Leite Gabriela Silva, Murray Laura, Lenz Flavio
Davida - Prostitution, Civil Rights and Health, Rio de Janeiro, RJ, Brasil.
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA.
Rev Bras Epidemiol. 2015 Sep;18 Suppl 1:7-25. doi: 10.1590/1809-4503201500050003.
Sex workers have been the protagonists and focus of HIV prevention campaigns and research since the late 1980s in Brazil. Through a review of national and international literature, combined with a history of sex workers' involvement in the construction of the Brazilian response, this article explores the overlaps and disconnects between research and practice in contexts of prostitution over the past three decades. We review the scientific literature on the epidemiology of HIV among sex workers and prevention methodologies. We conclude that although research focus and designs often reinforce the idea that sex workers' vulnerability is due to their sexual relationships with clients, their greatest vulnerability has been found to be with their nonpaying intimate partners. Few studies explore their work contexts and structural factors that influence safe sex practices with both types of partners. The negative effects of criminalization, stigma, and exclusively biomedical and peer education-based approaches are well documented in the scientific literature and experiences of sex worker activists, as is the importance of prevention programs that combine empowerment and human rights-based approach to reduce HIV infection rates. We conclude that there is a need for actions, policies, and research that encompass the environment and context of sex workers' lives and reincorporate the human rights and citizenship frame that dominated the Brazilian response until the end of the 2000s. As part of HIV prevention efforts, female sex workers need to be considered above all as women, equal to all others.
自20世纪80年代末以来，性工作者一直是巴西艾滋病预防运动和研究的主角及焦点。通过回顾国内和国际文献，并结合性工作者参与巴西应对措施构建的历史，本文探讨了过去三十年中卖淫背景下研究与实践之间的重叠与脱节。我们回顾了关于性工作者中艾滋病流行病学及预防方法的科学文献。我们得出结论，尽管研究重点和设计往往强化了这样一种观念，即性工作者的脆弱性源于他们与客户的性关系，但事实证明，他们最大的脆弱性在于与无金钱交易的亲密伴侣的关系。很少有研究探讨他们的工作环境以及影响与这两类伴侣进行安全性行为的结构因素。将性工作定罪、污名化以及仅基于生物医学和同伴教育的方法所产生的负面影响，在科学文献以及性工作者维权人士的经历中都有充分记载，同样，将赋权和基于人权的方法相结合以降低艾滋病感染率的预防项目的重要性也有记载。我们得出结论，需要采取行动、制定政策并开展研究，涵盖性工作者生活的环境和背景，并重新纳入直到21世纪末一直主导巴西应对措施的人权和公民身份框架。作为艾滋病预防工作的一部分，女性性工作者首先应被视为与所有其他人平等的女性。
