Sunday, February 11, 2018

Busting Sex Work Stigma: You Can't Catch HIV from Money

By Andrew Sorfleet

How do you determine who is at high risk for HIV infection?

According to Health Canada’s July 2016 safety brief on Truvada for HIV pre-exposure prophylaxis, “exchange of sex for commodities (e.g. money, food, shelter, drugs)” is a factor that “may help identify a person at high risk of HIV infection.1


In October 2016, funded by a grant from Elton John AIDS Foundation, Triple-X in partnership with the Dalla Lana School of Public Health, University of Toronto, organized and hosted a national consultation and invited 23 organizations from 10 provinces and territories who provide advocacy or services for sex workers.


Fifty women, men and trans people from across Canada that work with sex workers met in Toronto. The purpose of this national consultation was to give participants the opportunity to educate themselves, explore and grapple as a group with the implications of PrEP on the sex industry. PrEP (HIV pre-exposure prophylaxis) is the idea that a person could take a pill once a day and be protected from catching HIV, not unlike the birth-control pill which protects from unwanted pregnancy.


The "PrEP in the Context of Sex Work" meeting was held in response to the intention to make PrEP accessible to sex workers, because sex workers are considered at high risk for HIV infection. But, where did this idea come from?

Safe Sex Professionals

For 30 years now, sex worker activists have stated that: “Prostitutes are Safe Sex Professionals.” Sex workers are best placed in society to provide hands-on HIV prevention education and demonstration, with the very large and invisible portion of the public who are clients. What is annoying about this “key population” approach is that sex workers are not given any professional respect by HIV research that targets prostitution. It ignores the fact that sex workers should be a priority for HIV and STI prevention education and funding, not because sex work is a risk factor for HIV transmission, but because, to quote Valerie Scott in 1989:

"Whores are safe sex pros. We’re the ones who put the condoms on the guys. We’re the ones who do the education. And what do we get for it? At conferences like this all we get is shit on. ‘Prostitutes are spreading AIDS.’ That’s bullshit! As I said the other day, if that were true, half the government would be dead already.


Valerie Scott, Canadian Organization for the Rights of
Prostitutes at the 5th International Conference
on AIDS, Montreal, July 1989.

(Our Bodies Our Business video c. 2016 George Stamos)

Sex work is most often defined in HIV research to include ambiguous transactions, such as trading sex for commodities, a place to sleep, meals, etc. What can't be distinguished with this definition is whether perhaps the risks for HIV are poverty and desperation, and not sex work as an occupation at all. Sex workers after all, need to protect their sexual health to be able to work. Like this 1990 education poster from Prostitutes Association of South Australia says:


It’s in his interests to protect his assets. You can’t catch the virus from a credit card.

Prostitutes Association of South Australia
(PASA), c.1990. 

Courtesy of Australian Lesbian and Gay Archives

Truvada PrEP Approved

On July 16, 2012, the U.S. Food and Drug Administration announced their approval of Truvada for HIV pre-exposure prophylaxis (PrEP). Truvada was already approved for many years as an HIV treatment medication. Now, it could also be used as a prevention medication. Truvada’s safety and efficacy for PrEP were demonstrated in two large, randomized, double-blind, placebo-controlled clinical trials, according to U.S. FDA press release:

The iPrEx trial evaluated Truvada in 2,499 HIV-negative men or transgender women who have sex with men and with evidence of high risk behavior for HIV infection, such as inconsistent or no condom use during sex with a partner of positive or unknown HIV status, a high number of sex partners, and exchange of sex for commodities.”2

February 2015, Health Canada approved Truvada for HIV PrEP in Canada. Once approved, regional health authorities and national advocacy groups began drafting guidelines for prescribing Truvada as PrEP, an important step towards having it listed for public access — free for those at high risk of HIV infection, paid for by government.3

“High Risk” = Sex Work Stigma


The B.C. Centre for Excellence in HIV/AIDS research had already released guidelines for Truvada PrEP in 2014:

Before starting PrEP, confirm that the patient is at ongoing high risk for acquiring HIV infection. ...this will usually consist of having one or more of the following.

Among the list was “involvement in commercial sex work,” and “having sexual partners who are MSM (men who have sex with men) or use injection drugs or who are involved in commercial sex work.”4

In the United States, state governments also released guidelines for prescribing PrEP and assessing high risk of HIV infection. The New York State Department of Health AIDS Institute and the Centers for Disease Control and Prevention for example (Summary Statement on Pre-Exposure Prophylaxis to Prevent HIV Infection, October 2015):

Providers need to obtain a thorough sexual and drug use history and regularly discuss risk-taking behaviors with their patients to assess candidacy for PrEP, encourage safer-sex practices and safer injection techniques (if applicable), and assist in the decision of when to use PrEP and when to discontinue use.

In a table labelled “Potential Candidates for PrEP,” “Individuals engaging in transactional sex, such as sex for money, drugs, or housing,” are listed. However, all other candidates such as MSM and IDU (people who inject drugs) must ALSO be engaged in “high-risk behaviour.” This requirement, however is not listed for sex-worker candidates.5

At the 2016 Canadian Association of HIV Researchers (CAHR) conference in Winnipeg, CANPrEP — an ad hoc committee of HIV prevention professionals, doctors and researchers, supported by the Canadian HIV Trials Network funded by the federal government through the Canadian Institutes of Health Research — presented draft guidelines for prescribing Truvada as PrEP. These guidelines also mentioned “sex trade workers” as one of the groups with a “significant risk of having transmissible HIV.”6


Triple-Xers Andy Sorfleet and Kerry Porth
at The Forks in Winnipeg for the 2016
annual CAHR conference.
 Photo: Shawna Ferris


Sex Workers Push Back

During their presentation at CAHR, it became apparent that CANPrEP researchers had failed to consult sex workers when drafting their proposed guidelines. In response to this, delegates from seven organizations from across Canada who work with sex workers drafted an eight-page letter:

To suggest that sex workers are a population at higher risk for HIV infection and transmission assumes that professional sexual services are not performed safely in an occupational setting. This is a gross generalization. You have provided no evidence or references for this.

