According to UNAIDS, only one third of the world's nations have adopted policies that protect a group at high risk of HIV infection: sex workers. To provide more safeguards, many organizations advocate restricting prostitution and moving sex workers into alternative professions. But other activists say a better strategy would be to demand safer working conditions for the oldest of professions.
Even among people who have many sexual partners, some experts say that it's possible to reduce the spread of HIV.
"Not all sex work involves risky sexual practices. There's hand jobs. There's a lot of things you can do without exposing yourself to viruses," says priscilla Alexander.
Ms. Alexander is the spokesperson for the North American Task Force on Prostitution, and she has served as a consultant to the World Health Organization's Global Program on AIDS. While many women enter prostitution with little in the way of a support group, Ms. Alexander says those who are part of an organized labor network have more access to information about HIV prevention and can use their collective bargaining power to press for precautions against HIV transmission. In fact, she says, more experienced sex workers may be better than the typical AIDS educator at encouraging clients and other prostitutes to use safe sex techniques.
"They know how to eroticize condoms, for example, or if anybody does in a country, they do, and they are also the best at teaching their own community about safe sex, because they understand the context in which prostitution takes place."
But condoms can and do fail. What's more, some human rights activists say that many sex workers are so desperate for money, they consent to risky sex. The seriousness of the situation was documented by a recent survey of a South African gold mining community. It found that despite sex education campaigns and free access to condoms, 69 percent of local commercial sex workers were HIV positive.
"We all know that very often prostitutes have no power to dictate whether or not their client can or cannot wear a condom," says Taina Bien-Aimé, the Executive Director of Equality Now, which works to protect the human rights of women around the world.
The group is on the front lines of legal battles to shut down US-based sex tourism agencies, which arrange travel for Americans to brothels overseas. Ms. Bien-Aime says her group uses laws against prostitution and illicit sex with minors as the basis for their lawsuits. She adds that this multi-billion dollar, international industry thrives on poor girls and women from developing nations.
"Some are lured into prostitution. They're unaware of the commercial sexual exploitation that it involves or life of violence it involves, and once you are in the industry, it is extremely difficult to leave the practice. You are stripped of all dignity, and very often of your official documentation, so you are really in a no man's land situation of no passport, and no means to exit or to leave your captors."
Decriminalizing the sex trade might give governments more power to regulate working conditions and monitor sex workers for HIV. But Ms. Bien-Aimé says this approach also fosters a social acceptance of sex for hire that tends to increase demand for unsafe sex as well. So she supports the Swedish model that cracks down on the middlemen who procure women and children for the industry. And she applauds non-governmental organizations that teach sex workers how to escape prostitution and poverty.
Mildred Robbins Leet, who leads one of those groups, says many sex workers are eager to improve their lot.
"What we don't realize is that many prostitutes have children. and so it's not only trying to take care of themselves and make their own ends meet. It's to make the children clothed, fed and able to go to school."
Ms. Robbins Leet's group, called Trickle Up, tries to help the lowest-income people around the world start or expand their own businesses. She says that seed money has given many prostitutes other career options.
"They would buy the fish and sell it on the streets. they would cook it on the streets. and another was making sweaters. They used their skills they had to transform their lives. They no longer had to be prostitutes. they could become mother, wage earner and hold their heads up high," she says.
Although Priscilla Alexander considers the sex trade a respectable line of work, she agrees that seed money for starting other businesses can be helpful so that women don't enter the profession simply out of desperation.
"Even for people who went into prostitution because they chose it, there comes a time that they may want to stop doing prostitution. they get older, or they're tired of it, and they often need help making a transition to some other kind of work."
Additionally, Ms. Alexander would like more countries to legalize prostitution, so that sex workers can unite to call for safer working standards, including protection from HIV.
"There's some argument from sex workers about whether they want this, but you can mandate condom use, and then the sex worker doesn't have to negotiate it every time, because it's required."
Because poverty forces people into many professions with dangerous working conditions - not just prostitution -- Ms. Alexander says governments must work for higher safety standards in all occupations.