Side-Event: Young Sex Workers Who Use Drugs: Addressing the Stigma and Need for Change

Ruby: Youth RISE works with young people who use drugs around the world who are working in drug policy reform and ham reduction. We use the principle of Full Spectrum Harm Reduction and work to reduce stigma and discrimination. Created a research paper last year with a group of 7 people working in the field around the world. The paper calls attention to specific needs of young sex workers. Issues that put their physical and mental health at risk and sets out recommendations. There are some limits to the paper – it is a narrative research paper, collecting and analyzing accounts of people’s experiences. Paper highlights the need for more research on this population. First part focuses on discrimination, young sex workers who use drugs suffer from triple compounding stigma, more exclusion and marginalization. The community is very complex and diverse. There are many reasons for starting sex work some are about livelihood, autonomy or empowerment. Stigma manifests in a variety of forms, condescending attitudes and trying to convince young sex workers to quit sex work. Criminalization forces them into clandestine environments. Health professionals are uninformed about sex work. “Both drug use and sex work are illegal and stigmatized, keep sex work secret which makes it harder to connect with other sex workers. Do not openly use drugs in work, clients could weaponize this. Such secrets, lack of safety and stability don’t help mental health”. HIV prevalence varies wildly depending on region and other factors. Common patterns of use include chemsex and poly drug use. Studies show young age in sex work leads to further exploitation and increased HIV prevalence. Stigma represents a significant factor, one consequence of which is unreported crimes. Intersection of further vulnerabilities leads to further violence. Violence from state authorities, lack of access to justice represents other form of violence. High levels of violence have a significant impact on health. Sex work not just about risks – it is work. Work which can fit around other commitments. Pay can be greater than other jobs and greater flexibility. Form of escape and empowerment for those from varied backgrounds. 

Josephine: No other event shedding light on our key population, great process to be involved in this research to shed light on this. Globally, engaging young people from key populations is fundamental to harm reduction. Increasing support for engaging people who use drugs but limited focus on engagement of young people, young sex workers. Compounding stigma and discrimination. So many barriers to addressing issues, age of consent, policies in place limiting ability to access services. Age restriction in accessing services. Structural barriers placed by healthcare workers reluctant to provide these services to young people. Leads to community inflicted stigma and issues of barriers to access services leads to very poor health outcomes. Lack of strategies to ensure access to SRHR. In Kenya context issues around proximity of service, no community led clinics and no one stop shop so this creates systemic barriers. 

Marie: It feels great to have a platform to talk about my personal experiences. There is a lack of intersectional approaches to policy reform and research this week. YouthRISE is not just amplifying youth voices but considering the diversity of youth and many parts of youth identity. Germany and Kenya different in treatment of drug use and sex work. Sex work is legalized in Germany under the Prostitution Act 2017, registration as a sex worker is mandatory and brothel operators are required to provide certain protections such as age protections etc. Almost all organizations representing sex workers spoke out against this law. There was no involvement of sex worker led organizations and it reduced working conditions around Germany. Requirement to register is very problematic, it makes it impossible for migrants who are just pushed further into margins. Laws will never match the actual needs and need to further identify issues and needs of the community. Intersectional and feminist approach is vital to tackling this. Administrative and structural circumstances have impact on attitudes of general population. Stigma leads to discrimination and violence. Under representation is more true for young sex workers. Stigma further puts up barriers to accessing health services. Laws consolidate stigma. Frameworks in UNODC to include youth but there is no active community engagement. We call on further engagement. Very crucial time for sex work in Germany, the 2017 act was reviewed in the past year and final decision taken in 2025 for what will happen to the law. Decriminalization is called for and many sex workers have called out against this nordic model which would have a negative effect on sex workers in Germany. We can all speak up for decrim of sex work and drug use and against the nordic model.

Sukie Beavers: It is important we contextualize this issue, incidence of HIV among PWUD is a key driver in the epidemic and leading to increase in HIV infections in certain regions. In the Global AIDS Strategy, UNAIDS and all participants set out specific targets and outlined that it is punitive laws and policies driving these figures. In 54 out of 135 reported countries NSP is available and there are just 48 countries with Opioid Agonist Treatment. The age of consent and parental consent laws further restrict ability to access services. Majority of countries criminalize sex work and this all impacts health outcomes. Young sex workers who use drugs face a ttriple burden, and more when taking into account stigma and discrimination. Need to use an intersectional feminist approach to capture the reality of people’s lives. Overlapping and intersecting identities and need holistic human rights based approach including harm reduction and decriminalizing both sex work and drug use. Recent legal principles developed address that drug policy is incompatible with international human rights obligations. Intersecting inequalities only compounds disparities. What do governments need to do – we and they know what they need to do. We need to call on governments to remove legal and policy barriers to accessing HIV services and other services related to young people’s wellbeing. Importance of 10-10-10 targets.

Josephine: From community perspective we need to see decriminalization of both drug use and sex work. Grassroots organizing and peer engagement to offer peer to peer support can only go so far with the continuing legal and policy barriers. Active participation of the community at all levels. We need a more inclusive approach to optimize the community and not make decisions on our behalf. We need to be at the table to share real life experiences we are having within the community. Governments need to engage youth from a multitude of identities as young people are not homogenous. Young people need to be engaged in implementation and evaluation of youth friendly and youth led services. Donors need to be concerned with these intersecting issues. Meaningful community engagement and person centered care for sex workers who use drugs. 

Marie: In the German context, in a place where regulation is already in place, we need more research and data – we need young people involved in creating an intersectional approach in research. Laws are being made whether data is there or not so we all have responsibility to do this to inform policy makers. We call on government and UN bodies to make all efforts to involve young sex workers and reform archaic laws. We need to see compassion in dealing with vulnerable people and use of sensitive vocabulary. Less judgement and need harm reduction to adapt to needs. More age specific support needed and more guidelines. Lots of work to be done but what we believe is that young sex workers have the ability to catalyze change. Sex workers and people who use drugs are among the most diverse global populations and we need to include migrants, queer people, abortion rights etc.

Question: Do you have contacts with medical staff, young people with drug use disorders still require help despite stigma. Need to consider medical help, I am asking specifically within the Italian context.

Answer: No members in Italy but agree that they should be involved in the process. 

Question: Question for Suki – why is there so little research on communities and key populations? We also don’t hear enough about sub communities, queer sex workers using drugs etc. 

Answer: Stigma and discrimination is a big issue and invisibility is part of the problem that we need to dig into. Need more evidence, more data, quantitative, qualitative. Pointing to a huge gap we need to turn our attention to. Governments need to fund this and community led responses – 30 80 60 targets in the Global AIDS Strategy are all about ensuring communities are leading and this requires adequate research.

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