male sex work is advertised in virtual spaces64 . A study conducted on the border between Venezuela and Colombia reported that some sex workers “get clients and provide services in specific places (brothels) or in hotels, while others make contact in bars (waitresses) or in the street and then move to rooms in establishments. Still others offer their services through mobile or fixed specialised organisations, including those dedicated to so-called ‘human trafficking’ and finally others, in smaller numbers, 63 Lucinda Arroyo and Karina Amador, “Turismo y trabajo sexual en Cancún-México”, Estudios y Perspectivas en Turismo, 24 (2015): 982-992, accessed September 25, 2015, http://www. redalyc.org/articulo.oa?id=180741598012
return to their homes”65 . “In some places there are obvious exchange of sexual services for money recognised as brothels, bars, and street spaces”66 . Participants in the city of Campo Grande do Sul, Brazil, commented that, among the places they go to meet their clients and engage in sex work are: streets, motels, saunas, clubs, and “dark rooms”. On the other hand, they also mentioned that they contact their customers via the Internet, through cruising pages, social networks, or apps, such as Grindr. These young men believe that depending on the place where they engage in selling sex, the health risks changed. They mentioned, for example, that the risk is higher in dark rooms. They emphasised that there is more risk for violence if sex work is exercised in the streets. “It is true that economic conditions in parts of the world result in poor children selling sex, among other things, to survive in an informal economy. But the reality of young people involved in selling sex is more complex than the images presented in sensationalised media”67.
65 Jesús Aragón, “Variables cognitivo conductuales y vih en trabajadoras sexuales de la frontera de Venezuela y Colombia”, Aldea Mundo, vol. 5, 9, (2000): 5-19, accessed September 20, 2015, http://www.redalyc.org/articulo.oa?id=54300902 66
Overs and Longo, Haciendo el trabajo sexual seguro.
67 Ibid. 64
26
Mendieta, et al., “Prostitución masculina”. The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
“IN PARAGUAY, SOMETIMES ADOLESCENTS AND MINORS WHO AUTONOMOUSLY ENGAGE IN SELLING SEX ARE TAKEN TO STATE CARE FACILITIES AND CONSIDERED VICTIMS OF EXPLOITATION, EVEN IF THEY AREN'T”
–Comments from youth participants at the Regional Consultation "Egalitarian Health for All" held in Bogotá, 07/2015.
Life Story: Young Sex worker (Argentina)
‌ It just so happened that the police t working, he had to pay. And he said, “ working there inside the railway statio And I won't denounce the police extorti a shelter because I'm underage and t
told him that if he wanted to continue “I end up paying, because I feel safer on than exposing myself on the street. ing me because if I do then I'll be put in they'll say I'm a victim of trafficking�.
Adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean.
sciousness that allows them to carry out their practice; it is intentional. Its evolving capacities of the adolescents to make decisions are determined.
One of the most complex challenges is the approach and intervention with groups of underage young people engaged in selling sex. The literature review allows us to propose that this definition is concerned with (but not restricted to) the rules and policies that seek to specifically protect children from trafficking and sexual exploitation, however, they leave out those who decide to exercise selling sex autonomously.
Historically, the legal discourse has considered children and adolescents as subjects unfit to make decisions. However, the Declaration of the Rights of the Child allows a paradigm shift in relation to this issue68 .
1.2.4 Autonomous, neither victims nor pimps
68 Public Prosecutor of the City of Buenos Aires, “Las decisions de los niños, niñas y adolescents a la luz del principio de autonomía personal” (work documents of the Public Prosecutor Structure of the Autonomous City of Buenos Aires, Buenos Aires, Argentina), accessed December 10, 2015, http://mptutelar.gob.ar//sites/default/files/AGT_DT6.pdf
For this group of people, there is a double stigma: first, they carry the stigma of sex work and, added to this, the issue of age. The latter is automatically reason to assume they are victims of sexual exploitation. However, although the problem of human trafficking and csec is serious, it is not enough reason to consider all minors victims. That is, not all people who are under 18 are forced or coerced, but may be at risk of being exploited. Oftentimes young people, including minors, when they fall into the hands of the authorities, prefer to say they are victims of human trafficking because otherwise, they are accused of facilitating the sexual exploitation of others, i.e., they are identified as pimps, which may have more severe consequences for them. Depending on the laws of each country, the implications of being identified as a pimp or operator results in monetary fines and imprisonment. At the same event, those present discussed how they should be referred to. It was consensually decided that “adolescents and young people autonomously engaged in selling sex” is the most appropriate way. This entry is the key word autonomy because it is understood to be the will and con30
The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
This consideration is supported on the principle of the “progressive capacity of children and adolescents”, found in the Convention on the Rights of the Child, Articles 5 and 1269 . For Cavargnaro and Colazo70 this means the obligation of governments
69 Convention on the Rights of the Child (1989): “Article 5: State Parties shall respect the responsibilities, rights and du-ties of parents or, where applicable, the members of the extended family or community as provided for by local cus-tom, legal guardians or other persons legally responsible for the child, to provide, in a manner consistent with the evolving capacities of the child, appropriate direction and guidance in the exercise by the child of the rights recognised in the present Convention […] Article 12: 1. States Parties shall assure to the child who is capable of forming his or her own views the right to express their views freely in all matters affecting the child, the views of children being given due weight in accordance with the age and maturity of the child; 2. For this purpose, the child shall in particular be provided the opportunity to be heard in any judicial and administrative proceedings affecting the child, either directly, or through a representative or an appropriate body, in a manner consistent with the normal procedural rules of national law”. “Convention on the Rights of the Chid”, United Nations Human Rights, accessed December 10, 2015, http://www. ohchr.org/EN/ProfessionalInterest/Pages/CRC.aspx. 70 María Victoria Cavagnaro and Ivana Inés Colazo, “Las
in providing legal and social responses that result in the construction of standards that are founded in light of the paradigm shift where children and adolescents are recognised as true subjects of law. The principle referred to means a paradigm shift in niñas, niños y adolescentes como sujetos de derecho frente a la figura del usufructo paterno-materno: Una mirada a partir del interés superior del niño y de la capacidad progresi-va: Su abordaje desde la legislación vigente y proyecto de reforma de Código Civil y Comercial de la República Argentina”, Sistema Argentino de Información Jurídica (2013), accessed September 18, 2015, http://www.infojus.gob.ar/maria-victoria-cavagnaro-ninas-ninos-adolescentes-como-sujetos-derecho-frente-figura-usufructo-paterno-materno-una-mirada-partir-interes-superior-nino-capacidad-progresiva-su-abordaje-desde-legislacion-vigente-proyecto-reforma-codigo-civil-comercial-republica-argentina-dacf130019-2013-01-04/123456789-0abc-defg9100-31fcanirtcod
the treatment of children, saying that under proper care, adolescents are capable of making decisions that affect their lives. In this sense, state institutions should assess to what extent adolescents have the ability to make decisions, not assume in advance that cannot. There is a shift from the tutelage of the minor to the child –in this particular case, adolescent– as a legal entity.
Public policies and legislation on sexual and reproductive health and sex work in Latin America and the Caribbean
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Case Study
A case that exemplifies the transfer of guardianship to the child as a subject of law is Brazil. Although in most countries adolescents under 18 need to be accompanied in order to access hiv-related services, such as testing, delivery of results, and treatment services, Brazil stepped forward in 2010 when the Ministry of Health announced that young people –12 years old and over– could get tested for hiv without the need to be accompanied by their parents. The reason for this? It’s simple: hiv diagnosis reduces transmission to others, and, taking into account that the largest number of new infections in Brazil occurs in the population between ages 13 and 19, authorities announced that a preventive measure is to promote confidential testing. During counselling it is suggested that they be accompanied by an adult when receiving their results, but they still have the opportunity to decide whether or not they wish to receive them alone. Finally, if the result is positive, the health personnel have to assess if the adolescent has the ability to understand the results and receive information71.
71 For more information, please refer to the newspaper article: Lisiane Wandscheer, “Jovens podem fazer teste de aids a partir de 12 anos de idade, sem autorização dos país”, Agencia Brasil, February 14, 2010, accessed September 17, 2015, http:// memoria.ebc.com.br/agenciabrasil/noticia/2010-02-14/jovens-podem-fazer-teste-de-aids-partir-de-12-anos-de-idadesem-autorizacao-dos-pais
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The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
YOUNG WOMEN Young women who autonomously engage in selling sex in Latin America and the Caribbean perceive themselves at risk for hiv, other sexually transmitted infections, or unplanned pregnancies. This is because, on a daily basis, they experience situations that endanger their health and life. Among the most frequent negative experiences we find physical and verbal attacks by some of their clients, especially after refusal to perform sexual acts without a condom. They say that, from their perspective, there is no difference between engaging in selling sex on the street versus in a private or public establishment, since it is not always possible to identify whether clients are violent people or not. Moreover, the risk is perceived to increase when clients ask them to use drugs, an issue that happens even when they have let the clients know in advance that they do not use drugs. After their refusal to use drugs, sometimes they are hit and forced to use them. Most identify the owners of the establishments as people they can go to in these situations, because they do not trust the police. One of their main concerns is that they are seen by society as infectious agents. They suffer stigma and are discriminated against in health centres, especially in sexual
and reproductive health services, which they identify as deficient. An example of this is that sometimes the medical staff injure them during vaginal examinations. Because of the discrimination that prevails regarding sex work, sometimes they deny that they are engaged in selling sex. Their experiences with the police are often negative, especially among minors, and they do not trust the justice system. Another issue they face is the lack of sex education according to their needs and their minors are not allowed to receive condoms in health centers, which increases their vulnerability to infection or unplanned pregnancy. In addition, the fact that they have to be accompanied by some adult to access health services is not a good measure, as it discourages them from attending medical checkups and they believe it is a violation of their confidentiality. On the other hand, it is necessary to reinforce the idea that protected sex is beneficial to your health, including when with a sentimental partner.