The letter goes on to say:

To focus guidelines for assessing risk on populations rather than activity is in its own way stigmatizing. To quote the ‘Principles and Beliefs,’ Maggie’s Constitution, Toronto Prostitutes’ Community Service Project, 1993:

There are no high risk groups, only high risk practices. AIDS and sexually transmitted diseases (STDs) are not spread by sex work; they are spread by unsafe sex and needle sharing.”7

According to the Ontario HIV Treatment Network (OHTN), in a July 2012 brief titled “Sex Worker HIV Risk:”

Establishing the prevalence of HIV among sex workers is challenging because they are a hard-to-reach population. Estimates range from 1% to 60%.

Of 11 studies reviewed, only two addressed women working in indoor settings. Four studies assessed street youth specifically ("involved in survival sex"), three included only female drug users, one recruited Aboriginal women. OHTN were involved in developing the CanPreP guidelines. Their Rapid Response brief postulates:

There are three main categories of risk for HIV infection among commercial sex workers in Canada: high risk sex or sex with high risk partners, illicit drug use, and unstable living and working environments. Other risk factors include young age, tattooing or body piercing, and a history of sexual abuse.

The OHTN "Sex Worker HIV Risk" brief then states:

Little is known about these issues in Canada and other high-income countries. In the Canadian context, injection drug use among sex workers and heterosexual transmission to clients and then to their sexual networks is contributing to the HIV epidemic.”8

“High Risk?” Or “Key Population?”

The UNAIDS Key Population Atlas is divided into five categories: Sex Workers, Men Who Have Sex With Men, People Who Inject Drugs, Transgender People, and Prisoners. This website/app gives you UNAIDS statistics on HIV prevalence by country for each “key population.” One of which is “sex workers.” There’s a drop-down menu where you can choose statistics for population size estimate, condom use, knowledge of HIV status, and more. “Condom use” is defined as “Percentage of sex workers reporting the use of condom with their most recent client.”


UNAIDS Key Population Atlas for HIV Statistics

How intrusive would public health research need to be to collect that data from sex workers?

Currently, this data is mined from pre-existing research and numbers are calculated using meta-analysis software. There is a wealth of data from decades of concentration of HIV research in high HIV prevalence countries such as in sub-Saharan Africa and parts of Asia Pacific. However, in countries where HIV prevalence rates are low, there is little HIV prevalence research on sex workers, which includes knowing the size of the sex-worker population in a given region. And where prostitution is illegal, operating clandestinely, estimating population sizes is challenging.

The UNAIDS Key Population Atlas legend uses grey to indicate “no data.” When you select “sex workers” and “HIV prevalence” you will see there is no data for most of North America, as well as most of Europe and the Middle East.

Lack of Research = Flawed Statistics

In July 2014, in conjunction with the 20th International AIDS Conference held in Melbourne, the Lancet published a special issue on Sex Work and HIV. The second page is an infographic that states that 0.8% of the global general population has HIV. In comparison, 11.8% of female sex workers, 14% of male sex workers, and 27.3% of transgender women sex workers globally have HIV.


“Fake Stats”?
It’s curious how these global statistics were calculated given that there are not even population size estimates for sex workers in almost half of the world. What is also misleading, is that countries where sex workers have a high HIV prevalence rate tend to be countries with a very high rate overall. In a region where HIV is very low, you are much less likely to ever be exposed. Comparing an average rate for sex workers in high HIV prevalence countries to a global average is completely out of context.

Sex workers are central to African HIV epidemics,” the opening editorial states, “more than 50% of sex workers living with HIV are all in sub-Saharan Africa. 92% of all HIV/AIDS deaths attributed to sex work occur among African women.” The editorial goes on to speculate that:

With heightened risks of HIV and other sexually transmitted infections, sex workers face substantial barriers in accessing prevention, treatment, and care services. Why? Because of stigma, discrimination, and criminalisation in the societies in which they live. These social, legal, and economic injustices contribute to their high risk of acquiring HIV. Often driven underground by fear, sex workers encounter or face the direct risk of violence and abuse daily. They remain underserved by the global HIV response.”9

Another article in the special issue on HIV and Sex Work titled “Global epidemiology of HIV among female sex workers,” explains more the origins of the global sex worker statistic:

Worldwide, sex workers are disproportionately affected by the HIV pandemic. ... a review of HIV burden in female sex workers (FSWs) in 50 low-income and middle-income countries reported an overall HIV prevalence of 11·8% with a pooled odds of HIV infection of 13·5 compared with the general population of women of reproductive age.

In many high-income countries and regions, such as Canada, the USA, and Europe, epidemics that initially escalated in people who inject drugs in the mid-1990s shifted to FSWs. In settings such as Russia and central and eastern Europe, the scarce data available suggests emerging or established epidemics among FSWs who inject drugs.”10

These conclusions from that review, published in the Lancet March 2012, were drawn from:


102 selected articles and surveillance reports from 2007 to 2011 … representing 99,878 female sex workers in 50 countries. In 26 countries with medium and high background HIV prevalence, 30·7% of sex workers were HIV-positive and the odds ratio for infection was 11·6.”11

This statistic still has currency today. According to the World Health Organisation webpage on HIV and Sex Workers (January 28, 2018):

Globally female sex workers are 13.5% more likely to be living with HIV.

