A community empowerment-based response to HIV is a process by which sex workers take collective ownership of programmes to achieve the most effective HIV outcomes and address social and structural barriers to their overall health and human rights. Community empowerment has increasingly gained recognition as a key approach for addressing HIV in sex workers, with its focus on addressing the broad context within which the heightened risk for infection takes places in these individuals. However, large-scale implementation of community empowerment-based approaches has been scarce. We undertook a comprehensive review of community empowerment approaches for addressing HIV in sex workers. Within this effort, we did a systematic review and meta-analysis of the effectiveness of community empowerment in sex workers in low-income and middle-income countries. We found that community empowerment-based approaches to addressing HIV among sex workers were significantly associated with reductions in HIV and other sexually transmitted infections, and with increases in consistent condom use with all clients. Despite the promise of a community-empowerment approach, we identified formidable structural barriers to implementation and scale-up at various levels. These barriers include regressive international discourses and funding constraints; national laws criminalising sex work; and intersecting social stigmas, discrimination, and violence. The evidence base for community empowerment in sex workers needs to be strengthened and diversified, including its role in aiding access to, and uptake of, combination interventions for HIV prevention. Furthermore, social and political change are needed regarding the recognition of sex work as work, both globally and locally, to encourage increased support for community empowerment responses to HIV.

Globally, sex workers experience a disproportionate burden of violence and human rights violations linked to criminalisation, punitive law enforcement, and lack of labour protections. Social injustices including poor working conditions, violence and victimisation, police harassment, and discrimination constitute severe violations of sex workers’ health, labour and human rights, and abuses of their freedom and dignity. Policymakers, researchers, and international bodies increasingly recognise violence as a critical public health and human rights concern among the general population; however, human rights violations against sex workers remain largely overlooked within international agendas on violence prevention and in human rights conventions. This chapter provides an overview of the global literature on violence against sex workers, other human rights violations, and drivers of elevated violence and rights inequities across settings. In addition to synthesising global research findings, this chapter features contributions and case studies from community partners in Asia Pacific. Guided by a structural determinants framework, and in recognising the right to live and work free from violence as a human right, this chapter provides an evidence base pertaining to violence against sex workers towards that informs the development of policy and public health interventions to uphold human rights among sex workers worldwide.

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