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Criminalisation, legal oppression, stigma, discrimination and violence experienced by sex workers in Europe and Central Asia increase the vulnerability of sex workers to HIV, sexually transmitted infections (STIs) and other health risks such as mental health issues. Legal barriers and stigma effectively drive sex workers underground, away from medical facilities and other health care services. This also hinders the collection of reliable data on sexual and reproductive health issues faced by people selling sexual services and makes it difficult to present a clear picture of sex workers’ vulnerabilities to HIV and other STIs in the European region.
Available data shows, however, that sex workers in Europe and Central Asia are much more affected by HIV and STIs than the general population, while the HIV/STI prevalence among sex workers varies significantly depending on the country and sub-region of Europe.
The increased vulnerabilities of sex workers to HIV and STIs are often overshadowed by stigmatising perceptions of sex work and those involved, casting sex workers as vectors of disease and responsible for transmission. This view of sex workers presented in regional, national and local discussions from politically and ideologically motivated and further propel stigma experienced by people working in the sex industry and have often driven the surge of discriminatory and rights-violating policies and programmes, including mandatory testing and forced registration.
The COVID-19 pandemic has exacerbated the challenge. NGOs that have previously been able to support vulnerable populations have faced increasingly stretched resources and legal restrictions impeding their capacity. As their services have not been able to reach some people, those individuals have experienced greater isolation, vulnerability and risks to their physical and mental wellbeing.
Sex workers enjoy improved access to health care that is responsive to and meets their specific needs and improves health outcomes, both physical and mental, for all sex worker communities.
- Sex workers, including those who are migrants, enjoy access to inclusive, accessible health services, that are responsive to their needs and without the threat of punitive repercussions.
- Health inequalities experienced by sex workers are reduced and health outcomes improved, particularly in the areas of HIV, sexual, reproductive and mental health.
- Sex workers are engaged with, inform and are protected by public health responses without discrimination.
2023: An overview
COmmunity REsponse to End Inequalities
CORE is a 36-month EU Action Grant running from January 1st 2023 to December 31st 2025 and involves 24 partners from 16 EU Member States. CORE aims to reduce inequalities in the HIV, TB and viral hepatitis responses by promoting, strengthening and integrating the community responses that have proven key in reaching communities traditionally underserved by mainstream prevention and healthcare services. This approach is particularly vital in the context of countries where these responses are still inadequate compared to the EU average.
CORE is co-funded by the EU4Health Programme 2021 – 2027, the fourth and largest of the EU health programmes since their launch in 2003, with the total budget of €5,3 billion.
The project CORE is a practical reflection of the Global AIDS Strategy 2021 – 2026 which was adopted by the UNAIDS Programme Coordinating Board in 2021. The Global AIDS Strategy came to replace the previous because the world did not reach the 2020 HIV treatment targets and rather we experienced a substantial increase in inequalities around the world and within the countries. We observed how the HIV response has been pushed off track locally, regionally and globally and how COVID was used as an excuse for that. The new Global AIDS Strategy with its completely new approach makes a bold move to put people and communities in the centre of the HIV response.
Following the Global AIDS Strategy, CORE uses the following principles: inequality lens, community leadership, intersectionality, inclusivity, as well as the integration of community-led and community-based organisations into prevention, testing and counselling, and linkage to and retention in care services. The project pursues the following strategic goals: strengthening the capacity of community-led and community-based services; consolidating and increasing the scope and effectiveness of community-based linkage to care; supporting exchange and dialogue between community-led and community-based service providers, community networks, representatives of key affected communities, and other stakeholders; and addressing policy, legal and structural barriers.
CORE operates in two sets of countries: one set are the EU Member States in the countries of central and southeast Europe: Bulgaria, Hungary, Poland, Romania, Slovakia, and Slovenia. These countries have similar epidemiological trends; have been HIV low-prevalence countries, with HIV concentrated in the gay bisexual and other MSM communities. However, in recent years we have seen backlashes against key populations, lack of political will, and low level of recognition of the role of communities in HIV response. Another set of EU Member States where the project focuses on are countries of the west and south of the Union: France, Germany, Greece, Portugal, and Sweden. They have relatively successful responses to the HIV, viral hepatitis, TB, and STI epidemics, however, some key populations in these countries are left behind due to stigma and discrimination, racism and xenophobia, and other systemic legal and policy barriers.. Among these key populations are migrant communities, sex workers, trans and gender diverse people, and people who use drugs.