HIV Research? Or Invasion of Privacy?


This 2017 slideshow from AIDS Data Hub, “Review in Slides: Female Sex Workers,” shows HIV statistics for sex workers for the WHO global region, Asia-Pacific. UNAIDS statistics includes research data not only on population size estimations and HIV prevalence rates for sex workers but also:
  • sexually transmitted infection prevalence
  • proportion of FSW who reported condom use at last sex
  • proportion of sex workers under 25 years of age
  • average duration in the profession of selling sex
  • average number of clients (last week, last month)
  • proportion of FSW who reported consistent condom use with their clients
  • proportion of FSW who inject drugs
  • proportion of female sex workers who have been forced to have sex in the last year
  • proportion of FSW with comprehensive HIV knowledge.12


Meanwhile in Canada

Canadian Institutes for Health Research (CIHR) and other national and international research foundations will prioritize funds for research that can provide data for UNAIDS Key Population HIV statistics. This data is necessary to measure progress on the 90-90-90 Goal to End AIDS by 2030 (Global AIDS Response Progress and Global AIDS Monitoring). Organizations that provide support services for sex workers will be pressured through funding to participate in research on their clients. These numbers will set priorities for HIV programming in the provinces/territories.

Attempts to gather sex-worker data on HIV prevalence are underway in Canada. In 2015 here in British Columbia, the B.C. Centre for Disease Control (BCCDC) partnered with the Pacific AIDS Network (PAN), the B.C. Centre for Excellence in HIV/AIDS (BCCfE) and other key provincial stakeholders and contracted the Centre for Global Public Health (University of Manitoba) to develop size estimates for priority populations in B.C.:

It is well understood that a few key populations in British Columbia bear a disproportionately high burden of HIV and hepatitis C compared to the general population. These key populations include gay men and other men who have sex with men (MSM), people who use injection drugs (PWID), and heterosexuals who engage in high-risk behaviours (i.e., sex work).

In order for HCV and HIV services to determine if their programs are adequately serving these key populations, they need reliable estimates of key population sizes, ideally in their local jurisdiction. However, these estimates are difficult to get because many of these populations are hard to reach or hidden due to stigma, or occur too infrequently to be measured through the usual methods (i.e. censuses).”13

Triple-X was asked to participate in this population estimate project, but we politely declined, stating that involvement in a project with the provincial health authority at this time would undermine our efforts to gain trust and recruit members. Which is absolutely true.

In the final report, this “Cautionary Note” was my contribution, during our correspondence:

A key informant remarked that ‘counting’ SW may perpetuate the stigma and discrimination faced by SW as being more impacted by HIV than the general population. It was noted that risk for HIV infection is not inherent in sex work. Sex work is different from other social-sexual behaviours, because for the most part, sex work is performed in the context of employment for income generation.

The section goes on to state:

In fact, a SW study conducted in Victoria (n=201 adult SW aged ≥ 18 years, including 160 female, 36 male and 5 transgender individuals) has shown that condom use with clients among SW exceeds 90%, indicating that professional sexual services are performed safely in an occupational setting. However, there are individuals engaging in survival sex work or transactional sex in informal settings who may not identify as sex workers. These individuals may be faced with other issues such as poverty, violence (including intimate partner violence) and drug addiction that increase their risk for HIV/HCV acquisition. Therefore, for the purpose of HIV/HCV programming, a clear definition of a priority population based on behaviour and context that impose risk, rather than a general identification with a group, is needed.

In the following section however, “Supplementary Information on Sex Work as a Potential Risk Factor for HIV Acquisition,” there are sex work statistics gathered by the BCCDC on people who have tested positive for HIV. It states:

Historically, it has been assumed that sex work plays an important role in the heterosexual and same-sex transmission of HIV. ...the project team requested the BCCDC Surveillance Team to perform an analysis on new HIV diagnoses among men and women in BC from 2006-2015 to determine what proportion of these cases reported sex work as a potential risk factor. We found that the number of women diagnosed with HIV and who reported sex work declined from 22 and 26 individuals in 2006 and 2007 to only 2 and 1 individual in 2014 and 2015. Injection drug use was also reported by 33% — 100% of these women over the same period.”14

The BCCDC (the provincial health authority) questions people who test HIV-positive about whether sex work was a risk factor in their infection. The report also notes that 100% of those who reported sex work also reported injection drug use.

#SWPrEP 2016 Report

To report back on the national consultation in Toronto, Triple-X and DLSPH produced a book: #SWPrEP: HIV Pre-Exposure Prophylaxis and Sex Work in Canada 2016. The book was launched at the annual CAHR conference in Montreal, April 4, 2017. The book contains the transcripts of all the presentations, as well as the discussions that ensued between sex workers and those who provide services for sex workers. #SWPrEP participants were clear about some things they wanted to see in the report, and the Facilitator’s Summary (p. 135) highlights the top-ten concerns coming out of the consultation.




Among those concerns, participants did not want PrEP side effects played down. They wanted PrEP to be presented within the spectrum of HIV prevention and for more and equal promotion of condom use. They wanted educational presentations from healthcare professionals as well as from PrEP critics.

Furthermore, sex workers and sex work advocates were concerned that this new HIV prevention drug could result in elevated risks for sex workers, including new pressures from market competition to provide services without condoms if there is an expectation that sex workers should be on PrEP.

