The Peer and Non-peer: the potential of risk management for HIV prevention in contexts of prostitution. Sex workers have been the protagonists and focus of HIV prevention campaigns and research since the late s in Brazil. Through a review of national and international literature, combined with a history of sex workers' involvement in the construction of the Brazilian response, this article explores the overlaps and disconnects between research and practice in contexts of prostitution over the past three decades.
We review the scientific literature on the epidemiology of HIV among sex workers and prevention methodologies. We conclude that although research focus and designs often reinforce the idea that sex workers' vulnerability is due to their sexual relationships with clients, their greatest vulnerability has been found to be with their nonpaying intimate partners. Few studies explore their work contexts and structural factors that influence safe sex practices with both types of partners.
The negative effects of criminalization, stigma, and exclusively biomedical and peer education-based approaches are well documented in the scientific literature and experiences of sex worker activists, as is the importance of prevention programs that combine empowerment and human rightsbased approach to reduce HIV infection rates. We conclude that there is a need for actions, policies, and research that encompass the environment and context of sex workers' lives and reincorporate the human rights and citizenship frame that dominated the Brazilian response until the end of the s.
As part of HIV prevention efforts, female sex workers need to be considered above all as women, equal to all others. The concept of risk management assumes that people are autonomous and able to make decisions in their best interest if they have enough information to reduce their information on how to reduce their risk of getting HIV. Risk management strategies, such as those promoted by the social movement of sex workers in Brazil, prioritize autonomy and leadership while also recognizing that the context in which decisions are made have as much to do with the information available as to their interest in protecting themselves.
HIV prevention in prostitution contexts in Brazil remains an important subject for analysis and the development of new prevention strategies. Even after three decades as the focus of campaigns, sex workers continue to have a HIV prevalence of 4. By definition, prostitution involves sexual, affective and material exchange. Thus, risk management strategies must move beyond simply looking at decision making related to disease risk towards considering how sex workers manage financial and work related issues for example, clients offering more money to have sex without condoms, or sex workers having to accept, or refuse, certain prevention methods to keep their jobs.