In total, 31 young women engaged in selling sex participated
Over half of the participants (59%) were between the ages of 17 and 21
Focus groups were conducted in four countries: Brazil, Colombia, the Dominican Republic and Honduras
According to available data, on the three populations, they have fewer years of schooling
None of the participants mentioned living with hiv, although in June, 6 acknowledged not knowing their status
30% of the participants have children
General Findings by Population. Diverse Young People Who Autonomously Engage in Selling Sex in Latin America and the Caribbean.
HEALTH EQUITY POR ALL LATIN AMERICA COMPARATIVE TABLE BY COUNTRY
HEALTH & HEALTHCARE BRAZIL In relation to healthcare, transgender young women reported that usually depending on the problem, they prefer self-medicate; and only as a last recourse, when the situation is very serious, they visit to health services -preferably the Emergency Care Units (psus) operating 24 hours- because usually they need this service in late nights’ hours, when they suffer any physical aggression. In this service, often it takes a substantial amount of time to receive support and often suffer prejudice on the part of the health professionals when these services are offered. As an example of this situation, one reported that she was only helped quickly because she had been assaulted and severely beaten with a knife, by one of his clients. msm considered that abuse of alcohol was a great problem within their population. HONDURAS Mental pain was one of the most referred health problem for transgender persons and they associate it with discrimination. Young msm mentioned specifically “psychological trauma” as one grand health problem as a result from the stigma and discrimination they suffer for having sex with men and being engaged in selling sex. They gave a very suggestive idea to mention that discrimination is on of the factor by which health problems increased. Following this idea, they mentioned that health services must include mental health programs. The use of drugs was one of the health problems came to the discussion, since drugs are pretty often among them. For young women, among the weaknesses identified in relation to health systems, they mentioned that people under 18 years old can apply for services only if they are accompanied by their parents, which is a limitation to apply. This condition violates their confidentiality.
COLOMBIA For the transgender young women, the first findings show that they recognize their difference regarding their needs and problems in relation to heterosexual, homosexual and bisexual people. From an early age they assume their female identity, and as a consequence in most cases, they are forced to leave their home. Like many transgender women, they also decided to start a hormonal process for the physical change. Other treatments that they have used are silicone implants, injection of oil or other substances. this is closely related to their health because there alternatives do not usually have a professional medical care. This can endanger their lives. DOMINICAN REPUBLIC In relation to health services, transgender young women feel strongly discriminated since they arrive to the hospital. It is usual waiting more than other persons and frequently talk to them rudely and referring to them as they were men. They believe this situation affect the quality of the medical attention they deserve. Young men express negative experiences related to healthcare providers and services. They are specially worried about their confidentiality and rather not to say to doctors or anyone about they being engaged in selling sex. Young women focused the conversation specially around health services. They mentioned that it is difficult to obtain health services when they are under eighteen years old. If they need any medical attention, they must to be accompanied by an adult and they believe it broke their anonymous status. If they don't do it that way, the service is denied. Afraid of discrimination, they refuse to say they are engaged in selling sex to health providers
SECTION Access to sexual and reproductive health services, with an emphasis on hiv
“In 2012, about 2.1 million adolescents (between 10-19 years old) were living with hiv in low and middle income countries. Data on young adolescents (10-14 years) is limited, resulting in little information on progress towards the prevention of new infections or to prevent deaths among the adolescent population”72 . This section contains information that has been collected through community consultations with young men, women, and transsexuals who are engaged in selling sex in different countries of Latin America and the Caribbean. This document, in addition to being reviewed by those who have been given the task of conducting this project, has been reviewed by youth engaged in selling sex in different countries in the region, including Argentina, Brazil, Colombia, Costa Rica, the Dominican Republic, Guatemala, Honduras, Mexico, Panama, and Paraguay. In this way, we seek to ensure that the messages effectively respect the voices of those who are protagonists. It is noteworthy that although the focus is on sexual and reproductive health and hiv/aids, there are other considerations related to health, which the adolescents and young people have mentioned. These are included at the end of the chapter. 72 unaids, Informe Mundial, 17.
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The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
2.1 Access to prevention methods “The distribution of condoms reduces the rates of
hiv and other stis among sex workers”73 and “programs about condoms is an integral component of effective hiv prevention. If used correctly and consistently, condoms are still one of the most efficient methods available to prevent the sexual transmission of hiv”74 . Most of adolescents and young people engaged in selling sex identified places where they can obtain condoms and other prevention materials. That is, there is no problem in recognising that in health centers or in some civil society organisations working on hiv, they can access condoms and lubricants. However, although at first glance this recognition is positive, a problem exists regarding real access to these supplies. This is dues to, among which the following are highlighted: a) they have to pay for them; b) only male condoms are available; c) when adolescents and young people come to request them, they are asked questions that may be uncomfortable about the exercise of their sexuality. When condoms and other prevention supplies have a cost, not everyone can pay for them. This, in the case of adolescents, access to preventive methods becomes even more limited. In the specific case of lubricants, they identified that they can only be obtained in some civil society organisations. In general, the comments from the participants is that, when they are minors, access to condoms is far more limited than when they are 18 or older. Participants didn't make any reference to the use of female condoms. This may be because, as reviewed the participants from Argentina, Brazil, Colombia, and the Dominican Republic in the Regional 73 “unfpa, who and unaids: Position statement on condoms and the prevention of HIV, other sexually transmitted infec-tions and unwanted pregnancy”, unaids, 2015, accessed September 5, 2015, http://www.unaids.org/en/resources/presscentre/featurestories/2015/july/20150702_condoms_prevention 74 unaids, Informe Mundial, 16. Access to sexual and reproductive health services, with an empahisis on hiv
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Consultation by Stepping Stone of Aids Fonds, their availability is uncommon, either because civil society is not distributing them or because the price is higher than the male condom. However, they mentioned that when available, their colleagues accept them and regard it as a satisfactory form of protection, although it is sometimes listed as uncomfortable, either because of the material from which they are made, the rings, or because the friction that occurs during penetration may result in a noise that is annoying to them or to their clients. In the case of Panama, it was explained that its use was uncommon and that this could be due to the lack of knowledge about how to use it. It is necessary to promote the use of the female condom among young women engaged in selling sex because they are an effective barrier method to prevent stis, including hiv, and the research also suggests that female condoms offer a level of protection against stis similar to that of male latex condoms75 . It is important to emphasise the strategies adopted among peers, as participants commented that it is very common that condoms are obtained from friends. Taking this into account, it becomes essential to make use of these support networks to ensure access to these preventive devices. This example shows that “peer education is effective in promoting the adoption of preventive behaviours regarding hiv/aids”76 . This recognition leads to the supposition that this should be a key component of 75 who, et al, Preservativos femeninos: Especificaciones generales, precalificación y directrices de adquisición, 2012 (Geneva/New York, World Health Organization, unaids, United Nations Population Fund, FHI360: 2012), accessed September 5, 2015, https://www.unfpa.org/sites/default/files/ resource-pdf/Preservativos%20Femininos%20Escpecificaciones%20Generales_2012_0.pdf 76 unaids, Peer education and hiv/aids. Concepts, uses and challenges (Geneva, Joint United Nations Programme on hiv/ aids: 1999), accessed September 5, 2015, http://www.unaids. org/sites/default/files/media_asset/jc291-peereduc_en_0.pdf
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The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
hiv/aids prevention programs for the population of adolescents and young people autonomously engaged in selling sex.
2.1.1 Experiences using condoms with clients, and others, whether use is forced not It is difficult to negotiate the use of condoms with clients; it is very common for customers to offer them more money for sex without a condom. At the same time, during sexual activity, clients sometimes decide to take off the condom without informing them and, of course, without their full consent. The only situations in which condom use is not considered voluntarily is when performing oral sex. “Sex workers may find that their attempts to negotiate safer sex and/or insist on condom use may result in violence”77. In their day-to-day experience, negotiating condom use with clients is not a simple matter, on the contrary, it may turn so violent that they fear the reaction it can cause. On the other hand, they also fear losing customers if they refuse to have sex without protection when requested. When they have ingested alcohol or drugs –either the clients and/or the young people– it may further complicate negotiations. Due to the high degree of vulnerability faced by adolescents and many young people autonomously engaged in selling sex, they can begin to maintain sexual relationships without condom use with their clients. Although this is not a circumstance that excludes adult sex workers, it may intensify in young people to the extent that they have not yet developed negotiation skills at the same level as their adult counterparts. The result may be the transmission of sexually transmitted infections, including hiv. For female youth that sell sex, a consequence may be unintended pregnancies. It is also necessary to emphasise the need to cre77
“Trabajo sexual y vih/sida”.
ate prevention strategies with their romantic partners as much as with their clients: strengthening dialogue between partners, and reaching mutual agreements, could reduce the risks in this particular situation. If prevention and risk reduction only focuses on young people engaged in selling sex, then it is leaving behind an area where appropriate and sensitive prevention related to their emotional experience is urgently needed. Young people engaged in selling sex in Argentina, Dominican Republic, Guatemala, and Panama want more condom use campaigns that also include their clients as one of the target populations; this is in accordance with the unaids Guidance Note on hiv and Sex Work, which provides that the information for sex workers and their clients and others in the sex industry must urgently be expanded and adapted to different local contexts and individual needs78 .
