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This report reflects the voices and opinions of 140 participants, including resource persons and sex workers, at the first Asia and the Pacific Regional Consultation on HIV and Sex Work, held on October 2010 in Pattaya, Thailand. It covers critical components of the HIV and sex work responses, and four key areas – namely, creating an enabling legal and policy environment, ensuring sexual and reproductive health and rights, eliminating violence against sex workers, and addressing migration and mobility in the context of HIV and sex work.

In their work and lives, sex workers experience disproportionate levels of violence including police abuse, sexual assault, rape, harrassment, extortion, and abuse from clients, agents (pimps), sex establishment owners, intimate partners, local residents, and public authorities.  Violence against sex workers is a violation of their human rights, and increases sex workers' vulnerability to HIV.

Evidence suggests that HIV interventions in the sex industry are more effective when sex workers themselves have direct ownership in designing, implementing and monitoring of programmes.  This entails moving beyond standard HIV prevention programmes and addressing the overall health - including sexual and reproductive health - and well being needs of sex workers and their clients while, at the same time, respecting fundamental human rights.  Sex workers must be recognised as agents of change rather than as 'vectors' of infection and this requires a paradigm shift in the way sex workers are viewed and engaged in the response.

Sex workers are highly mobile populations, moving both within and accross national boundaries, as either documented or undocumented labour.  However, labour laws rarely, if ever, offer protection and benefits to local or migrant sex workers.  Migration and mobility factors that can significantly increase the vulnerability of sex workers to HIV and sexually transmitted infections, in large part due to their undocumented status including lack of work permits, poor working conditions in some cases, lack of access to health care, occupational health and safety standards, and other forms of labour protection. 

Governments and the United Nations have recognised the need to address the legal and policy barriers and stigma and discrimination faced by sex workers in order to respond to the HIV epidemic.  In many countries, laws, policies and practices against sex workers limit their right to basic social economic rights such as access to education, health care, housing, banking facilities, inheritance, property and legal services.  They may also lack citizenship or legal status, resulting from migration or unfavourable regulations, which can lead to exclusion of sex workers from health services, social programmes and communities.