Structured Vulnerabilities: The Problem With Mandatory HIV Testing For Sex Workers In Greece

by: Cassandra Warren

April of this year, sex workers in Greece were arrested through a brothel raid. The clients were released while the workers were tested for HIV without their consent. Those who tested HIV-positive had their photograph, HIV status, and personal information (name, birth date, and address) posted on a public website. These workers were further charged with intentionally causing grievous bodily harm, also called “spreading disease dangerous to life”. These charges are felony offenses. Within the same time period, a similar situation occurred in Malawi: a brothel raid ended in workers being arrested, undergoing mandatory HIV tests without their consent, and the HIV-positive workers had their personal information posted publicly.

After reading a few reviews and talking with some folks, the argument for mandatory testing goes something like this: sex workers are individuals who deserve human rights, but as they provide a service, they should be held accountable to provide a safe service. To ensure this, individuals participating in the sex trade should undergo mandatory testing and then pubic awareness of their HIV status in order to prevent transmission. Now, I’m not an expert, but I think this this argument ignores that HIV is not a social issue or an issue deeply related to human rights. It also does not hold accountable the social and cultural systems that have a role in the transmission of HIV. Yes, in theory HIV is a virus that can affect anyone regardless of sexuality, gender, race or socioeconomic status.

However, the transmission of HIV has proven differently. In fact, your sexuality, gender, race and socioeconomic status are the largest predictors of your HIV status, statistically. Additionally, the treatment, prevention, and care of HIV is also not objective: it is steeped in privatized medicine and pharmaceutical bureaucracy, which if we even knew the half of would most likely put some multimillionaire(s) on death row. There is a lot of good research that will support that fact that there is a direct link between gender, sexuality, inequality, race, and the global politics of intervention and regulation. Although, it’s not without it’s complexity: too much for the scope of this blog post. In fact, I might as well ask this now, please forgive me for trying to address to many layered issues into such a short piece. I should admit, I’m sometimes drowning in the information and swallowed up by how to address its complexity.

My first thought on these cases was to ask how I see them related to the larger discussion of how methods for HIV treatment, prevention and care are directly linked to the four above markers. In the Greek and Malawi cases, the point of blame and the framework for which there is a presumed starting point of HIV transmission (and prevention) is the sex worker. As in many cases, the worker becomes a scapegoat. The focus of treatment and “protection” then becomes focused on prosecuting individual workers (not providing them protection).

An example of this can be seen in Greek Minister Loverdoes comment on the event, “Unfortunately my predictions were confirmed. I had warned that AIDS is dramatically increasing in our country and a part of the problem is located in illegal immigration and illegal prostitution.” I see Minister Loverdoes’ statement (regardless of whether it is supported by valid and reliable data) as constructing the sex workers as outsiders, as threatening harm to the ‘good’ citizen. It reflects the discourse for which we understand who the state does not legitimize as citizens of the state, and thus who the state is not liable to protect, giving the state the right to their privacy, to their body. It also serves as an example to the image we have of sex workers. Here, we see the sex worker becoming a triple threat as they embody an other who is an illegal immigrant, a sexual deviant and a vector of disease.

Research over the past decade as proved that mandatory testing reinforces and perpetuates stigma, which is known to be counter productive to HIV prevention. It also fails to protect people from infection or provide them with adequate care and services. Furthermore, regulations like mandatory testing, or other laws criminalizing HIV transmission disproportionately affect those most profiled by law enforcement (i.e, street workers, racial and gendered minorities)[i]. The Joint United Nations program on HIV/AIDS (UNAIDS), Amnesty International, Global Network of Sex Worker Projects, and the Global Network of People Living with HIV/AIDS all condemned the decision by the Greek government. The following are quotes from Amnesty International’s statement addressing the situation in Greece:

“Publication of names, photographs and positive HIV status is a fundamental breach of confidentiality and exposes sex workers to stigma and violence.”

“The measures adopted by the Greek authorities are completely misguided and ineffective.”

“Amnesty International calls on the Greek authorities to take appropriate measures and provide those individuals found to be HIV positive with counseling and information and to encourage the voluntary counseling and testing of those who are unaware of their HIV status.”