In addition, “#SWPrEP,” a seven-minute video that teases out the issues discussed at the consultation was released.

On June 11, 2017, as part of the 5th Annual Red Umbrella March, Triple-X and PACE hosted an afternoon discussion to present the #SWPrEP report and screen the #SWPrEP video for the consultation participants from Vancouver as well as for anyone else who was interested in the topic of sex work and PrEP.

The results of the national consultation were widely well received. By the end of November 2017, the website recorded 51,000 downloads of the #SWPrEP book since the time of its release in March. The Canadian AIDS Treatment Information Exchange (CATIE) reported that “Conversations That Matter — Sex Workers & PrEP” (posted May 16, 2017) was the 8th most read blog post of 2017.

#SWPrEP: Why Does It Matter?

Truvada will not be the only HIV prevention product being sold to governments for people at high risk. There new ARV pills, injectables, and vaginal rings and gels.

There are also HIV vaccines going into clinical trial phase. The drug company Johnson & Johnson has designed a vaccine to treat all strains of HIV, which has already proven to be 100% effective at achieving immunity against the virus after a trial of 350 volunteers.

For this first large trial, the most at-risk people in the population will receive the vaccination and will include 2,600 young women (18-35 years) from five different African nations.”15


AVAC ARV-Based Prevention Pipeline

There are also new ultra-sensitive HIV spit-testing technologies being developed for on-the-spot testing. In a research study released January 22, 2018, this new HIV Oral Fluids (OF) Test:

could be broadly deployed to screen at-risk populations using OF in many settings, including those ... where needles are inconvenient (pediatrics) or unsafe (prisons).”16

Such broad deployment could include on-the-spot testing of sex workers in the workplace.

Sex Workers’ Rights are Labour Rights

There is a history of governments and employers trying to force medical treatments on workers in the name of public health and safety. One notable and relevant dispute is here in B.C. between the provincial health authority and the B.C. Nurses Union.

In November 2017, health authorities started to remind members of their obligation to receive the flu vaccine. As per the policy, health care workers must be vaccinated against seasonal influenza or wear a mask at all times during the declared flu season. The policy has been under dispute since it was introduced in 2012. BCNU has always opposed mandatory flu vaccinations:

Nurses and other healthcare workers should have the right to decide whether to be vaccinated against influenza, based on their understanding of the current evidence and in discussion with their own family physician or other care provider.”17

BCNU filed an industry-wide application dispute (IWAD) last fall that has since been referred to arbitration.

In another recent labour decision in B.C., United Steel Workers (USW) won an arbitration January 29, 2018 that puts an end to random drug testing by Teck Resources at its unionized coal mines in the Elk Valley. Teck began random testing employees in December 2012. The arbitrator completely rejected the idea that some theoretical, but non-existent safety risk justifies the intrusion of random testing when there is no evidence of workplace problems.

USW District 3 Director Stephen Hunt lauded the decision as a “significant victory for not only Steelworkers, but all workers.

The safety of workers is paramount and we fight for it every day,” says Hunt. “Random testing is a distraction that invades privacy and does nothing to keep workers and communities safe.”18

#SWPrEP: Policy Outcomes

On November 27, 2017, the Canadian Medical Association Journal published “The Canadian Guidelines on HIV Pre-exposure Prophylaxis and Non-Occupational Post Exposure Prophylaxis.”

In Table 1: “Categories of risk that a person has transmissible HIV infection,” substantial risk is assigned to "HIV status unknown, but from a population with high HIV prevalence compared with the general population (e.g., men who have sex with men, people who inject drugs).

The guidelines go on to say:

National data on HIV incidence among sex workers and their clients are scarce, perhaps in part because sex work is criminalized in Canada; as such, this guideline should be applied to these individuals based on the presence of other risk factors.”19

In a December 28, 2017 press release, the B.C. Government Ministry of Health announced new free access to PrEP and expanded PEP for people at risk as of January 1, 2018.

Effective Jan. 1, 2018, British Columbians at high risk of HIV infection will be able to receive pre-exposure prophylaxis (PrEP), a daily oral antiretroviral medication that prevents new HIV infection, at no cost. ...People at risk include men and transwomen who have sex with men, people who inject drugs, and people who have sex with individuals living with HIV.”20 

No mention of involvement in commercial sex.

PrEP will be made available through the B.C. Centre for Excellence’s HIV Drug Treatment research program, which is funded by the Ministry of Health through the B.C. PharmaCare program. People interested in accessing PrEP should discuss their personal risks with their health-care provider. PrEP is not to be confused with PEP (Post-Exposure Prophylaxis) where anti-retroviral therapy is given immediately after a possible exposure to HIV to prevent becoming infected. The B.C. Ministry of Health is also expanding the existing free PEP program to include coverage for non-occupational exposure.

Conclusions: Sex Workers and HIV Risks

Making the universal claim that "sex workers are more likely to catch HIV" perpetuates the “sex worker as disease vector” stigma. Sex workers are safe sex professionals!

A recently published study (November 2017), shows that HIV risk is associated with poverty not sex work. “Risk factors for HIV infection among female sex workers in Bangui, Central African Republic” (a country with high overall HIV prevalence of 4.9%) recruited 345 women to examine HIV risk factors for six different categories of female sex workers. “Two groups were the ‘official’ professional FSW” working in hotels and night clubs and “four groups of ‘clandestine’ non-professional FSW” including street and market vendors, girls, students and housewives involved in occasional transactional sex. The study concluded:

Our observations highlight the high level of vulnerability for HIV acquisition of both poor professional and non-professional ‘street vendor’ FSW categories. These categories should be particularly taken into account when designing specific prevention programs for STIs/HIV control purposes.”21

Every community where ever, and whatever circumstances deserves HIV prevention health care that is distinct and tailored to its individual needs. Sex workers are best placed in society to provide hands-on HIV prevention education and demonstration with the very large and invisible portion of the public who are clients.