The following organisations are part of the project: Institute of Tropical Medicine Antwerp, European AIDS Treatment Group, European Sex Workers Rights Alliance (Belgium), Health without Borders (Bulgaria), AIDS Solidarity Movement (Cyprus), Czech AIDS Help Society (Czechia), Federal Paraliu Rouge (France), AIDS Action Europe/Deutsche Aidshilfe, Afrikaherz (Germany), Positive Voice and Praksis (Greece), HATTER and Right Reporter Foundation (Hungary), Fundacja Edukacji Społecznej (Poland), LILA Milano (Italy), GAT (Portugal), ARAS and Carusel (Portugal), Odyseus (Slovakia), Legebitra (Slovenia), CEEISCAT (Spain, Catalunya), Noaks Ark Mozaik (Sweden), Africa Advocacy Foundation and Correlation – European Harm Reduction Network (the Netherlands).
The project kick off meeting took place on January 30th 2023 where all the partners could meet and discuss the project implementation and outcomes. Stay tuned for more information and outcomes of the project on the Core website which will go live in summer 2023!
Sex Workers Inclusive Policies and Programmes in Europe
Improve sex workers’ access to health and HIV services
- 1 training for trans sex workers
(sex workers who identify as trans feminine, trans masculine or non binary sex workers)
The calls for trainers and participants will be launched soon.
- 1 training for MSM sex workers
The calls for trainers and participants will be launched soon.
- 1 workshop on stigma and discrimination for healthcare professionals
- 1 community-based research on stigma and discrimination
- 1 briefing paper on stigma and discrimination
- 1 tool kit on stigma and discrimination for healthcare professionals
- 1 factsheet on trans sex workers
- 1 factsheet on MSM sex workers
- Development of the Sex Work & Health Network (SWHN)
- Participation in scientific conferences and community events
- Organisation of the Sex Work & Health Conference (SWHC)
Red Umbrella Academy 2
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1. Increase knowledge of sex workers around HIV and specifically on combination prevention
2. Document the accessibility of PrEP for sex workers and identify
challenges in access to PrEP by taking into account the specificities and the intersections of identities of the community
3. Disseminate the findings of the research on access to PrEP at international, European and local levels and among different stakeholders (academic, scientists, HIV activists, service providers, sex workers...)
Organisation of 1 training on access to HIV combination prevention tools including PrEP for 24 sex workers from 8 countries
Find the call for participants in the RUA2 programme here
The call for trainers will be launched soon.
Development of 1 Participatory Research on Sex Workers’ Access to PrEP
Find the call for a Researcher here
- Launch of the participatory research at national levels
- Participation in scientific conferences and community events
Sex Work Therapist Training
Reduce stigma faced by sex workers in mental healthcare services.
Organisation of 1 training for therapists about sex work, stigma and discrimination.
To be kept updated about the next training sessions, register here
Presentation of the training and briefing paper on sex work and mental health in conferences and events
Regarding health, ESWA has been concentrating efforts on developing resources and improving the capacities of sex worker-led organisations around the prevention and treatment of HIV and STI’s and is working on the issue of mental health within the community.
Engagement with European institutions and partnerships
ESWA is engaging with European institutions and civil society organisations. ESWA is a member of:
Our current activities
Community Response to End Inequalities - CORE
CORE, Community Response to End Inequalities is a 2,8 million euros 4-year project funded by EU4Health. Led by Aids Action Europe, the CORE project consortium comprises 24 Beneficiaries and 1 Affiliated Entity, consisting of a mix of regional networks, national and local community-based and community-led organisations, and academic institutions. The Beneficiaries and the Affiliated Entity are from 16 different EU Member States.
The aim of the CORE project is to reduce health inequalities by promoting, strengthening and integrating community responses, especially for “hard to reach” populations through mainstream prevention and healthcare services.