In the Malawi case there has been a similar human rights response. However, this time it is a direct action inspired not by major human rights organizations, but by 14 sex workers who decided to fight back. They are suing their government on the charge that mandatory HIV testing is unconstitutional. The case is on going. And, because I feel compelled to plug this in, Thierry Schaffauzer started a petition to stop the forced testing of and outing of sex workers in Greece, which you can sign here.

I hope readers do not think I am arguing here that it’s okay to intentionally transmit HIV, because that is far from the focus of this piece or the point I want to make. The main point I want to make is how it is problematic to create methods of HIV prevention, treatment and care that ignore the ties between race, sexuality, gender and socioeconomic status and the transmission of HIV. To me the problem is that when panic ensues, key groups are targeted, and the response to HIV is done without regard for the fact that the transmission and infection of HIV is a response to already existing sexual, racial, and gendered inequalities.

So, instead of tailoring policy and law around providing the best care, treatment, and prevention, these types of responses increase the link between HIV and sexuality, race, and socioeconomic status. When developing strategies for ending the HIV/AIDS epidemic (and providing adequate prevention, treatment, and care to individuals) it needs to be done with the knowledge that structured gendered, sexual and racial vulnerabilities exist in the transmission of HIV, and a person’s capacity to protect themselves, gain access to services and survive with HIV are directly related to these structured vulnerabilities.


[i] Too many examples of this to list here, but for a local, Chicago, example check out Rachel Lovell’s (sociologist at DePaul) recent research, and Emi Koyama responding blog post,

Cassandra Warren completed their MSC from the University of Amsterdam in Sociology with concentrations in gender and sexuality. What does one do with that? Nothing “officially,” but as Warren experiences the unique condition of being an organized, task-oriented person with a short attention span, Warren is constantly found with multiple hands in various cookie jars. The most recent use of hir time includes: helping to organize calls to action around U.S. policy on sex work and HIV, researching the effects of anti-human trafficking campaigns on human rights/policy development, facilitating workshops on intimacy and communication, singing in queer choir and writing/re-writing/submitting papers for conferences and journals, as well as the constant writing of resumes and cover letters for “real” jobs.

3 responses to “Structured Vulnerabilities: The Problem With Mandatory HIV Testing For Sex Workers In Greece

  1. Respectfully, I disagree with one of your premises. How is HIV not deeply related to human rights? The right to live and be healthy must be a human right. Without them, all other rights are useless. Without those rights, how can we have any foot to stand on to demand access to healthcare? And of course, on the bases of these rights, we demand that government regulate the products and services we consume to ensure at least a minimal amount of safety (we regulate product safety, food and drug safety, create health regulations, regulate who may practice the art of medicine, endeavor to constrain disease and hunger largely for these purposes – admittedly, we need to do even MORE of that, but still, the basis of these regulations ultimately relates back to our right to be healthy, even if it is corrupted by politics and money to a degree).

    Skipping the argument of whether sex work should be legal, to the extent that sex work is a lawful occupation, it must be subject to safety and health inspections. When I worked in the restaurant industry, I had to have my blood drawn to test for certain transmittable diseases because I could transmit disease if I was infected. I fail to see how this is different (and my local government did occasionally raid and shut down restaurants for failure to comply). Any sex worker who has HIV must be prevented from continuing to engage in sex work as a matter of health and safety, not as a matter of marginalization.

  2. HIV is DEEPLY related to human rights. That is the exact point I am making in this article. The fact that HIV (and related policy, criminalization, law, methods, treatment, care, prevention) is foremost a human rights issue is what I wanted readers to understand. I will continue to re-read and edit this piece to figure out where the miss-communication came from.

    The point for me is that because HIV and health care are so deeply tied to human rights a large proportion of people are getting taken advantage of and not provided the good care or services they need. Who the government can decides has access to healthcare is based in a methods that have an outcome of sexual, racial, ethnic, and class discrimination. And there is nothing separate about that discrimination when it comes to sex work, especially so because it is common practice for people to use sex workers as scapegoats and to not treat them as equal human beings. And yes, sex workers as a key population, need to be provided adequate healthcare, and non-judgmental services when they find out they are HIV positive.

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