Give sex workers the respect we deserve as Safe Sex Professionals.

Footnotes
  1. “Safety Brief: Truvada for pre-exposure prophylaxis to reduce the risk of HIV-1 infection in adults at high risk — recommendations to support the appropriate use.” Health Product Infowatch, July 2016 p.4-5 http://triple- x.org/safety/prep/HCinfowatch-201607.pdf
  2. “FDA approves first drug for reducing the risk of sexually acquired HIV infection,” News Release, July 16, 2012 https://triple-x.org/safety/prep/FDAprep-20120712.pdf
  3. “Did Health Canada just approve Truvada as PrEP?,” Xtra!, February 27, 2015 https://www.dailyxtra.com/did-health-canada-just-approve-truvada-as-prep-70309
  4. “Guidance for the use of Pre-Exposure Prophylaxis (PrEP) for the prevention of HIV acquisition in British Columbia,” B.C. Centre for Excellence in HIV/AIDS research, 2015 https://triple-x.org/safety/prep/bccfe-prep2014.pdf
  5. “New York State Summary Statement on Pre-Exposure Prophylaxis to Prevent HIV Infection,” New York State Department of Health AIDS Institute and the Centers for Disease Control and Prevention, October 14, 2015 https://triple-x.org/safety/prep/NYCDCprep-20151014.pdf
  6. Canadian HIV Pre-exposure Prophylaxis and Non-Occupational Post Exposure Prophylaxis DRAFT Guidelines – Executive Summary, May 12, 2016 http://triple-x.org/safety/prep/CanadianPrEPguide-201605.pdf
  7. Letter to Kevin Pendergraft, Ad Hoc Committee on Canadian Guidelines for HIV PrEP and nPEP c/o CIHR Canadian HIV Trials Network, Re: Canadian Guidelines for HIV PrEP and nPEP Draft Guidelines, May 31, 2016. http://triple-x.org/about/pr/PrEPguideLetter-160531.pdf
  8. "Sex Worker HIV Risk" Rapid Review #58: July 2012, Ontario HIV Treatment Network https://triple-x.org/safety/prep/OHTNHIVsexwork-2012.pdf
  9. "Bringing sex workers to the centre of the HIV response," the Lancet, July 22, 2014 https://triple-x.org/safety/prep/Lancet-HIVandSW-2014.pdf
  10. “Global epidemiology of HIV among female sex workers: influence of structural determinants,” the Lancet, July 22, 2014 https://triple-x.org/safety/prep/LancetHIVsexwork-140722.pdf
  11. Baral S, Beyrer C, Muessig K, et al. “Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis.” Lancet Infect Dis 2012; 12: 538–49. https://triple-x.org/safety/prep/LancetHIVburden-2012.pdf
  12. “Review in Slides: Female Sex Workers,” AIDS Data Hub for Asia-Pacific, December 2017 http://www.aidsdatahub.org/female-sex-workers-2017-slides
  13. “Estimated sizes of key populations for HIV and HCV in BC,” Smart Sex Resource, B.C. Centre for Disease Control, April 4, 2017 https://smartsexresource.com/health-providers/blog/201704/estimated-sizes-key-populations-hiv-and-hcv-bc
  14. Estimation of Key Population Size of People who Use Injection Drugs (PWID), Men who Have Sex with Men (MSM) and Sex Workers (SW) who are At Risk of Acquiring HIV and Hepatitis C in the Five Health Regions of the Province of British Columbia: Final Report, October 5, 2016. Submitted to the B.C. Centre for Disease Control and the Pacific AIDS Network by The Centre for Global Public Health, University of Manitoba. http://www.bccdc.ca/resource-gallery/Documents/Statistics%20and%20Research/Statistics%20and%20Reports/STI/PSE%20Project%20Final%20Report.pdf
  15. “The fight against HIV/AIDS just made a monumental breakthrough with this vaccine,” Gay Times, September 27, 2017 http://www.gaytimes.co.uk/news/87967/fight-hivaids-just-made-monumental-breakthrough-vaccine/
  16. “Antibody detection by agglutination–PCR (ADAP) enables early diagnosis of HIV infection by oral fluid analysis,” Proceedings of the National Academy of Sciences, January 22, 2018 http://www.pnas.org/content/early/2018/01/12/1711004115
  17. “Position Statement: Influenza Control Policy,” B.C. Nurses Union, March 2015 https://www.bcnu.org/AboutBcnu/Documents/position-statement-influenza-control.pdf
  18. Steelworkers Arbitration Victory Ends Random Drug and Alcohol Testing At Teck’s Elk Valley Unionized Mines, Media Release, January 29, 2018, United Steel Workers https://www.usw.ca/news/media-centre/articles/2018/arbitration-victory-ends-random-drug-alcohol-testing-at-teck-elk-valley
  19. “The Canadian Guidelines on HIV Pre-exposure Prophylaxis and Non-Occupational Post Exposure Prophylaxis,” Canadian Medical Association Journal, November 27, 2017 http://www.cmaj.ca/content/cmaj/189/47/E1448.full.pdf
  20. “Preventative medication will protect people at risk of HIV,” BC Gov News, December 28, 2017 https://news.gov.bc.ca/releases/2017HLTH0114-002108
  21. “Risk factors for HIV infection among female sex workers in Bangui, Central African Republic,” PLOS One, November 6, 2017 https://triple-x.org/safety/prep/PLOS-RiskFSWBangui.pdf

Thursday, September 21, 2017

So You Wanna Be A Slave



The realm of fetish is one seriously diverse world where you can pretty much find anything that tickles your fancy. 