2.1.2 Diagnosis and treatment of sexually transmitted infections (sits) and hiv Confidentiality refers to an individual’s right to protect their personal information, in such a way that you can prevent the misuse of information by third parties79 . Of course, this includes information relat78 “Guidance Note on hiv and sex work”, 8 79 unaids, “Guidelines on Protecting the Confidentiality
ed to sexual and reproductive health and sensitively, to hiv. Regarding their experience with the diagnosis and treatment of sexually transmitted infections, including hiv, the results were variable. For example, while the young people in Brazil managed to fully identify the services they receive in the Diagnostic and Counselling Center (cta), other participants expressed that services related to diagnosis and treatment are limited and expensive. On the other hand, the youth participants agreed that it is common to receive counselling during testing, however, those who access these services do not necessarily have adequate information to receive support, and therefore, the quality may be poor. Moreover, they sometimes receive moral criticisms related to their work. Overall, this is a poor practice, in that, while the information that health professionals obtain from those who request their services, should serve to provide the best possible quality of care regarding health or, when the case, this information should be used to better understand a specific condition in that context, and they should be able to propose strategies to counter its effects in the population; therefore, use of such information as an excuse
and Security of HIV Information” (proceeding from a workshop at the Joint United Nations Programme on hiv/aids, Geneva, Switzerland, May 15, 2007), 23, accessed December 10, 2015, http://data.unaids.org/pub/manual/2007/confidentiality_security_interim_guidelines_15may2007_en.pdf
Access to sexual and reproductive health services, with an empahisis on hiv
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to discriminate and violate the rights of the person from whom it was obtained, is a practice that contradicts the rights of these people.
result when they undergo hiv testing. This is due to the existing stigma and the lack of training in providing information at health centers where they go.
On the other hand, it could be possible that examination in health centers is mandatory, which can lead to the confidentiality of the adolescents and young people who seek care at these centers not being respected. This confirms the thesis that “the ability to deliver essential services to some young people is hampered by the limited protection of confidentiality and the right to medical privacy”80 . Furthermore, in the International Agreement on Civil and Political Rights refer to the right to physical intimacy and the need to respect the confidentiality of personal information of all persons81.
Unless they consider that they are going through a period of serious illness, do not seek professional medical help in public services. In that vein, the young people commented that, although they sometimes recognise the need for specialised health care and facing the denial of government health services, they cannot go to private medical clinics because the costs can be very high and exceed their ability to pay.
Adolescents and young people engaged in selling sex suffer double discrimination: first, due to the recognition of their activity and, secondly, due to hiv. The degree of vulnerability increases when it comes to young transsexuals. With special attention, they require to be named and treated with respect. One of the most common conditions when they are adolescents, at the moment of soliciting services for detecting or treatment for hiv, is the request to submit the application accompanied by an adult. To avoid having to deal with this situation, when possible, they ask for identification documents from their peers involved in sex work, who are already adults. Among some of the obstacles that this represents, as it is a common situation, records and statistics on stis and hiv may not be so reliable. It was also clear that there is widespread fear of a positive hiv 80 “Informe Mundial. onusida, informe sobre la epidemia mundial de sida 2013”, 18. 81 unaids, Handbook on hiv and Human Rights for National Human Rights Institutions (Geneva, Joint United Nations Programme on hiv/aids and Office of the United Nations High Commissioner for Human Rights: 2007), accessed December 10, 2015, http://www.ohchr.org/documents/publications/ HandbookHIV_NHRIsAug2007.pdf
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The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
A group of young people engaged in selling sex from Dominican Republic prefer to ignore their HIV status; this is directly related to the high level of stigma among hiv. As can be seen in the next page case study, in the case of Colombia, the public health institutions focus their attention on this group based on the risk of transmitting sexually transmitted infections82, thereby limiting the quality of their health and the exercise of their rights83.
82 Amaya, et al., “Estigmatización de las trabajadoras sexuales”, 65-74 83 Misael Tirado, “El trabajo sexual desde una perspectiva de los derechos humanos: implicaciones del vih/sida e infecciones de transmisión sexual”, Civilizar. Ciencias Sociales y Humanas, vol. 27, 14 (2014): 97-110, accessed September 18, 2015, http://www.redalyc.org/pdf/1002/100235716005.pdf
Case Study
Currently, those engaged in sex work in Colombia are fighting for a law to regulate this activity and recognise the rights of those who exercise it. Colombian women involved in sex work feel they are still seen as aa source of infection. Having a sex work law would make health services more accessible to them. According to current health regulations, sex workers in Colombia must attend, regularly, a forty-hour training class on sexual and reproductive health, and undergo three exams to detect any sexually transmitted infection. This way, they can get access to an identification card and are allowed to practice sex work. However, access to the identification card is complicated; therefore, some sex workers prefer to pay medical examinations with their own money even if it means making a sacrifice in their personal or family finances. For them, one of the main problems to generate the changes that they deem necessary is the lack of will by the authorities, which translates to lack of support. This type of health regulation is controversial because it only recognises the obligations of sex workers, but completely ignores those of the client. That is to say, all the responsibility is placed on the professional sex worker. They also stated that the 1997 Decree No. 1543, which states that no Colombian citizen can be forced to get tested for HIV, does not apply to them. In addition, often carrying the card is a source of stigma and discrimination as well as extortion by the police. In this sense, they demand not only the improvement of health standards, but also security measures for sex workers, including minors engaged in selling sex.
Access to sexual and reproductive health services, with an empahisis on hiv
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2.2 Health and Health Services 2.2.1 Experiences of young women with family planning and maternal care
“Adolescent women face greater risk of sexual abuse, early pregnancy and unsafe abortions”84. As shown in this section, this situation intensifies among those who choose to engage in selling sex in the region. Particularly in the case of young women, the experiences varied from one country to the next, but in most cases the need to improve the services offered by state health centers was apparent. Participants from the Dominican Republic commented during the consultation in Bogota that oftentimes, upon identifying themselves as people who sell sex to doctors, they are injured or hurt with medical instruments during gynaecological examinations. This comment is similar to those expressed during the focus groups by participant sex workers from Colombia. Also, during the consultation, participants from the Dominican Republic explained that selling sex does not only imply only checking the sexual and reproductive apparatus, but rather holistic health check-ups. Young women in Brazil believe that they have sufficient information and consequently, the use of condoms and contraceptives is prevalent. However, the responses of these young women speak of them as individuals, not of their direct experience with the health system. Unlike them, other young women engaged in selling sex have argued that, specifically regarding contraception, sometimes they have to self-medicate and undergo treatments that, from their point of view, can be dangerous to their health. If this practice is recurrent among them –especially among adolescents– it is because in health centers, access to family planning services is limited. And when it is possible to obtain medical care, they must 84 Pan American Health Organization, Salud sexual y reproductive al alcance de los adolescentes pobres y en situación de vulnerabilidad (Washington, Pan-American Health Organization: 2013), accessed December 10, 2015, http://www. paho.org/hq/index.php?option=com_docman&task=doc_ view&gid=25322&Itemid=
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The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
be accompanied by an adult. When they do access these services, doctors sell them the prescriptions. Faced with these situations and with the intention of avoiding them, and also to avoid the stigma and discrimination they face in health services, they resort to dangerous homemade practices. For this reason, it is necessary to emphasise awareness raising among those health providers to strengthen their skills and attention with a human rights and gender perspective. Some of the young women participants are mothers. The majority of participants knows about contraceptive methods and considers it an advantage to use them. However, they do not always have access to them because they are not always available in health centers. When they are available, it sometimes happens that those offering health services sell them. Sometimes, due to the lack of contraceptive method options, they must conform to using the methods available, instead of an individual-based recommendation. This may result in them not feeling comfortable or feeling that the method is not working for them. There are myths about the possibility of becoming sterile if they try to interrupt unintended pregnancies, and when they want to do it with a health care professional, the cost is high, which impedes it being done in an adequate way and puts their life at risk. Particularly participants from the Dominican Republic spoke about abortion saying that it must be legalised in the country, on the grounds that, by not being legal, young people engaged in selling sex have to perform home abortions and they know that that can endanger their lives. They know of cases of other sex workers who, because they did not have access to a legal abortion, lost their lives. In order to abort, they may resort to medicines to treat gastric problems, or different herbal teas, among other remedies that are not recommended.
Young people engaged in selling sex in Latin America and the Caribbean perceive health centers as places where they are abused and stigmatized, that do not attend their sexual and reproductive health, and they prefer practices at home or self-medicating, even if they are not safe, because they have no money to pay private doctors. The aforementioned is verified in part due to the results of research conducted by Pechiny85. This can endanger their sexual and reproductive health and make them vulnerable to sexually transmitted infections, including hiv, and unplanned pregnancies.