To strengthen community responses, CORE will use capacity building, networking, and the exchange of good practices and innovative approaches, including data monitoring and reporting. To ensure ownership and stakeholders’ interest in implementing and sustaining these interventions, it will proactively reach out and engage relevant stakeholders. To promote integration of these approaches into disease prevention and health promotion strategies and systems, it will address legal, policy, and structural issues.
ESWA is the co-lead on two work packages: work package 4 on capacity building and work package 6, Stakeholder Engagement and Sustainability.
More information about the CORE project here.
Contact: [email protected]
Sex Work Inclusive Policies and Programmes in Europe - SWIPE
SWIPE, Sex Workers Inclusive Policies and Programmes in Europe, is a programme funded by Viiv. The aim of the Sex Workers Inclusive Policies and Programmes in Europe (SWIPE) project is to improve sex workers’ access to health and HIV services by building the capacities of sex workers and in particular, trans and MSM sex workers, improving knowledge available about stigma and discrimination faced by sex workers and strengthening networks of key stakeholders to better include sex workers in service provision, data collection and policy making.
The programme is divided into 3 workstreams:
- Capacity Building
ESWA will organise 2 trainings for trans and for MSM sex workers. Whilst there is an overlap between trans and MSM communities (i.e. trans masculine sex workers, non-binary sex workers), these trainings will be an opportunity for community and movement building by focusing on specific issues faced by each community.
30 trans and MSM sex workers will be able to join the training sessions. In line with ESWA's overarching priority on racial justice and migrant rights, racialised and migrant LGBT sex workers will also be prioritised.
The training will focus on HIV, sex work and peer-based interventions for trans and MSM sex workers. The training will build the capacities and empower trans and MSM sex workers by increasing their knowledge of HIV testing, prevention and treatment.
Topics of the training will include:
- Introduction to HIV: HIV life cycle, transmission, treatment options, history of HIV;
- HIV combination prevention;
- Access to PrEP;
- Realities of Sex Work in Europe;
- Needs and barriers of different groups of sex workers with regard to access to HIV services;
- speciﬁc vulnerabilities: stigma and discrimination, criminalization;
- Sex work and mental, health;
- Specificities of MSM and Trans sex workers;
- Current issues and community challenges such as chemsex.
- Inclusion of peer workers; benefits of working with peer - based approaches, recruiting, training and supporting peer workers, risks and risk management associated with peer-based work, advocating for the recognition of peer-based work.
The call for participants will be launched soon.
- Research & knowledge production
This workstream 3 activities:
- Development of participatory research and report on stigma and discrimination
ESWA develops participatory research on stigma and discrimination faced by sex workers in health care and HIV services. ESWA will hire and train 10 peer researchers from different European countries to conduct interviews and set up focus groups to gather data on discrimination in healthcare and HIV services at national levels (Find the questionnaire here and the call for participants here).
The research will focus on 10 different European countries where sex workers face a variety of stigma and discrimination with an intersectional perspective taking into account stigma and discrimination faced not only by sex workers but, more specifically, by LGBTQI+, migrant and racialised sex workers and sex workers living with HIV.
Based on these consultations, ESWA will develop a briefing paper that will provide an overview of the stigma and discrimination faced by sex workers in Europe with a focus on marginalised communities such as LGBTQI, migrant and racialised sex workers.
- Creation of a tool kit and workshop for healthcare professionals based in the research
The tool kit will identify best practices, challenges and give practical advice for healthcare professionals and HIV service providers. It will give concrete examples of what can be done in healthcare settings to better serve sex workers and especially sex workers facing multiple discriminations and will showcase best practices of initiatives happening on the ground. This tool kit can be used separately as a first step to train medical professionals or in combination with the workshop on sex work, stigma and discrimination developed for the Sex Work and Health Conference.
- Publication of two fact sheets on best practices for better inclusion of MSM and trans sex workers.
To further disseminate knowledge shared during the WS1 MSM and Trans SW trainings, two fact sheets showcasing best practices related to HIV service provision for male and trans sex workers will be produced. The fact sheets will include best practices and recommendations for the inclusion of trans and MSM sex workers in HIV services and programmes.
