Central America hosts a thriving sex work industry that is a key source and transit region for sex trafficking and undocumented migrants engaged in sex work. Sex workers -- particularly those who are migrant -- are at high risk for HIV and other sexually transmitted infections as well as physical abuse and in some cases murder. However, the existing network of international, national, and local criminal and human rights policies applicable to sex workers can be confusing and contradictory, not only in the context of access to sexual health preventions and interventions, but also for investigators seeking to conduct that can lead to effective sexual health services.
The dense web of existing regulations -- everything from criminalizing sex work, to being illegally present in a country, to mandatory public health testing to extortion by police-means that U.S. based researchers hoping to illuminate these health disparities while well-intentioned, can ultimately put persons involved in sex work in harm's way including arrest or deportation.
In many instances, while sex work is illegal nationally, it is condoned and supported by local officials. Knowledge of existing laws but more importantly, the way they are implemented is thus crucial for investigators in this region if they are to avoid recruitment and data collection activities that compromise the safety of potential research participants.
On June 8 and 9, 2016, Fordham University Center for Ethics Education Director and Director of the National Institute on Drug Abuse (NIDA)-funded HIV and Drug Abuse Research Ethics Training Institute (RETI), Dr. Celia B. Fisher highlighted ethical issues surrounding international research involving sex workers at the National Institutes of Health (NIH) meeting on the ethical, legal and policy challenges in HIV research with key populations, including sex workers.
According to Fisher, the "key populations meeting was a unique and important opportunity to focus on the ethical and related human rights challenges facing researchers conducting global research on HIV in vulnerable populations."
Drawing upon the work of early career professionals whose work is supported by the RETI, Dr. Shira Goldenberg and Dr. Lianne Urada, as well as the RETI Program Administrator Dr. Elizabeth Yuko, Fisher highlighted the legal issues surrounding the intersectionality among vulnerabilities of sex workers, migrants and trafficked women who are also drug users and detailed the types of ethical questions --including protecting of confidentiality, avoidance of coercion, and duties of care -- that must be posed and addressed by investigators and institutional review boards (IRBs) responsible for protecting the rights and welfare of participants.
While the existing web of laws and human rights guidelines may seem difficult to navigate, failure to conduct such research will unfairly deprive individuals engaged in sex work research data that can lead to policies to reduce the significant health disparities within this highly vulnerable population.
For more detailed information, or to read the case study, Fisher's full NIH presentation can be downloaded here.
Goldenberg, S., Rivera Mindt, M., Jimenez, T.R., Brouwer, K.C., Miranda, S.M., & Fisher, C.B. (2014). "Structural and interpersonal benefits and risks of participation in HIV research: perspectives of female sex workers in Guatemala." Ethics & Behavior, 25(2): 97-114.
Urada, L. A., & Simmons, J. (2014). "Social and Structural Constraints on Disclosure and Informed Consent for HIV Survey Research Involving Female Sex Workers and Their Bar Managers in the Philippines." Journal of Empirical Research on Human Research Ethics, 9(1), 29-40. PMID: 24572081. PMC4217476