2.2.2 Experiences related to hormone treatment of young transsexual women The specific objective of a hormone treatment, in the case of trans people, is to suppress or minimise original, secondary, sexual characteristics and induce certain characteristics of the sex with which they identify86. It is the most widely used treatment for body modification processes. It includes administering anti-androgenic therapy and oestrogen therapy. The who “recommends the use of oestrogen via sublingual, transdermal and injectable routes of administration regarding oral hormones, since this prevents liver metabolism”87. 85 Mario Pecheny, “Estigma y discriminación en los servicios de salud a las mujeres trabajadoras sexuales en América Latina y el Caribe”, Gazeta de Antropología, 30 (2014), accessed September 17, 2015, http://www.gazeta-antropologia.es/ wp-content/uploads/GA-30-3-08-Mario-Pecheny.pdf 86 Martha L. Centurión, et al, Salud, vhi-sida y sexualidad trans (Argentina, unaids: 2008), accessed December 10, 2015, http://www.paho.org/arg/images/KMCARG/salud_vih_sida_ libro.pdf?ua=1 87 “Guía de atención integral en vih/Sida-it’s a personas glbti”, Ministry of Public Health of Ecuador, 2013,
Access to sexual and reproductive health services, with an empahisis on hiv
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IF WE GO TO A HEALTH CENTRE AND SAY WE ARE SEX WORKERS, THEY ONLY CHECK OUR VAGINAS. THEY ISOLATE US, DISCRIMINATE AGAINST US AND STIGMATISE US. –Young Sex Worker (Dominican Republic)
When it comes to hormonal treatments, often the first guidance on the subject is from the previous experiences of their peers. Among the first observations shared by the young trans participants, we found that hormone drugs can be purchased in virtually any pharmacy, without need for a medical prescription. As such, they know of alternate routes where they can buy hormone treatments, if they cannot get them at a pharmacy or drug store. These alternative routes are illegal and are better known as black market. “The desire and anxiety to change their phenotype often leads them to try to double the hormone dosage and/or to resort to unconventional and harmful treatments for their health”88.
When they don't have access to treatment, they may decide to resort to highly dangerous health practices, such as injecting aircraft oil or cooking oil (vegetable) in the buttocks or other body parts. Such practices can lead them to contract serious infections that, when faced with the lack of appropriate attention in health centers, can become complicated to the point of endangering their lives. On the other hand, facing the lack of capacity of most health services to guide and care for transgendered people, participants mentioned that it is through health promoters of civil society organisations that they can obtain information, advice and support about hormone treatments and other issues related to their gender identity.
http://m.sb-10.com/medicina/6553/index.html 88 Centurión, et al, Salud, vih-sida y sexualidad trans. Access to sexual and reproductive health services, with an empahisis on hiv
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2.3 Access to hiv Treatment and hiv Care In the unaids technical update of 2003, a refer-
ence is made that “sex work professionals who are living with hiv/aids are often discriminated against by health workers and other service providers”89. People with a negative hiv status mentioned that although they lack the necessary information about treatment, they recognise that when they go for an hiv test, the health counsellors give them guidance on the issue. Participants living with hiv complained that it's common the delay in delivery of their arv medications. They did recognise that this situation is becoming less frequent, so we can assume that the delivery of drugs for people living with hiv is increasingly timely. They recognise that without treatment for HIV at public hospitals and other health systems, it would be difficult to get the antiretroviral drugs because prices are so high. This information coincides with unaids propose as one of the world’s major goals for the eradication of hiv/aids, that at least 90% of people who know they are living with hiv receive antiretroviral treatment by 202090.
According to the unaids report on people living with hiv, “programmes to increase awareness and reduce stigma among health service providers increase the satisfaction with such services and improve outcomes”91. A positive aspect is that drug delivery is always accompanied by medical supervision, which can answer questions and concerns. On the other hand, it mentions that in the case of minors, as in other circumstances already men89
“Trabajo sexual y vih/sida”.
90 unaids, Fast-track. Ending the aids epidemic by 2030 (Geneva, Joint United Nations Programme on hiv/aids: 2014), accessed December 10, 2015, http://www.unaids.org/sites/default/files/media_asset/JC2686_WAD2014report_en.pdf 91 unaids, People Living with hiv (Geneva, Joint United Nations Programme on hiv/aids: 2014), accessed December 10, 2015, http://www.unaids.org/sites/default/files/media_asset/01_PeoplelivingwithHIV.pdf
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The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
tioned, it is necessary that they be accompanied by an adult. Sometimes these teenagers and young people engaged in selling sex have to travel long distances to health centers for their antiretroviral treatment, and this can make it difficult for them to take them regularly.
provided to people living with hiv. When the services they receive in health centers are not what they need, they can complement the attention the attention they receive in different civil society organisations, specialised in treating people living with hiv. Although they believe that support groups are an important space of awareness, support, and promote positive changes in the lives of people living with hiv, they feel that lately the quality of these support groups is declining.
2.3.1 Access to hiv care The range of responses varied among the participants. Among the main answers was the fact that, although they have some knowledge of appropriate care needed by people living with hiv, they need more guidance on the subject. They also identified that there is a considerable lack of resources, and this prevents it from being the best possible care
Of course, when it comes to hiv care, one of the most problematic issues was that sometimes there are not enough drugs in health centers. Another issue mentioned was the fear of discrimination, especially within their family groups. It was also mentioned that the cost of drugs is conditioned by individual socioeconomic status and, for minors, they have to seek hiv care at paediatric centers.
Access to sexual and reproductive health services, with an empahisis on hiv
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“IN PANAMA, IT'S THE CIVIL SOCIETY ORGANISATIONS THAT ARE TRAINING INDIVIDUALS ENGAGED IN SELLING SEX ON THEIR RIGHTS SO THAT THEY KNOW THAT SEX WORK IS NOT A CRIME. ”
–Comments from youth participants at the Regional Consultation "Egalitarian Health for All" held in Bogotá, 07/2015.
YOUNG MEN Because some of them have a girlfriend or wife, they prefer not to be associated with engaging in selling sex, for fear of being recognised. This made them, of the three key populations, the most difficult to locate to participate in this research.
that that they are not specific to young people. In addition, they say that they have gone through several negative experiences in health centers. They are concerned that their confidentiality is not guaranteed and therefore do not identify as engaged in selling sex.
When asked what they do, they often invent activities. However, they acknowledge that due to the lack of better opportunities in their countries, they have to engage in selling sex.
In addition to the problems arising from sexual activity they mentioned that, because of the stigma and discrimination they can actually develop "psychological trauma". In that vein, they emphasised the need to integrate mental health services within the health care programs.
Young men who autonomously engage in selling sex mentioned that one of the most common problems related to their health is sexually transmitted infections, including HIV. This may be due to limited access to prevention (condoms and lubricants), together with the request of customers to not use condoms during sex.
They also recognised that the use of drugs and alcohol is high among young people engaged in selling sex. They said that stigma, discrimination and violence in the streets is an issue that they face on a daily basis.
When identifying symptoms of an infection, they prefer self-treatment before resorting to health centers because they fear discrimination. In this sense, they show that discrimination is one of the main reasons why health problems have increased.
From their perspective, the police are one of the greatest obstacles, no only because they [police] discriminate against them but because they force them to have sex while detained, as a condition for being released, thus assuming their engaging in selling sex is illegal.
They agreed that it can be difficult to reject the offer to earn more money in exchange for unprotected sex, despite recognising the adverse consequences it may have for their health. However, couples who have a sentimental partner, said they tend to be very careful in protecting themselves, because they would not like their engagement in selling sex to affect their partners.
Although in general, these young men tend to have higher education levels in comparison with their trans and female peers involved in selling sex, they recognised they they lack knowledge on hiv and other sexually transmitted infections.
On the other hand, although they identified some programs for sexual and reproductive health, they mentioned
47% of participants were between the ages of 18 and 21
In total, 32 young men engaged in selling sex participated
Focus groups were conducted in four countries: Brazil, Colombia, the Dominican Republic and Honduras
According to available data from the three populations, they are the ones who have more years of schooling
Only one of the participants mentioned living with hiv, although three did not know their status
General Findings by Population. Diverse Young People Who Autonomously Engage in Selling Sex in Latin America and the Caribbean.
HEALTH EQUITY FOR ALL LATIN AMERICA COMPARATIVE TABLE BY COUNTRY
SEXUAL & REPRODUCTIVE HEALTH SERVICES, INCLUDING HIV PREVENTION, TESTING, TREATMENT & CARE BRAZIL For transgender young women engaged in selling sex, sometimes it is difficult to negotiate the use of condoms with clients and they believe it may represent a chance to get infected with sexually transmitted disease, including hiv. Young msm cited several situations that put both your life and your health at risk. These situations are but not limited to sti's, especially HIV and customers wanting to have sexual intercourse without the use of condoms. On access to health services reported not having difficulty and seek preferably the Centers for Testing and Counseling (cta) for hiv testing and Emergency Care Units (psus) operating 24 hours. Do not suffer prejudice by professionals of these services as they don´t identify themselves as people who sell sex. Young women placed several situations that put both their life and their health at risk. These situations include getting infected by sexually transmitted diseases, especially
hiv, verbal and physical aggression that may suffer in the room with the costumer, when they want to have sex without condom. For them the health risks are the same, regardless of where they work, because they have no way of knowing what kind of person are entering in the room with. As well as young msm, women usually turn to health services, the Center for Testing and Counseling (cta) for both hiv tests as other issues, to stay close to the place they engaged in selling sex. Also they make use of the Emergency Care Units (psus) operating 24 hours for other issues. Complaints of care in services are in relation to delay and sometimes suffer prejudice on the part of the professionals of these services for being engaged in selling sex. More confidentiality is needed when visiting health services. More sensitization campaigns are needed for health providers.
