The Intersection of Human Rights, HIV and Sex Work: Implications for Ending AIDS in Thailand by 2030

Abstract

Introduction

Sex work significantly shapes the Thai economy and the HIV epidemic, yet its criminalization restricts access to health services and exacerbates human rights violations. This study examines experiences of stigma, discrimination, gender-based violence (GBV) and incarceration among sex workers (SWs), exploring how these factors intersect with HIV services. This research is a component of a larger study investigating factors associated with pre-exposure prophylaxis (PrEP) uptake among SWs in Thailand.

Methods

We conducted a post hoc analysis of a cross-sectional survey (September–December 2023) of 1511 Thai SWs recruited through convenience and quota sampling in seven provinces. Eligible participants were adults who self-reported HIV-negative or unknown status and had exchanged sex in the past 3 months. Trained peers administered anonymous face-to-face questionnaires covering demographics, work characteristics, HIV service utilization, stigma and discrimination, GBV, and PrEP. Descriptive statistics and bivariable and multivariable logistic regression were used to examine factors associated with past-year human rights violations.

Results

41.3% of SW participants reported experiencing at least one human rights violation, including stigma, discrimination, GBV and incarceration. Specifically, 18.1% experienced stigma and 35.8% reported GBV within the past year. Male sex workers (MSWs), transgender women sex workers (TGSWs), younger individuals, people who use drugs and those with a history of incarceration were the most affected groups. Geographical location was strongly correlated with these violations. A lack of human rights protections contributed to low uptake of HIV testing and sexually transmitted infection (STI) screening. PrEP uptake was critically low across all SW sub-populations: 14.8% for TGSWs, 13.9% for MSWs and only 1.3% for female sex workers (FSWs).

Conclusions

A human rights approach to HIV and sex work is indispensable to ending AIDS. Criminalization, stigma, discrimination and GBV intersect to produce layered vulnerability among different SW populations in Thailand, with TGSWs particularly affected. These structural conditions negatively shape access to HIV testing, STI screening and HIV prevention services, including PrEP. The findings reinforce that punitive legal environments and social stigma directly undermine HIV prevention efforts. Addressing the stigmatisation and human rights violations of sex workers are essential to ending AIDS in Thailand.