Friday, August 12, 2016

Sex workers listed as "source for transmissible HIV" at Canadian HIV conference

Guest Post by Andrew Sorfleet

8 things you didn't know about Truvada, PBS April 12, 2015
There's been a lot of hype lately about a new drug that you can take every day which prevents you catching HIV. 

The anti-retroviral medication - Truvada - has been used for a while now as an effective treatment for people who have HIV. 

Recently, large demonstration research trials have proven that Truvada also works as effective prevention: Pre-Exposure Prophylaxis for HIV, or "PrEP."

Sexual Health & Safety: WTF is PrEP?

A study released in 2015 reported that after 2.5 years, a group of more than 600 San Francisco men who have sex with men taking Truvada as PrEP have had zero cases of HIV infection. 

That study also found that 45 per cent of study participants stated they used condoms less; and more than half of those in the group study had contracted at least one sexually transmitted infection (STI) within one year.

There has been high demand for access to PrEP from gay men. 

In Canada, this has led to the development of some guidelines for prescribing Truvada for what is called "off-label" use - which means a doctor can prescribe a drug for a use other than what the drug was approved for. 

Then in February 2016, Health Canada approved Truvada for use as PrEP for HIV in Canada. (Truvada was approved by the U.S. Food and Drug Administration for use as PrEP in 2012.) 

Truvada is but one of many PrEP medications available or in development. Global Advocacy for HIV Prevention (AVAC) tracks all the drugs being researched on a monthly chart: the ARV-based Prevention Pipeline.

On May 12, 2016, at a symposium of the 25th Annual Canadian Conference on HIV/AIDS, new draft Canadian guidelines for PrEP and an emergency treatment for HIV exposure called “nPEP” (non-occupational Post-Exposure Prophylaxis) were presented. 

The proposed national guidelines featured a table which listed "source" groups for "transmissible HIV." The idea was that if you have a risky contact with someone from one of these groups listed in Table 6B, you would be eligible for "nPEP" where you would be given ARV medications immediately after the risk for HIV took place. 

"PEP" (Post-Exposure Prophylaxis) has been available for some time now for emergency workers and nurses who face risks from contact with blood including needle-sticks and such.

From around the room, comments arose about the inclusion of sex workers in Table 6B: "Likelihood Source has Transmissible HIV," and the fact that sex work clients would have access to nPEP, yet there were no guidelines for access to nPEP for sex workers themselves.

As it turns out, there were a dozen representatives from sex-work organizations from around Canada, including Maggie's Toronto, Stella Montreal, SWAN Society Vancouver, SHIFT Calgary and several people from Winnipeg where the CAHR conference was being held. 

After the symposium, a group of the delegates drafted and submitted a letter outlining their concerns (22 in number) about the draft PrEP and nPEP guidelines. Here’s a quote from the letter:

"The use of the term "survival sex trade" encourages stigma and discrimination toward certain citizens. Our group feels strongly that the emphasis on "populations" rather than "behaviours" is problematic when describing sex workers in general.  
"The implication is that risks for HIV infection and transmission are inherent in sex work. However, sex work (as opposed to other forms of sexual exchange) most often takes place within a sex-industry workplace."

The reason there were an unprecedented number of sex-worker groups attending the CAHR conference is because they were there taking part in an invitation-only ancillary event to the conference called, "PrEP in the Context of Sex Work: Possibilities and Limitations." 

The focus of this ancillary event was to plan for a national consultation of the same name, to be held in Toronto on October 19 and 20 at the Dalla Lana School of Public Health (DLSPH), University of Toronto.

The national consultation is a team effort, spearheaded by the Triple-X Workers' Solidarity Association of B.C. 

In May 2015, I came across a link on Facebook to "Guidance for the use of PrEP in B.C." from the B.C. Centre for Excellence in HIV/AIDS Research. These guidelines recommended prescription of PrEP for persons at risk of HIV which included people who had "involvement in commercial sex work."

At the time, I was alarmed that guidelines for prescribing PrEP for sex workers listed sex work as a risk for HIV, when there had been absolutely no consultation with or input from sex workers. 

"How can we fix this?" I asked long-time friend and sex-worker ally Dr. Dan Allman who is currently an Assistant Professor at DLSPH

The answer was to organize a national sex-worker and sex-worker ally conference on PrEP. Together DLSPH and Triple-X applied for and were awarded a grant from the Elton John AIDS Foundation (EJAF) for $75,000 to do exactly that. 

"I'm a Truvada Whore" Criticisms in gay community
over Truvada vs condoms.

Cartoon: Ranslem, Washington Blade
This is the first EJAF grant ever awarded for a national community consultation with sex-worker organizations to discuss pre-exposure prophylaxis (PrEP) in the sex industry workplace.

Globally, sex workers and others engaged in trading sex have been identified by UNAIDS as a "key population" in need of PrEP to reduce HIV infection rates, particularly in countries where HIV rates are high. 

To date, almost all of the research data about the effectiveness and safety of PrEP has involved men and some transgender women. 

There is little research about PrEP for cis women, but there is data that suggests that absorption rates are not the same as for cis men. (Journal of Infectious Diseases, Feb 24, 2016

Internationally, sex workers in most countries have no mechanism to provide direct input into public health policies or programs for implementing PrEP in the sex workplace. This is also true in Canada.

DLSPH and Triple-X also received a small grant from the Canadian Institutes of Health Research (CIHR) which funded the planning session meeting at the CAHR conference in Winnipeg. 

At the Winnipeg meeting, sex workers and activists identified distinct pressures related to PrEP and the sex-work marketplace, including impact on workplace sexual health and safety practices, confidentiality of workers' private health status, competition among workers and shifting expectations from clients and employers

The group also produced 17 recommendations for a successful sex-worker consultation about PrEP, including the need for "a better and more robust peer-­empowerment model of HIV education in order to discuss PrEP and other new HIV-­prevention technologies."

"PrEP in the Context of Sex Work: Possibilities and Limitations" is a national sex-worker group consultation to learn about, discuss and make recommendations regarding the use of PrEP in the sex workplace setting. 

It will take place in Toronto on October 19 and 20 at the Dalla Lana School of Public Health, University of Toronto. The event is by invitation only, and is open to sex workers and allies who work for sex-worker support agencies from across Canada.


Interested in learning more? Visit http://triple-x.org/safety/prep/ for details, or email Triple-X at info@triple-x.org


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.

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