COLOMBIA One of the major concerns among young women engaged in selling sex is that they are see as infectious agents. They referred to be discriminated and suffer stigma in public and priva health services, especially those related to sexual and reproductive health. Specifically, they rate the sexual and reproductive health care as a bad service. Some of them stated that sometimes clinicians hurt them while using devices to make vaginal examinations. A highlight of the discussion was that those engaged in selling sex should be coordinated with the authorities to monitor that medical services are performed with respect and treat them with dignity and that they should be comprehensive and not only provide hiv testing
HONDURAS For transgender people, hiv and stis is the mayor health problem. Health services, police and the population in general offend them because of their gender identity. This is one of the reason they better medicate themselves before going to visit the doctor. When they do, it is because a decease linked to stis and violence suffered from one of their customers. They do not have problems to obtain condoms, but negotiate it with the costumers who usually offer more money to engage in unprotected sexual intercourse with them. Because of the economic difficulties they may go through, sometimes accept doing it. They recognize that the younger a transgender is, the easier will be to manipulate her by the client (referring of not using condoms). They pointed out that usually don't use protection with their sentimental partner. They identified that one of the mayor needs that have to be address is that healthcare providers should develop skill of how treating a transgender person. As well as the other demographics, the young msm from Honduras identified that one of the most common health problems are stis. The poor distribution of
condoms was one of the circumstances for what they are in risk for infections. They rather self-medicate than go to medical services because they are afraid of the discrimination that may occur. In relation to hiv, it seems quite common that people access to hiv treatment just if they have enough resources to pay for it. Young people engaged in selling sex not really have the amounts to cover the price of the medicine if they need it. They identify programs for hiv, but none of those specifically for young persons. Among the major health problems that address the women, sexually transmitted infections, unwanted pregnancies, violence suffered by customers and the lack of information, especially in the prevention of stis is found. Another difficulty in terms of sexual health care is the lack of access to condoms to minors. It is interesting notice a difference in condom use between their clients and their sentimental partners. They usually don´t use a condom when the costumer offers to pay more. With their romantic partners condoms are often not use.
DOMINICAN REPUBLIC Trans women did not express any concern about getting condoms now but they often referred when they were younger and recently engaged in selling sex, buying them was hard specially with the economic need they had, which was at first time the reason they decided to get involved in this activity. The reasons to not use condoms with clients are shared among allt hree key populations: They can´t have an erection with the condom on; That the intercourse will last very long; It provoques allergy on them. Negotiate condom with costumers is not easy and even more difficult to use with their sentimental or romantic partner. Even when they identify that they have certain abilities to negotiate the use of condoms, they understand that those were developed recently and that younger transgender might not have the skills to confront this kind of situations. For young MSM, Some participants recog-
nize that it is hard to deny the opportunity to earn more money when the costumer proposes not usinga condom during sexual intercourse. Since many of them describe to have a female partners (and they do not know about their activity), they express a very genuine concern to take care of their own health in order to protect the health of their beloved ones. A very few participants, influenced by stigma, showed to be uninformed about their HIV status. Some of them said they prefer not to know. In other parts of the dialogue they express their knowledge about HIV (specially testing), but they do not know enough about treatment and it might be because none of them lives with HIV. Differently form their peers, they do not express difficulties to obtain condoms. Even more, they said sometimes costumers bring their own condoms.
SECTION Experiences of discrimination, stalking, and abuse by police and health care providers
It is known that stigmatisation, marginalisation and violence are factors that appear to increase the vulnerability of sex workers to hiv infection92. Stigma refers to unfavourable attitudes and beliefs directed at some individuals; it involves discrediting said individuals due to characteristic attributed to them that can be arbitrary93. On the other hand, discrimination may be defined as “any form of distinction, exclusion or arbitrary restriction affecting a person; usually, but not always, it is motivated by a personal characteristic or a person’s belonging to a particular group”94, as in the case of the young people who engage in selling sex. This section will address situations of stigma, discrimination and violence by law enforcement and public health personnel experienced daily by young people who autonomously engage in selling sex in Latin America and the Caribbean. These experiences of violence can lead to underground sex work95, hampering further efforts to provide hiv -related services to this population. In this sense, it is recognised that respecting and ensuring the human rights of vulnerable populations –in this case young people autonomously engaged in selling sex– is a key factor to stopping the spread of the hiv epidemic among them.
92
“Trabajo sexual y vih/sida”.
93 Pan American Health Organization, Manual de actividades para la reducción de estigma y discriminación relacionados a its, vih y sida (Washington, Pan-American Health Organization: 2013). 94 unaids, Orientaciones terminológicas de onusida (Geneva, Joint United Nations Programme on hiv/aids: 2011), accessed December 10, 2015, http://www.unaids.org/sites/default/ files/media_asset/JC2118_terminology-guidelines_es_0.pdf 95 unaids, Notas de orientación onusida sobre vih y el trabajo sexual.
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The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
3.1 Problematic issues Stigma, discrimination and abuse related to the exerbeyond Health Services cise of selling sex were issues discussed by the par-
ticipants. As set forth in the work of Pecheny, there is “discrimination due to poverty, gender, sex work, and hiv”96. Particularly transgender youth from Colombia and Honduras commented that this situation became more evident in health centers due to the prejudice of staff attending them. For them, being discriminated against is a factor that affects their decision to visit or to not visit health centers. The young participants engaged in selling sex from Honduras emphasised that they preferred to self-medicate when they suspect a sti in order to avoid the risk of discrimination in clinics. In other words, the negative impact of stigma and discrimination in young trans people who engage in selling sex can increase their vulnerability to hiv and other sexually transmitted infections. As mentioned above, added to this is the lack of confidence that their information will be treated confidentially by health care providers, which also influences their decision to attend health services. From their perspective, there is a real need to conduct awareness campaigns targeted at health care providers. Participants from Colombia emphasised the discrimination they experience in health services and, on the other hand, the young people of Brazil who, despite identifying some situations related stigma and discrimination against sex work, mentioned that their experience with the Centers for Testing and Counselling (cta) has been adequate. In addition, they mentioned the advantage of the Emergency Health Units (pus), which they are open 24 hours. Fortunately, the young people who engage in selling sex who suffer discrimination by state health services, know they can go to civil society organisations or community-based support. Women and transgender individuals from the Dominican Republic recognised the group of health promoters called “Las Mensajeras” (or “The Messengers”, in English) as a friendly group where they can receive information about hiv, other stis and condoms.
96 Pecheny, “Estigma y discriminación en los servicios de salud a las mujeres trabajadoras sexuales en América Latina y el Caribe”. Experiences of discrimination, stalking and abuse by police and health care providers
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3.2 Experiences with the Police The most traumatic experiences suffered by young
men and women engaged in selling sex was in relation to the police, which is paradoxical as its main role is to safeguard the security of citizens. Among the negative experiences are mentioned notice and humiliation. For these young people, going to the police is not an effective resource when they have suffered some form of violence by their customers; from their perspective, as the police are highly corrupt in each of their countries, they cannot be trusted to come to her help them resolve these situations. The police even sometimes take away the money they have earned as a product of their work. This corroborates the findings of Rodríguez, Fuentes, et al, in a study about situations of violence of Mexican young women engaged in selling sex97. 97 Eva María Rodríguez, et al, “Violencia en el entorno laboral del trabajo sexual y consumo de sustancias en mujeres mexicanas”, Salud Mental, vol. 37, 4 (2014): 355-360, ac-
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The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
On the other hand, they referred to the police as racist and homophobic. The police often abuse and blackmail adolescents and young people who independently engage in selling sex, threatening to arrest them if the youth do not comply with their demands to have sexual relations with them. In the opinion of transgender women who participated in the focus groups it is often the youngest who concede to this type of blackmail, either because of fear or in order to avoid major problems with the police.
cells for men. Similarly, with the promise of releasing them, they are forced to have sex with different police force personnel, often without protection, increasing their vulnerability to sexually transmitted infections, including hiv.
Young msm who have experienced detention by the police say it is common to be arrested arbitrarily or the charges are invented; and that throughout the time of their detention, they are forced to work and are physically abused.
Their overall idea of the police is that, instead of protecting them, the young people engaged in selling sex must defend themselves from them, and that that are a cause of fear and danger. For these reasons, when they are victims of rape, it is not reported.
Moreover, young trans women stated that if they need legal assistance, they have to go dressed as men to the Attorney General’s because if they do not, they will not receive services.
Transgender women are especially at risk of sexual abuse while in detention because they are placed in cessed September 30, 2015, http://www.redalyc.org/articulo. oa?id=58231853010 Experiences of discrimination, stalking and abuse by police and health care providers
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Case Study In countries like Mexico or Argentina, possession of condoms may be enough for the police to accuse someone of sexual exploitation or reason to consider those engaged in selling sex as victims of human trafficking. Ironically, the condoms that have been used as evidence of this crime are the same provided by the Ministry of Health through its hiv prevention programmes. These contradictions in judicial practice is one of the reasons why the adolescents and young people who autonomously engage in selling sex may feel hesitant to access sexual and reproductive health services in their communities. Especially because there is a selective application of police standards, or put another way, the police decide who of those in possession of condoms, should be charged with “prostitution�. This criterion is limited to the appearance of the person, age, and place where they were arrested; so these laws, regulations and administrative practices can particularly affect certain populations, and the case of trans women is a clear example of this situation.