The various resources will be translated into French, Russian and Spanish to increase the reach of the resources and recommendations.
The work stream 3 includes 3 activities:
- Development of the Sex Work & Health Network (SWHN)
ESWA will create and coordinate the Sex Work & Health Network (SWHN) to facilitate collaboration between various stakeholders working on sex work HIV and access to health. The SWHN will include representatives of sex workers’ health organisations, researchers, representatives of European institutions such as ECDC and DG Sante as well as international bodies such as WHO and UNAIDS.
ESWA will organise, facilitate and document quarterly SWHN meetings to share information between participants and strategise on how to best collaborate to improve sex workers’ access to health and HIV services. Topics will include HIV/STI and access to PrEP, mental health, data collection and discrimination in the health system.
- Participation in scientific and community events
ESWA will also participate in key events such as EACS in Poland and Europride in Malta to further disseminate research findings.
- Coordination of the Sex Work & Health Conference.
As final step of the project, ESWA will coordinate the Sex Work & Heath Conference on barriers to access to healthcare and in particular HIV services for sex workers. The conference will be held over 3 days with ca. 100 participants including sex workers’ rights activists, representatives of civil society organisations and European and international institutions, policy makers, researchers and funders.
Contact: [email protected]
Red Umbrella Academy 2 - RUA2
Building on the success of the first Red Umbrella Academy, which took place in 2020, ESWA is launching the Red Umbrella Academy 2.0 with the support of Gilead Science.
The programme is divided into three different workstreams:
- Capacity building
ESWA will coordinate a 3-day regional training for sex workers bringing together 24 sex workers’ rights activists from 8 countries. The training will include sessions on advocacy, HIV prevention, Quality of Life including mental health, community leadership, stigma and discrimination and takes into account the different intersecting identities of sex workers.
For this second edition, the Academy will be held in English and Russian to better include sex workers from the CEECA region.
A key focus area of the training curriculum will be the main obstacles and challenges in access to combination prevention and especially in access to PrEP for sex workers as well as role of peer workers and community leadership in HIV prevention.
The training will take place in October in conjunction with the European Aids Conference EACS2023.
You can find the call for participants here.
Sex workers remain a vulnerable population often ‘defined as’ difficult to reach by HIV prevention and treatment services. To better address this issue, ESWA is developing a participatory research project on access to and continuation of PrEP for sex workers. With this research project ESWA will explore the needs and challenges sex workers face in accessing PrEP in our region.
The goal of this research project is to document the access to PrEP for sex workers and to support advocacy activities at national, regional and international levels.
Participants in the RUA2 training will also take part in the research process and help map out the situation of access to PrEP for sex workers in their local contexts.
The lead researcher on this project will be supported by an advisory expert committee of researchers who have expertise in participatory research and PrEP.
The goal of the research report on access to PrEP is to support advocacy efforts at local and international levels. The report will be translated in the 8 local languages of the training participants and launched at national levels. Small grants will support trainees in implementing local advocacy activities to share the findings of the research report on access to PrEP with local stakeholders (HIV activists, healthcare providers, researchers, policy makers, funders...). In doing so, project participants will apply and adapt the knowledge they have acquired during the training to the local contexts.
ESWA will also present the results of the report in different scientific and community events such as EACS2023.
Contact: [email protected]
Sex Work Therapist Training - SWTT
In 2021, ESWA implemented its first programme to support the mental health of sex workers and advocate for the inclusion of sex workers in mental health services. The programme, funded by ILGA Europe, was designed to offer tools on how to prevent and address mental health crises in the community while developing a briefing paper exploring the issues related to access to mental health care for sex workers and a tool kit to support sex worker organisations in dealing with mental health crises.
ESWA identified therapists’ lack of knowledge and stigma around sex work as critical obstacles faced by sex workers in their access to mental health care. To address this issue, ESWA has developed the Sex Work Therapist Training (SWTT) project
to develop and deliver a training on sex work for counsellors and psychotherapists.
The training has been developed by sex workers as we believe they are best placed to provide knowledge on their own lived experiences, in collaboration with mental health practitioners (see below for more information about the team).
