Sex workers lead the way

Sex workers in unceded Australia have been at the forefront of sexually transmissible infection (STI) and HIV prevention since the late 1970s. At that time, most forms of sex work were criminalised, brothels were regularly raided, and condoms could be used as evidence of “prostitution” in court.

When HIV emerged and our friends, lovers and communities started dying, science was still catching up. Sex workers, gay and bisexual men and people who inject drugs understood that something linked to unprotected sex and shared injecting equipment was causing these deaths, and we acted before formal public health responses.

• Sex workers built peer networks to source and distribute condoms, lube, and safer injecting equipment on outreach.
• We normalised condom use with clients, first in street-based work and then across indoor workplaces (like brothels and massage parlours).
• We also negotiated with brothel managers and operators to make condoms a standard and expected part of every booking.

As evidence caught up, research showed these community-led strategies worked.

COVID-19: sex workers lead in crises

During COVID-19, many sex workers stopped in-person work early, shifted online, and shared peer-led harm reduction advice long before governments recognised the specific impacts on our work. While sex workers were often excluded from income support, peer organisations mobilised emergency funds, food and information to keep our communities safer.

We dismantle structural barriers to sexual health

Clients often see sex workers as “sexperts” and ask us questions they would never ask a doctor.

This puts sex workers in a unique position to share accurate, non-judgemental information about HIV, STIs, safer sex practices and testing with people who may never otherwise engage with health promotion. Decriminalisation and peer-led programs give sex workers the conditions to use this role safely and effectively. Evidence from Australia and internationally shows that decriminalising sex work:

• Reduces HIV risk for both sex workers and clients
• Supports safer working conditions
• Increases sex workers’ confidence to negotiate safer sex
• Improves access to health services
• Strengthens responses to trafficking and exploitation

Joint United Nations Programme on HIV/AIDS (UNAIDS) has recognised Australian law reform as a best-practice example of how decriminalisation reduces HIV transmission and improves safety.

Sex workers need better laws and financial backup to continue the effective, evidence-based systems we have built to protect our communities. The data shows these approaches work and that our communities trust us, especially on sexual health and HIV/STI prevention.

To continue and strengthen these outcomes, sex workers demand:

• Full decriminalisation of sex work in all states and territories, including explicit anti-discrimination and anti-vilification protections
• Sustainable, flexible funding for sex worker peer organisations, so we can continue outreach, peer education, and support.
• Recognition of sex worker peer organisations as key partners in HIV, STI, and sexual health policy and programming at every level.

Partnerships, not “rescue”, deliver results.

From the early 1980s, sex workers organised to form peer organisations such as the Australian Prostitutes Collective and later the Sex Workers Outreach Project (SWOP), one of the first sex worker organisations in the world to receive government health funding. These organisations have since partnered with health departments, sexual health clinics and researchers to design, deliver and evaluate evidence-based Blood Borne Virus (BBV) and STI prevention and health promotion initiatives. Australia’s national HIV, STI and hepatitis strategies recognise peer-based, community-led responses as central to success and include sex worker representation on key advisory bodies such as the Blood Borne Viruses and Sexually Transmissible Infections Standing Committee, ensuring sex workers have a formal seat at the table and that responses are rights-based and grounded in lived experience. This partnership approach has delivered the virtual elimination of HIV transmission within the Australian sex industry, alongside consistently low HIV incidence and high levels of safer sex knowledge and practice.

In practice, this looks like:

• Sex worker peer educators doing outreach to brothels, massage parlours, private/independent workers and street-based workers.
• Sexual health clinics partnering with sex worker organisations to break down access barriers including sex worker-only clinics and co-designed service models.
• Sex workers, clinicians, and researchers coming together to co-design studies, evaluate programs and publish world-leading evidence on HIV and STI prevention.
• Governments funding peer organisations and including them in advisory structures to lead HIV, STI, and Hepatitis prevention in our own communities.