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The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
TRANS YOUNG PEOPLE For young trans women autonomously engaged in selling sex in the region, sexually transmitted infections and hiv are the biggest health issues. Although generally they have adequate information to prevent hiv and regular access to condoms, they identified that it is difficult to negotiate with their clients or deny the offer of more money for unprotected sex, especially because they often go through great economic difficulties. They mentioned that while it is difficult to negotiate the use of a condom with clients, it is even more difficult to do so with their sentimental partners. They report that young trans women have less ability to negotiate condom use with their clients. They identified their gender identity at an early age and this can be a reason to be forced to leave their home. This type of discriminatory situation causes them serious emotional suffering. As part of their process, they decide to undergo hormone treatments (usually without professional supervision) or other treatments that are unsafe. These include: oil injection, or injection other substances, or silicone implants. Often these treatments can endanger their lives. As people engaged in selling sex, they tend to suffer discrimination, verbal and physical abuse, while carrying out their profession.
to go to the doctor it is because they have an sti or have suffered severe violence at the hands of a client, and they often go to establishments that provide medical services 24 hours. For them, it is essential that health care providers are trained on gender and sexual identity, as it is common that they are referred to as if they were men. They said that if they were sure that confidentiality would be respected and they would not receive poor treatments, they would be more likely to seek out services. A common problem is that their customers want to force them to use substances, such as alcohol and drugs. In not complying with the client’s demands, they can become victims of abuse. Young trans participants, just as the young women and young men, identified the three most common justifications that clients use to justify not using a condom as: they cannot maintain an erection, they take longer to ejaculate , and condoms provoke allergic reactions. Like other populations, they often suffer serious violations by the police. Among the most common is physical and emotional abuse and blackmail to take them to jail if they do not submit to having sex with them, usually without protection. They believe that the most vulnerable in these situations are the youngest.
Because of their gender identity, they are often discriminated against by society in general, and particularly by the police and health services. It is for this reason that sometimes they prefer to self-medicate. When they do decide
In total, 36 young trans people engaged in selling sex participated
Focus groups were carried out in four countries: Brazil, Colombia, the Dominican Republic and Honduras
Over half of the participants (59%) were between the ages of 18 and 21
According to available data, over half of the population of young trans women participants had completed primary education
None of the participants mentioned living with hiv, although three participants commented that they did not know their status
General Findings by Population. Diverse Young People Who Autonomously Engage in Selling Sex in Latin America and the Caribbean.
HEALTH EQUITY POR ALL LATIN AMERICA COMPARATIVE TABLE BY COUNTRY
OTHER SERVICES & ISSUES
BRAZIL During the dialogue, the transgender participants expressed a wide range of problem which they have to deal as consequences of being engaged in selling sex. Also, it is frequent they suffer assaults, verbal and physical aggression in the streets or when go with clients in their cars. They don´t identify “safe places” every since it doesn´t matter where they meet their clients, they can never know what kind of a person they are dealing with. Another frequently problematic situation was that sometimes some costumers require them to use drugs even if they communicate that they don´t use of they are not willing to use, and they are harmed by them.
For younger msm, frequent assaults suffering when working on streets represent an everyday issue to deal with.
HONDURAS
COLOMBIA
The participants referred that stigma and discrimination are some of the biggest problems they go through in their everyday life.
Like other populations, stigma, discrimination and abuse were an important aspect in the discussion, not only for being transgender but for being engaged in selling sex. This is more evident when seeking health services due to the prejudices of the medical personnel. They believe that this aspect is critical when deciding whether or not use the services, plus they are not sure their confidentiality is going to be respected and guaranteed. the physical and verbal abuse mostly borne by the police.
Transgender people report being emotional and physically abused by police, they blackmail them, force them to have unprotected sex, the blackmail the youngest ones that if they don’t have sexual intercourse with them will send them to jail. The police are a grand obstacle to these young msm engaged in selling sex: not only steal their money but also force them to have sexual intercourse to put them on freedom when they get arrested, assuming that what they do is illegal. For young women, the experiences with police may not be pretty effective neither because as minors, don't seem to count for justice system
Young women identified higher risk for them when clients require them to use drugs. Whether they do it or not clients become aggressive and abusive. In case that violence occur, they may call to manage and security of the house in which they sell sex. Different form another populations, they mentioned having good experiences with the police.
DOMINICAN REPUBLIC Police abuse and society in general. Stigma and discrimination from health providers.
HEALTH EQUITY POR ALL LATIN AMERICA COMPARATIVE TABLE BY COUNTRY
INFORMATION & EDUCATION
BRAZIL
COLOMBIA
Like other groups, young msm also suffer prejudice when approached by the police. Although they have a higher level of education than participants in the other groups consider that lack more information and publicity related to hiv and other diseases in addition to the seasonal campaigns and those who receive when they seek the cta. It is a need to make more campaigns around hiv and stis prevention.
They identified that although in Colombia has a health law that allows them to access to services provided by the state, ignorance of the Act No. 1543 by health providers difficulties in ensuring their universal right to health. Women and transgender women have less access to information and education.
HONDURAS
DOMINICAN REPUBLIC
In general, They emphasized that having information makes a big difference and therefore need access to formal or informal education
For both young women and transgender, the reference resource are a group of health promoters named “Las mensajeras�. They provide information about hiv and other stds.
SECTION Conclusions and recommendations
This section is not intended to be a closure but rather a trigger of a series of reflections and proposals that emerge from the experience with the young people participating in focus groups or the regional meeting that took place in the city of Bogota. It will try to respond mainly to the following questions: What needs to be done in order to improve access to sexual and reproductive health and hiv services, by the adolescents and many young people who autonomously engage in selling sex in Latin America and the Caribbean? What resources do these young msm, women, and trans people need? Finally, the recommendations made during the First Consultation on Diverse Adolescents and Youth People Who Autonomously Engage in Selling Sex in Latin America and the Caribbean will be presented, which summarise (but are not limited to) a common voice of this population. 64
The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
4.1 What needs to be done in order to improve access to Sexual and Reproductive Health, including hiv Services
To narrow the gap that currently exists between sexual and reproductive health and adolescents and young people who autonomously engage in selling sex, it is important to generate strategies that include them as key actors and provide for their opinions; in this way, it is guaranteed that the programs aimed at them are effective to the problems and needs they face on a daily basis answers. This implies, in the first instance, their real recognition. While they can benefit from hiv prevention, testing and treatment and care programs aimed at adult sex workers, the youngest people have particular needs and should be taken into account as such: they do not feel comfortable when health center's require that they be accompanied by an adult in order to receive services because they feel that this practice does not guarantee confidentiality; although they are minors, it is important to have access to preventive resources and are not turned away. Generally, they need laws that protect them and consider them subjects of rights, without victimising them. There is also an urgent demand for health-service providers who have the necessary elements to provide services for them, without discrimination. They should be trained on how to care for adolescents and young people who autonomously engage in selling sex and the lgbti community. They believe that if they did not receive negative treatment by providers of sexual and reproductive health, it is likely that they will access services and prevention methods. While some of the participants expressed that it is a good measure that some countries have specific hours and/or special places designated for sex workers, they warned that it is necessary to be careful that this situation does not become another mechanism of exclusion. Among the most enriching discussions that took place at the regional meeting that was held in BoConclusions and recommendations
65
gota, we found that there is an understanding that the lack of educational and economic opportunities has had great influence at the moment when these adolescents and young people decide to begin engaging in selling sex. There was a consensus on the need for governments of different countries to ensure their access to education and employment opportunities. However, the fact that there are young people who, beyond the initial reasons that led them to engage in selling sex, decide to make this their source of income, was emphasised. And above all, it was concluded that beyond focusing on the reasons of why they choose to engage in selling sex, and beyond trying to get them to engage in other economic activities, so long as there are young people engaged in selling sex, their human rights must be guaranteed. Of course, in the best case scenario, governments would provide each and every one of these adolescents and young people necessary and sufficient development opportunities so that they would not have to engage in selling sex. But even if that happens, some will be decide, without coercion of others, to engage in selling sex; and so long as they do, it is important that their sexual rights are protected.
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The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
Based on their experiences in their local contexts, they recognised that a percentage of the population begins as adolescents in order to help the family budget. They also recognise that while some get jobs babysitting and informal helpers in small or working in fast food business, there are others who choose to sell sex. For these young people, their legal recognition by the state is important because in this way they access rights that they otherwise would not have, such as housing, social security, or retirement. In addition, this legal recognition would protect them from the police persecution and the humiliating and painful situations which have already been mentioned elsewhere in this document. However, they recognise that even when laws do exist to protect them, it is critically important that the same cultural changes that eradicate stigma and discrimination are promoted, as these are the main trigger of violence towards them. Faced with this complex situation, the participants of the regional meeting were given the task of proposing five different recommendations from their point of view that can contribute to improving the living conditions of the young people who autonomous engage in selling sex in Latin America.