One request I get on a regular basis is to be my personal slave, a slave that will do anything I order, for me, and mostly to me. 

As tempting as the offer is, I find myself politely declining on most occasions. Why? Well let me clarify.

Being a personal slave for many usually comes with the applicant’s pre-conceived notions of what that is, and notions that 99.99 percent of the time don’t coincide with my own. A slave for most means providing sexual gratification to Mistress or Master, and that generally isn’t what I am looking for in a slave.

Being submissive is also a requirement and with intentions to reside with me under my lock and key, and with constant direction on every aspect of daily life. Ah the fantasy, and that’s just what that is, a fantasy, but done right can be seriously satisfying!

I know a lot of folks living a 24/7 lifestyle and others that play for an afternoon, evening, or a few hours here and there.

Personally I prefer a slave that is high functioning in society, thinking, working, living, socializing, eating, breathing……….but knows their place.

Most on the market for a personal slave have a long list of duties along with a check list of attributes to be rigorously and thoroughly checked off. Hopeful, potential slaves don’t realize it’s not all about the sex, and as much as I love a serious muff dive, there are, household chores to be done. Chores like cleaning the bathroom, vacuuming the rugs, wiping the windows, doing the dishes and laundry. Mistress can’t be expected to live in squalor can she? 

What of the utility bills, rent, or mortgage? Money doesn’t grow on trees!

That proverbial “check list” is something everyone has, even the slave, it’s a list that’s very clearly defined before a person goes looking. Aside from having interests in common there is also the delicate subject of whether or not you are each other’s “type” let alone attracted to each other, if that is the direction you are going. 

It’s a subject so delicate that it can seriously offend a person, because for some that are looking for a slave or wishing to be one, the thought is, “if you’re on the market that anyone and everyone should be eager to graciously accept the offer of servitude or command.”

Just as with dating, compatibility is the issue, and does seriously matter for a relationship to happen, let alone a connection. Then there is a little thing called aesthetic ,we all have that certain aesthetic we appreciate and adhere to, and it’s unique to each and everyone of us.

Other items the list includes is the types of interests you both may share, something to ask prior to the interview, if the information is available. You don’t want to begin a new relationship only to discover they are the ones that want to wear the dress and heels when you were expecting a man’s man. 

Make sure it is clearly defined, you may be a masochist, but they may not be the sadist you were hoping for.

What I hope is that you think before you leap and don’t be afraid to ask questions, if it feels right chances are it is, if i doesn’t keep on looking. And folks, please do remind yourselves not to be offended if rejection comes your way.


About the Author

Velvet is widely known for her appearance on the wildly popular documentary series KINK. She is also a woman, a woman who is a transexual advocate, educating folks on the good, the bad, and the ugly of the world of sex toys and adult therapeutical aids, and as an activist, crusades for the rights of others. As an advocate she created the first Fetish Night in Vancouver which ran for 10 years. Life as a fetishist and visual artist led her to sexual activism, recently finishing work with the City of Vancouver Task Force on Sex Work. She recently finished work as a sensitivity facilitator with Living In Community, sits on the advisory of the Canadian Alliance for Sex Work Law Reform and is an active member of the British Columbia Coalition of Experiential Communities. Her website at www.velvetsteele.com presents all her current body of work to the public.

Porn’s Most Popular Stars

Guestpost by TheStripClubReviewer.com

There is no clear formula to success especially in the adult entertainment industry, but these ten adult performers have shown that it can be done.


Adult Entertainment’s Ten Notably Popular Stars
A few adult entertainers have encountered a fleeting ascent and fall in popularity over the span of a year. Meanwhile, others have gathered enough audience to keep them afloat for many years. Unpredictable as it may seem, but achieving notoriety in the porn business is a tough thing to achieve.




In spite of this fact, there is truly no genuine recipe for success in the sex industry, just trade secrets.

But these 10 entertainers have proven to be more than just a flash in the pan. Their resilience through the years and their huge fan following have proven that there is no stopping them.


1. Ashlynn Brooke
Even though it has been just about a decade since she joined the business, this woman has proven that she is a force to reckon with. Winning multiple accolades and recognition, and starring in the movie, “Piranha 3D” has helped propel her to stardom. These days, however, she has her eyes set towards directing naughty parodies of mainstream films, such as Wonder Woman and Little Red Riding Hood.


2. Jenna Haze

This 34-year old beauty has been rocking the AVN Awards (that is porn’s answer to the Oscars) after she was nominated for “Female Performer of the Year” for three consecutive years. Currently, she is one of the most sought-after stars of the Adult Entertainment Broadcast Network (AEBN) – the largest internet video-on-demand provider of the porn industry.


3. Lisa Ann

She has been around since the 1990s and remains as one of the best adult performers around. Ranked number one in popular porn sites, such as PornHub, she has achieved fame after starring as Sarah Palin in a parody in 2008.

4. Evan Stone

Dabbed as Ron Jeremy’s successor, his sense of humour and gorgeous golden mane have made this man almost every lady’s favourite. The 52-year-old adult film star has performed in approximately 1,821 films and directed eight in his entire career as of the moment.