The main objective of the training is to provide therapists with the tools to help sex workers feel positive embodiment within their personal and work lives even when presented with mental health challenges.
The different goals of the Sex Work Therapist Training are to:
- Reduce barriers to accessible mental health support for sex workers.
- Challenge therapists’ biases and stigmas to help bring inclusion and equity for sex workers within the therapy room.
- Provide resources and information which therapists can use to support sex workers.
- Be aware of stereotypes and the nuances of sex work.
The training takes place online and gathers around 15 therapists (or therapists in training). The training is delivered in English and is open to therapists based in Europe and Central Asia (WHO definition of Europe).
Participants will receive a Certificate after completion of the training.
The 8-hour training is divided into two parts spread over two half days:
- Part 1: sex work, stigma and discrimination
- Part 2: specific issues in mental healthcare settings
To be updated about the new dates of the training please register here.
Contact: [email protected]
Our past activities
e-MPOWER - Partnership to Overcome Challenges of Online Learning and to Empower Youth Actors in the Field of Sexual Health Promotion in the COVID-19 Era
eMPOWER has been specifically designed to combat the additional challenges posed by the COVID-19 pandemic. With NGO capacity impacted by limited resources and legal restrictions, eMPOWER aims to increase the capacity of young advocates and activists working or volunteering in healthcare to help meet the needs of the sex worker community. Recognising the need for such training to be provided in remote, rather than in-person, settings, eMPOWER aims to meet the challenges and provide tools for effective online learning.
The project, running until September 2022, will:
- Adapt training activity for young advocates/activists previously offered by sexual health orgs so that it can be online
- Focus on mental health - particularly the impact of structural issues such as criminalisation and stigma - and offer tools to the community to deal with mental health issues
- Focus on sexual health - meeting the specific needs of the sex worker community, as well as those who may be living with HIV or a member of the LGBTQ+ community, and understanding how criminalisation and stigma interacts with these needs
- Provide knowledge of online safety and digital rights - such as data protection, privacy issues and censorship - which can be relevant to young stigmatised or criminalised populations
- Provide the means to exchange knowledge and best practices through an online platform providing a clear and implementable model of training that can be accessed by other organisations and advocates with a focus on sexual health
ESWA envisions the following outcomes from the eMPOWER project:
- Needs assessment and research to inform the design of future activities
- Written recommendations based on the above
- Monitoring and evaluation framework of trainees to assess the impact of training activities
- Wellbeing guide for trainees
- Youth activist training materials online toolbox that will be freely accessible
- Presentation of the project outcomes via a public webinar, recorded and shared online via project partner social media platforms
- Pilot training to test the programme and materials
Disclaimer for e-MPOWER
This project has received funding from the European Union’s ERASMUS+ programme under grant agreement No 008320
The content of the project's outputs is solely the opinion of the author(s); The EU Commission is not liable for any use that may be made of the information contained therein.
The outputs of the project are licensed under the Creative Commons Attribution 4.0 International (CC BY-NC-ND 4.0) licence.
Mental Health Programme
In 2021, ESWA implemented its first programme to support the mental health of sex workers and advocate for the inclusion of sex workers in mental health services. The programme was designed to offer tools on how to prevent and address mental health crises in the community while developing a briefing paper exploring the issues related to access to mental health care for sex workers.
The capacity-building part of the programme included:
5 thematic session webinars open to all ESWA members: presentations and discussions on thematics such as sexual violence, anxiety, addiction, suicide, wellbeing
7 support sessions in a closed group of LGBTQI sex workers’ rights activists
The resources include a briefing paper as well as a small ‘organisation tool kit’. The briefing paper is developed through an e-consultation with all ESWA members, focus groups and case studies on community-led projects in Europe and Central Asia. In parallel, an awareness campaign is being developed showcasing sex workers as part of the support sessions through illustrations and testimonies (illustrations by Ambrose).
Sex Workers on the Frontline: The Role of the Sex Worker Rights Groups in Providing Support During the COVID19 Pandemic (31/03/21)
Assessment On The Impact Of Covid-19 On Sex Workers’ Access To Health Services In Europe And Central Asia (10/06/20)