By Marlise L. Richter, Matthew F. Chersich, Fiona Scorgie, Stanley Luchters, Marleen Temmerman and Richard Steen
The 2010 FIFA World Cup presents a strategic opportunity for South Africa to respond to the challenges that the sex industry poses in a strategic and rights based manner. Public health goals and growing evidence on HIV prevention suggest that sex work is best approached in a context where it is decriminalised and where sex workers are empowered. In short, the authors argue for a moratorium on the enforcement of laws that persecute and victimise sex workers during the World Cup period.
Although a subject not usually broached by mainstream media or politicians, sex work has recently received increased attention in southern Africa. A Swaziland senator sparked public debate by suggesting sex work be legalised . In Malawi, human rights non-governmental organisations (NGOs) are taking up a case against the police after they arrested 14 sex workers, forcibly tested them for HIV and reported their HIV results in the media . The women were fined 1000 Malawian Kwatcha for trading in sex while having a sexually transmitted infection (STI). In the build-up to the FIFA 2010 World Cup in South Africa, alongside concerns about crime and the coaching of the South African football team, there has been consternation over an anticipated increase in demand for paid sex during the tournament [3, 4].
Some have called for the temporary legalisation of sex work, while others have advocated a forceful crackdown on sex workers, involving mandatory HIV testing and sex worker registration with a regulatory authority [3-7].
Sex work is currently a criminal offence in most southern African countries  – as indeed it is in most of the world. Few health professionals have openly questioned whether criminalisation of sex work is a sound public health notion. These questions are particularly pertinent in southern Africa, a region with hyper-endemic HIV .
Rather than directly challenging legal frameworks, some health workers have sought to provide HIV prevention services for sex workers. This indirect approach has been encouraged by international funding agencies such as the US Presidential Emergency Plan for AIDS Relief (PEPFAR), which make funding conditional on a pledge by recipient organisations that they will not advocate for the legalisation of sex work [10-12]. Given the legal and funding impediments to the work of NGOs and the lack of government support for these initiatives, health care programmes have only managed scattered and broadly ineffective attempts at preventing HIV in sex workers in southern Africa, their clients and by extension, the general population [13, 14].
The laws of demand and supply
Sex work will not go away. A narrow market perspective suggests that demand for paid sex will be met by supply . This may be especially true of settings with marked economic and gender inequities, as research by the International Labour Organisation indicates: “poverty has never prevented men from frequenting prostitutes, whose fees are geared to the purchasing power of their customers” .
Sociologists, economists and psychologists have argued for recognition of a number of factors that render the demand-supply approach to sex work more complex. These factors include: the social construction of sexuality; (female) bodies being available for (male) consumption; the existence of viable alternative employment opportunities for sex workers; the social stigma that attaches to sex work; and the role of global consumerism .
Sex work is not regarded as the oldest profession for nothing and demand will almost certainly grow with increased globalisation , regardless of the legal framework a country adopts. Among other things, demand is driven by the expansion of cultural conceptions of sex as a commodity, the increased movement of people and capital, and the rapid expansion of Information and Communication Technology .
Sex worker vulnerability to HIV
Much of the vulnerability of sex workers to HIV in southern Africa stems directly from the criminalisation of their work and the patriarchal context in which they operate.
Limited access to services
Sex workers are often marginalised and face multiple barriers to accessing the health and social services they need: STI screening and treatment, HIV testing and tailored counselling, post-exposure prophylaxis after rape, access to male and female condoms, antiretroviral treatment, as well as mental health support and substance abuse treatment . Health care workers with negative or prejudiced attitudes towards sex workers further restrict access to services [19-21] and drive sex workers away from treatment and support.
Sexual and gender-based violence
Sex workers commonly experience violence [22, 23]. Criminalisation prevents sex workers from reporting abuse to the police or from seeking legal recourse after rape or sexual assault, which in turn serves to strengthen clients’ power and dominance over them. Police harassment of sex workers is well-documented, and can take the form of assault, unlawful arrests, rape, extortion, and demands for sex or money as bribes [24-29].
Unsafe work conditions
The illegal nature of their work means that sex workers operate in risky and often crime-laden areas