5. Tori Black

Winning as AVN’s performer of the year for two consecutive years (2010 and 2011) has cemented her status as one of the industry’s in-demand entertainers. Within just a few years into her career as an adult entertainer, she starred in more than 200 films starting with the Penthouse Pet.





6. Bobbi Starr

Known as one of the contestants in “America’s Next Hot Porn Star”, she has accumulated a huge following even after failing to win in that pay-per-view reality competition. On the other hand, she is set to be the next crossover artist after being cast in the mainstream film “Drive” alongside Ryan Gosling, Christina Hendricks, and Albert Brooks.


7. Lexi Belle

Probably the youngest on this list, she has received recognition as one of the top-performers in two of porn’s largest award giving bodies, AVN and Xbiz. She made her crossover to mainstream film after starring as Hera in the 2015 action flick, Samurai Cop 2: Deadly Vengeance with co-stars Kayden Kross and Tommy Wiseau.

8. Sasha Grey

Even though she has been in hiatus with performing in adult films, Sasha Grey remained visible to her fans as she took the lead role in Steven Soderbergh’s “The Girlfriend Experience” in 2008. She also appeared as a recurring character on HBO’s series, “Entourage”.

9. Rocco Siffredi

The Italian Stallion, as many called him, has been in the adult industry for more than 3 decades after meeting Gabriel Pontello, a porn actor, in a French strip club in the 80’s. He starred in more than 1,300 pornographic films beginning with Attention Fillettes in 1987. Currently, he works as a producer and director of adult films and has amassed a fortune, making him one of the richest in the adult entertainment.

10. John Holmes

Also known as John Wadd in some of his films, he is one of the most prolific male adult performers of all time. Appearing in almost 2,934 films, he achieved notoriety during the Golden Age of Porn in the 70s and 80s. His life as a porn star and his death had made him the subject of numerous books, an essay in the Rolling Stone magazine, and two feature-length documentaries, and the inspiration of two mainstream films: Wonderland (2003) and Boogie Nights (1997).

Conclusion

As adult entertainers, these people have managed to stand out from the crowd. Popularity may wane but legacies will surely remain, and these men and women have left an indelible mark in the porn industry.







(Source)

Sunday, April 23, 2017

Conversations That Matter - Sex Workers and PrEP

Triple-Xers Andrew Sorfleet, Anna Smith,
Dan Allman from DLSPH, Sandra Wesley
from Stella and Brenna Bezanson from PACE.
Guest Post by Andrew Sorfleet

NOTE: This article links to some awesome resources on this topic!

There is a long and troubled history when it comes to PrEP research and sex workers

PrEP (HIV pre-exposure prophylaxis) is the idea that a person could take a pill once a day and be protected from catching HIV, not unlike the birth-control pill which protects from unwanted pregnancy.

The troubles began in 2004, when Gilead's HIV treatment product, Viread (tenofovir) was set to be tested on 960 sex workers in Cambodia. 

The Cambodian Women's Network of Unity -- a group of sex worker activists -- demanded health benefits for those who would become HIV-positive. 

The WNU protest was very effective, and researchers halted the placebo-controlled trial after "a verbal directive" from the Cambodian Prime Minister, Hun Sen, that the trial violated human rights.

By 2006, two more tenofovir PrEP clinical trials which involved sex workers were also shut down because of ethical concerns as a result of sex worker and AIDS activists protesting in Cameroon and Nigeria. From 2004 to 2009 three PrEP trial protocols were refused ethics approval in Malawi.

Good Participatory Practices

As a result of these clinical trial closures and because of such successful activism, new clinical ethical guidelines were produced by UNAIDS.

Called "Good Participatory Practices" these new guidelines enabled clinical trials to begin again in Africa and Thailand. In 2010, iPrEx, a clinical study involving 2,133 gay men and 366 transgender women from Peru, Brazil, Ecuador, Thailand and the United States reported high success of Gilead's HIV treatment product Truvada (tenofovir plus emtricitabine) as HIV PrEP.

In 2011, the FEM-PrEP clinical trial in Kenya, South Africa and Tanzania involving 2,120 women was stopped early because of lack of efficacy. In 2012, the VOICE clinical trial in South Africa, Uganda and Zimbabwe involving 5,069 women found no significant difference in the rate of HIV seroconversion between a group receiving oral tenofovir and a tenofovir vaginal gel and the group receiving the corresponding placebo.

While there were still little data for efficacy in women, the U.S. Food and Drug Adminstration approved Truvada for PrEP in 2012. Involvement in commercial sex was listed by the U.S. Centers for Disease Control as risk factor for which Truvada should be prescribed for HIV PrEP.

Truvada for PrEP Comes to Canada
In February 2015, Health Canada also approved Truvada for HIV PrEP in Canada and also listed "involvement in commercial sex" as a risk factor for which Truvada should be prescribed. 

As more provincial and national guidelines were being drafted, involvement in commercial sex, or transactional sex, continues to be listed as a risk factor for which Truvada should be prescribed for HIV PrEP. 

Risk factors also typically include geographical areas or social networks where there is a high number of people who are HIV-positive, as well as illegal drug use.

At the 2016 Canadian Association of HIV Researchers (CAHR) conference in Winnipeg an ad hoc committee of HIV prevention professionals, doctors and researchers, supported by the Canadian HIV Trials Network funded by the federal government through the Canadian Institutes of Health Research, presented draft guidelines for prescribing Truvada as PrEP [http://triple-x.org/safety/prep/CanadianPrEPguide-201605.pdf]. 