4.2 Recommendations for decision- 4.2.1 Regional Consultation on Diverse Adomakers from young people who lescents and Youth People Who Autonomously autonomously engage in selling sex Engage in Selling Sex in Latin America and the Caribbean
This document is an initiative created and directed by diverse adolescents and young people autonomously engaged in selling sex in Latin America and the Caribbean. We have gathered in the city of Bogota to discuss and develop a set of recommendations addressed to representatives of governments, international agencies, human rights organisations and civil society, so that they recognise the problems and needs we experience on a daily basis and so that they can launch actions under consideration. Those who attended agree that the recommendations presented below are not definitive, but signify a first step in the recognition of this population. Likewise, through them it is hoped that a dialogue horizontal will be opened with the social and political actors mentioned above. Recommendations of young people selling sex in Latin America and the Caribbean a) The adolescents and young people gathered in this consultation demand to their governments the implementation of laws and policies related to sex work, and to differentiate between trafficking, sexual exploitation, and autonomous sex work, establishing that, under no circumstances, should those who autonomously decide to engage in selling sex should be criminalised. b) The creation of specialised spaces, with trained and aware personnel, within reporting center’s so that adolescents and young people who autonomously engage in selling sex can report, for example, in situations of police abuse, discrimination suffered in health centers, and the arbitrariness by public officials in different public institutions. Such complaints may be anonymous, and above all, these young people demand to not Conclusions and recommendations
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have to be accompanied by parents or guardians and that their integrity and the confidentiality of personal information should be protected.
2. That national governments assume responsibility of providing public health services to this population.
c) The creation of public policies and campaigns around self-care and detection, prevention, treatment, and care for hiv and other sexually transmitted infections, and that sexual and reproductive health campaigns be part of programs under the Ministries of Health, because if such campaigns are carried out by sex workers or civil society organisations, we will be accused of promoting and facilitating trafficking, child prostitution, pandering, or child sexual exploitation. Therefore, we propose:
3. That condoms and other health supplies are not used as evidence of a crime; but rather as health prevention resources.
1. To review the laws, in order that providing health services and supplies to the population of diverse adolescents and young people who autonomously decided to engage in selling sex, would not be framed as facilitating sexual exploitation or human trafficking.
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d) That mechanisms for the protection of confidentiality are created. That existing laws protecting the rights of adolescents and young people be respected and/or that laws that violate the access to health of diverse adolescents and young people who autonomously decided to engage in selling sex be modified. e) The creation and dissemination of policies and access to information about health and rights to public, private, civil institutions and society in general, and that they be accessible and effective, without stigma or discrimination towards the population of diverse adolescents and young people autonomously engaged in selling sex.
“IN THE DOMINICAN REPUBLIC, IT IS COMMON THAT THOSE ENGAGED IN SELLING SEX ARE ABUSED BY THE POLICE”
–Comments from youth participants at the Regional Consultation "Egalitarian Health for All" held in Bogotá, 07/2015.
Anexxes
Documents and treaties that serve as support for the promotion of education and the sexual and reproductive health of adolescents and young people —The Universal Declaration of Human Rights (1948). —The World Health Organization Constitution (2006). —The Millennium Declaration (2000). —The Declaration of Commitment on hiv/aids (ungass 2001). —Copenhagen Declaration on Social Development and Programme of Action of the World Summit on Social Development (1995). —The political declaration and further actions and initiatives to implement the Beijing Declaration and Beijing Platform for Action (2000). —The political declaration and further actions and initiatives to implement the commitments made at the World Summit on Social Development (2000). —The key measures to continue implementation of the Programme of Action of the International Conference on Population and Development (1999) measures. —The Declaration of the Tenth Ibero-American Summit of Heads of State and Government (2000). —The Pan-Caribbean Partnership against hiv/aids (2001). —The Buenos Aires Declaration of the Ministers of Education (2007). —The San José Pact (1969). —The Andean Charter of Human Rights (2002). —The Convention on the Rights of the Child (1989). —Convention on the Elimination of All Forms of Discrimination Against Women (1981). —The Pact on Civil and Political Rights (1976). —The Pact on Economic, Social and Cultural Rights (1976). —World Declaration on Education for All (1990). —Final Report of the Dakar World Education Forum (2000) report. —Montevideo Consensus (2013). —Millennium Development Goals (2000). —Ministerial Declaration “Prevention by Education” (2008).
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The case of adolescents and young people who autonomously engage in selling sex in Latin America and the Caribbean
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—. People Living with hiv. Geneva, Joint United Nations Programme on hiv/aids: 2014. Accessed December 10, 2015. http://www.unaids.org/sites/default/files/ media_asset/01_PeoplelivingwithHIV.pdf United Nations Children's Emergency Fund. Estado mundial de la infancia 2011. La adolescencia, una época de oportunidades. New York, United Nations Children's Emergency Fund: 2011. Accessed Febraury 15, 2016. http://www.unicef.org/mexico/spanish/ SOWC-2011-Main-Report_SP_02092011.pdf who, unaids, unfpa, and fhi360. Preservativos femeninos: Especificaciones generales, precalificación y directrices de adquisición, 2012. Geneva/New York, World Health Organization, unaids, United Nations Population Fund, fhi360: 2012. Accessed September 5, 2015. https://www.unfpa.org/sites/default/files/ resource-pdf/Preservativos%20Femininos%20Escpecificaciones%20Generales_2012_0.pdf
JOURNAL ARTICLES Allen, Betania; Cruz-Valdez, Aurelio; Rivera Rivera, Leonor; Castro, Roberto; Arana García, María Ernestina; and Hernández Ávila, Mauricio. “Afecto, besos y condones: el abc de las prácticas sexuales de las trabajadoras sexuales de la Ciudad de México”. Salud Pública de México, vol. 5, 45 (2003): 594-S607. Accessed May 22, 2015. http://bvs.insp.mx/rsp/articulos/articulo.php?id=000452 Amaya, Adalgiza; Canaval Glady Eugenia; and Viáfara, Elizabeth. “Estigmatización de las trabajadoras sexuales: Influencias en la salud”. Colombia Médica, vol. 36, 3 (2005): 65-74. Accessed, May 20, 2015. http://www.redalyc.org/articulo.oa?id=28310109 Aragón, Jesús. “Variables cognitivo conductuales y vih en trabajadoras sexuales de la frontera de Venezuela y Colombia”. Aldea Mundo, vol. 5, 9, (2000): 5-19. Accessed September 20, 2015. http://www.redalyc. org/articulo.oa?id=54300902 The case of adolescents and young people who autonomously
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Arroyo Lucinda, and Amador, Karina. “Turismo y trabajo sexual en Cancún-México”. Estudios y Perspectivas en Turismo, 24 (2015): 982-992. Accessed September 25, 2015. http://www.redalyc.org/articulo. oa?id=180741598012 Britos, Patricia. “¿Por qué la prostitución debe ser un trabajo sexual?” A Parte Rei, 66 (2009): 1-12. Accessed: May 22, 2015. http://serbal.pntic.mec.es/AParteRei/ britos66.pdf Cavagnaro María Victoria, and Colazo, Ivana Inés. “Las niñas, niños y adolescentes como sujetos de derecho frente a la figura del usufructo paterno-materno: Una mirada a partir del interés superior del niño y de la capacidad progresiva: Su abordaje desde la legislación vigente y proyecto de reforma de Código Civil y Comercial de la República Argentina”. Sistema Argentino de Información Jurídica (2013). Accessed September 18, 2015. http://www.infojus.gob.ar/maria-victoria-cavagnaro-ninas-ninos-adolescentes-como-sujetos-derecho-frente-figura-usufructo-paterno-materno-una-mirada-partir-interes-superior-nino-capacidad-progresiva-su-abordaje-desde-legislacion-vigente-proyecto-reforma-codigo-civil-comercial-republica-argentina-dacf130019-2013-01-04/123456789-0abc-defg9100-31fcanirtcod Córdova, Rosío. “Identidades sexuales y prácticas corporales entre los trabajadores del sexo de las ciudades de Xalapa y Veracruz”. Nueva Antropología, xxi, 69 (2008): 83-103. Accessed May 20, 2015. http:// www.redalyc.org/pdf/159/15912420005.pdf Dorais, Michel. “Intimidad en venta: ¿cómo se llega a ser trabajador sexual?” Desacatos, 16 (2004): 52-68. Accessed May 22, 2015. http://www.redalyc.org/articulo.oa?id=13901604 Juliano, Dolores. “El trabajo sexual en la mira. Polémicas y estereotipos”. Cadernus Pagu, 25 (2005): 79-106. Accessed May 22, 2015. http://www.scielo.br/pdf/ cpa/n25/26523.pdf