Once again, the guidelines mentioned "sex trade workers" as one of the groups with a "significant risk of having transmissible HIV."

The Sex Industry Responds

Because the researchers drafting the guidelines had failed to consult sex workers, seven organizations who work with sex workers drafted an eight-page letter which outlined serious concerns [http://triple-x.org/about/pr/PrEPguideLetter-160531.pdf]. 

Triple-X Workers' Solidarity Association of B.C. who authored the letter has yet to receive a formal response over a year later. A final draft of PrEP prescription guidelines are expected sometime this year.

National Consultation
In October 2016, funded by a grant from Elton John AIDS Foundation, Triple-X in partnership with the Dalla Lana School of Public Health, University of Toronto, organized and hosted a national consultation and invited 23 organizations from 10 provinces and territories who provide advocacy or services for sex workers. 

Fifty women, men and trans people from across Canada that work with sex workers met in Toronto. The purpose of this national consultation was to give participants the opportunity to educate themselves, explore and grapple as a group with the implications of PrEP on the sex industry.

Topics covered during the two-day consultation included:

• History of community-based participation in HIV research
• PrEP basics: questions and answers
• How drugs get covered under public and private health insurance
• HIV, sex work and human rights; and
• Clinical trials involving sex workers and research ethics.

Sex workers and sex work advocates are concerned that the new HIV prevention drug, Truvada could result in elevated risks for sex workers, including new pressures from clients and the marketplace to engage in condomless sex because sex workers are expected to be on PrEP.

At the national consultation in Toronto, the Dean of the Dalla Lana School of Public Health, Dr. Howard Hu, gave sex workers a warm welcome and stated that... 

"these kinds of conversations that you have had are some of the many difficult conversations that have to happen in the school of public health. In fact, we call them 'conversations that matter' and creating safe spaces for you and others to conduct these kinds of conversations, we believe, is critical."

#SWPrEP in Montreal

Triple-X and DLSPH held an ancilliary event at the 2017 CAHR Conference in Montreal on April 5 to present "#SWPrEP: HIV Pre-Exposure Prophylaxis and Sex Work in Canada 2016" [http://triple-x.org/pdf/SWPrEPbook.pdf]. 

This report contains the transcripts of all the expert presentations as well as as the discussions that ensued between sex workers and those who provide services for sex workers.

The #SWPrEP report also features a chronology of PrEP research and a factsheet on Truvada side effects and stills and interviews from sex workers' rights activists featured in the historic 1989 video, "Our Bodies Our Business" which was screened at the 2016 consultation [https://vimeo.com/195574653]. 

In addition, "#SWPrEP," a seven-minute video that teases out the issues discussed at the consultation [https://vimeo.com/209825247].

"Nurse Annie" (Triple-X director, Anna Smith) made a surprise appearance in full uniform and gave us a sneak preview of a film she made in 1986 - Canada's first safer sex film.

#SWPrEP was funded by Elton John AIDS Foundation with additional support from Gilead Sciences Canada, Inc., and Canadian Institutes for Health Research (CIHR) a funding program of the federal government.

Included with the report is a 2Gb USB drive which contains the PDF version of #SWPrEP complete with hyperlinks to many of the resources and research available online. 

In addition there are three video files: #SWPrEP: Pre- Exposure Prophylaxis, Our Bodies Our Business: Prostitutes’ Rights Activists at the 5th International Conference on AIDS 1989, and The Condom: How-To.

• #SWPrEP Video: https://vimeo.com/209825247
• #SWPrEP: HIV Pre-Exposure Prophylaxis and Sex Work in Canada 2016: http://triple-x.org/pdf/SWPrEPbook.pdf
• Our Bodies Our Business: Prostitutes' Rights Activists at the 5th International Conference on AIDS in Montreal, 1989: https://vimeo.com/195574653
• The Condom: How-To: https://vimeo.com/196748953
• More information about PrEP and Sex Work: http://triple-x.org/safety/prep/

About the Author

Andrew Sorfleet has worked in the sex industry for over a decade and has been a sex workers' rights activist since 1990. He is currently president of the board of Triple-X Workers' Solidarity Association of B.C.

Friday, April 7, 2017

Ten Signs You Spend Too Much Time in Strip Clubs

By Annie Temple

The other night, I was sitting the strip club talking to a cherished regular. A song ended...I clapped; he saw me clapping and put his hands together too. Then we realized no one was on stage.

"You know you spend too much time in a strip club when..." I yelled over the next song, laughing. 

That was the inspiration for this post. Please let me know in the comments if I'm missing anything.

xo


10. You clap at the end of a song...that's playing on the radio.




9. You have two Facebook profiles.




8. You don't bother with bathroom stall doors anymore. 

This is what you're used to.















7. Instead of giving your lover a massage, you just pay for one at the strip club. (You're there anyway.)




6. You stash your money in multiple locations on your body. 




5. You've been featured on The Dirty


"What can i say? People are jealous."

4. You have the phone numbers of several drug dealers even though you don't do drugs. 




3. You can find your way anywhere...in relation to the nearest strip club. 




2. There is no topic of conversation in existence that will make you blush.



1. No one understands you except DJ's and Strippers. 





About the Author

Annie Temple is the stage and writing name of Trina Ricketts. Trina is a former striptease artist and a sex worker rights activist, but she's been a rebel all her life. In 2000, she founded NakedTruth.ca to support other entertainers by reducing isolation, educating about health and safety, sharing information about gigs, challenging stereotypes, teaching etiquette to customers, and organizing in-person events for charity and to promote ethical businesses in the industry.