Lamas, Marta. “Trabajadoras sexuales: del estigma a la conciencia política”. Estudios Sociológicos, vol. 14, 40 (1996): 33-52. Accessed May 22, 2015. http://codex.colmex.mx:8991/exlibris/aleph/a18_1/apache_ media/68H5YA9LBIU89SFIXRJBI9HDT7B7NY.pdf Mendieta, Giovane; Ramírez, Juan Carlos; and Pérez, Elizabeth. “Prostitución masculina: una revisión narrativa”. Andina, vol. 17, 31 (2015): 1368-1389. Accessed May 23, 2015. http://www.redalyc.org/ html/2390/239040814008/index.html Mercedes Bohórquez, Ingrid; Caballero, Sandy; Carrera, Lourdes; Chávez, Rosario; Espinoza, Rocío; Flores, Letsie; Llanos, Miguel; Luna, Elena; Vega, Juan; Vera, José; Salvatierra, Héctor; and Pereyra, Héctor. “Factores asociados a síntomas depresivos en trabajadoras sexuales”. Anales de la Facultad de Medicina, vol. 71, 4 (2010): 277-282. Accessed: May 21, 2015. http://www.redalyc.org/articulo. oa?id=37919982012 Morales, Roxana; Rojas, Roselby; and Ramírez Iris. “Patriarcado y trabajo sexual en el imaginario social de la Costa Rica del siglo xxi”. La Ventana, 38 (2013): 122-163. Pecheny, Mario. “Estigma y discriminación en los servicios de salud a las mujeres trabajadoras sexuales en América Latina y el Caribe”. Gazeta de Antropología, 30 (2014). Accessed September 17, 2015. http:// www.gazeta-antropologia.es/wp-content/uploads/ GA-30-3-08-Mario-Pecheny.pdf Rodríguez, Eva María; Fuentes, Patricia; Ramos-Lira, Luciana; Gutiérrez, Rafael; and Ruiz, Eunice. “Violencia en el entorno laboral del trabajo sexual y consumo de sustancias en mujeres mexicanas”. Salud Mental, vol. 37, 4 (2014): 355-360. Accessed September 30, 2015. http://www.redalyc.org/articulo. oa?id=58231853010 Théodore, Florence Lise; Gutiérrez, Juan Pablo; Torres, Pilar; and Luna, Gabriel. “El sexo recompensado: una práctica en el centro de las vulnerabilidades (sti/hiv/
aids) de las jóvenes mexicanas”. Salud Pública de México, vol. 46, 2 (2004): 104-112. Accessed May 24, 2015. http://www.scielo.org.mx/scielo.php?pid=S 0036-36342004000200004&script=sci_arttext Tirado, Misael. “El debate entre prostitución y trabajo sexual. Una mirada desde lo socio-jurídico y la política pública”. Revista de Relaciones Internacionales, 6 (2011): 127-148. Accessed May 20, 2015. http:// www.redalyc.org/articulo.oa?id=92722560005 —. “El trabajo sexual desde una perspectiva de los derechos humanos: implicaciones del vih/sida e infecciones de transmisión sexual”. Civilizar. Ciencias Sociales y Humanas, vol. 27, 14 (2014): 97-110. Accessed September 18, 2015. http://www.redalyc. org/pdf/1002/100235716005.pdf Valencia Jiménez, Nydia Ninna; Cataño Vergara, Gledis Yolima; and Fadul Torres, Ana Karina. “Percepción de riesgo frente a las infecciones de transmisión sexual de trabajadoras sexuales de algunos establecimientos de la ciudad de Monteria-Córdoba (Colombia)”. Investigación y Desarrollo, vol. 19, 1 (2011): 64-87. Accessed May 21, 2015. http://www.redalyc.org/articulo.oa?id=26820752007
ARTICLES IN NEWSPAPER News Medical. “Jamaica will not decriminalise, regulate commercial sex work, Prime Minister says”. News Medical, June 26, 2008. Accessed September 20, 2015. http://www.news-medical.net/ news/2008/06/26/39535.aspx Wandscheer, Lisiane. “Jovens podem fazer teste de aids a partir de 12 anos de idade, sem autorização dos país”, Agencia Brasil, February 14, 2010. Accessed September 17, 2015. http://memoria.ebc.com.br/ agenciabrasil/noticia/2010-02-14/jovens-podemfazer-teste-de-aids-partir-de-12-anos-de-idade-semautorizacao-dos-pais
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DOCUMENTS Constitution of the Commonwealth of Puerto Rico. “Para enmendar los Artículos 2, 3, 5, 7, 8, 11 y 58 de la Ley Núm. 246 de 2011, Ley para la Seguridad, Bienestar y Protección de Menores”.Accessed December 10, 2015. http://www.lexjuris.com/lexlex/Leyes2014/ lexl2014225.htm Public Prosecutor of the City of Buenos Aires. “Las decisions de los niños, niñas y adolescents a la luz del principio de autonomía personal”. Work documents of the Public Prosecutor Structure of the Autonomous City of Buenos Aires, Buenos Aires, Argentina. Accessed December 10, 2015. http://mptutelar.gob. ar//sites/default/files/AGT_DT6.pdf RedTraSex. “Estudio sobre estigma y discriminación en los servicios de salud a las mujeres trabajadoras sexuales en América Latina y el Caribe”. Summary of the Regional Executive Report, 2013. Accessed December 10, 2015. http://www.redtrasex.org/IMG/pdf/resumen_regional_est_disc.pdf ssa. “Declaración Ministerial ‘Prevenir con Educación’”. Report presented at the First Meeting of Ministers of Health and Education to Stop hiv in Latin America and the Caribbean, 2008. Accessed December 10, 2015. http: //www.censida.salud.gob.mx/descargas/ declaramin.pdf unaids. “Guidelines on Protecting the Confidentiality and Security of hiv Information”. Proceeding from a workshop at the Joint United Nations Programme on hiv/ aids, Geneva, Switzerland, May 15, 2007. Accessed December 10, 2015. http://data.unaids.org/pub/ manual/2007/confidentiality_security_interim_guidelines_15may2007_en.pdf United Nations. “Declaración de compromiso en la lucha contra el vih/sida”. Report presented at the United Nations General Assembly, New York, United States, 2001. Accessed December 10, 2015. http://www.unaids.org/sites/default/files/sub_landing/files/aidsdeclaration_es.pdf The case of adolescents and young people who autonomously
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—. “Risks, rights and health”. Report of the Global Commission on hiv and the Law presented at the United Nations Development Program, New York, United States, 2012. Accessed May 20, 2015. http://www. hivlawcommission.org/resources/report/FinalReport-Risks,Rights&Health-SP.pdf —. “Global report on trafficking in persons. Human Trafficking, a crime that shames us all”. Report presented at the United Nations Office on Drugs and Crime. New York, United States, 2009. Accessed December 10, 2015. http://www.unodc.org/documents/Global_Report_on_TIP.pdf — “Convención de las Naciones Unidas contra la delincuencia organizada trasnacional y sus protocolos”. Report presented at the United Nations Office on Drugs and Crime, New York, United States, 2004. Accessed December 10, 2015. http://www.unodc.org/ documents/treaties/UNTOC/Publications/TOC%20 Convention/TOCebook-s.pdf United Nations Population Fund. “Report from the International Conference on Population and Development”. Report presented at the International Conference on Population and Development, Cairo, Egypt, 1994. World Health Organization. “La salud de los jóvenes: un desafío para la sociedad”. Report presented at the who study group about young people and “Health for All by the year 2000”, Geneva, Switzerland, 1986. Accessed December 10, 2015. http://apps.who.int/iris/ bitstream/10665/36922/1/WHO_TRS_731_spa.pdf
WEBSITES Ibero-American Youth Organization. “Convención Iberoamericana de derechos de los Jóvenes”. 2005. Accessed December 10, 2015. http://www.unicef.org/ lac/CIDJpdf%283%29.pdf
Global Network of Sex Work Projects. “Sex Work is Not Trafficking Summary”. 2011. Accessed December 10, 2015. http://www.nswp.org/es/resource/ sex-work-not-trafficking-summary RedTraSex. “Human rights situation of female sex workers in 15 countries of the Americas”. 2015. Accessed August 20, 2015. http://www.redtrasex.org/publicaciones/cidh_resumenejecutivo_disenado1/index.html Organization of American States. “Temáticas de la Juvenud. Salud sexual y reproductiva”. Accessed December 10, 2015. http://www.oas.org/es/youth/ Salud_Sexual_y_Reproductiva.asp Ministry of Public Health of Ecuador. “Guía de atención integral en vih/Sida-it’s a personas glbti”. 2013. http://m.sb-10.com/medicina/6553/index.html unaids. “El sida en cifras 2015”. Accessed December 10, 2015. http://www.unaids.org/sites/default/files/media_asset/AIDS_by_the_numbers_2015_es.pdf —. “Trabajo sexual y vih/sida”. 2003. Accessed May 21, 2015. http://data.unaids.org/publications/irc-pub02/ jc705-sexwork-tu_es.pdf —. “unfpa, who and unaids: Position statement on condoms and the prevention of hiv, other sexually transmitted infections and unwanted pregnancy”. 2015. Accessed September 5, 2015. http://www.unaids. org/en/resources/presscentre/featurestories/2015/ july/20150702_condoms_prevention United Nations Human Rights. “Convention on the Rights of the Chid”. Accessed December 10, 2015. http://www. ohchr.org/en/professionalinterest/pages/CRC.aspx United States Department of State. “Trafficking in persons report 2015”. 2015. Accessed December 10, 2015. http://www.state.gov/j/tip/rls/tiprpt/2015/ index.htm
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“WE YOUNG PEOPLE WHO ENGAGE IN SELLING SEX FROM COSTA RICA NEED MORE INFORMATION ABOUT OUR RIGHTS AND SEXUAL AND REPRODUCTIVE HEALTH”
–Comments from youth participants at the Regional Consultation "Egalitarian Health for All" held in Bogotá, 07/2015.