Clients Of Sex Workers Research Articles

Size estimation of key populations and ‘bridge populations’ based on the network scale-up method in Ukraine

IntroductionCorrect estimation of the size of key and bridge populations is crucial for an efficient HIV/AIDS response in resource-limited settings, enabling efficient program planning and resource allocation. The hidden nature of these groups poses challenges to traditional methods, leading to the adoption of innovative approaches like the network scale-up method (NSUM). In this article we present the results of a NSUM study conducted in 2020 in Ukraine, focusing on four key populations and three bridge populations, highlighting challenges and contributions to development of the method.MethodsFrom July to September 2020, we conducted a nationally representative survey in Ukraine via computer-assisted telephone interviews, and applied the known population method and summation method to estimate social networks sizes. Results were weighted based on individual sampling probability and adjusted for social respect and visibility factors to address potential limitations.ResultsOur study achieved a 20% response rate with 10,000 completed interviews. The social network size, using the known population method, was 213 people, and 125 using the summation method. Adjusting for the social respect and visibility, estimated key populations sizes were 295,857 [248,714–343,001] people who inject drugs, 152,267 [109,960–194,573] men who have sex with men, 78,385 [57,146–99,619] sex workers, and 9,963 [7,352–12,571] transgender people, detailed by age and gender. Bridge populations were estimated at 62,162 [50,445–73,879] sexual partners of people who inject drugs, 284,348 [233,113–335,583] clients of sex workers, and 13,697 [7,370–20,026] female partners of men who have sex with men.ConclusionsNSUM proves reliable for estimating key populations size with appropriate corrections. It shows promise for further use in Ukraine, considering limited geographic coverage of the integrated bio-behavioral studies to use multiplier-based methods. However, the validity concerns persist for estimating bridge populations size, emphasizing the need for further method refinement and addressing implementation issues, particularly those related to data collection.

Condom Use Behavior among Female Sex Worker Clients in Makassar City

Indonesia has not yet emerged as one of the countries with the highest HIV/AIDS epidemic rate in the world. The United Nations Organization for AIDS, namely the United Nations Joint Program on HIV and AIDS, said that over the past two years, Indonesia's position has not changed, namely that it is still the country with the fastest AIDS epidemic in Asia. HIV-AIDS transmission in Indonesia is growing rapidly, one of the triggers is risky sexual behavior, including sexual behavior among female sex worker clients. This study aims to analyze the factors that influence condom use behavior among female sex worker clients in Makaassar. This research uses quantitative methods with an explanatory research design with a cross sectional approach. Qualitative data carried out as triangulation was used to support the results of quantitative analysis extracted from female sex workers and pimps as a cross check of answers from female sex worker customers. The method used was in-depth interviews and Focus Group Discussions on female sex workers and pimps. The sample size was 66 people. Data analysis was univariate, bivariate with chi-square and multivariate with logistic regression. The results show that the majority of respondents (71.2 %) behave consistently in using condoms.

Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: a socioecological approach

IntroductionPre-exposure prophylaxis (PrEP) is an effective HIV prevention tool when taken as prescribed. However, suboptimal use may challenge its real-life impact. To support female sex workers in their efforts to...

The human rights of sex workers in Portugal from 2020 to 2022

The legal, social and economic effects of the Coronavirus call for an analysis around law projects to change the current criminal law in Portugal on sex work. In the current social and economic crisis, Portugal is facing challenges in protecting the rights of those providing sexual services. In 2020 and 2021, respectively, two law projects were presented, one by a group of sex workers, and one by an independent member of parliament. The first aims to criminalize clients of sex workers, who are not criminalized under the present law, and the second aims for partially decriminalize procuring, which is currently a crime in Portugal. The evolution of this ongoing debate on enacting legislative alterations around the further criminalization or decriminalization of certain aspects of sex work will be analysed in this paper, with a focus on criminal law, human rights, and gender from an intersectional perspective. More specifically, labour and health rights will be approached, as well as the difference between human trafficking, forced prostitution, the exploitation of prostitution and sex work per se. Lastly, some pathways for a new regulatory model for Portugal, as well as for an international human rights ethics code for sex work will be proposed.

The impact of COVID19 pandemic and government enforced lockdowns on levels of attendance and context of sexual assaults reported at Saint Marys Sexual Assault Referral Centre

Globally, government enforced lockdowns were one measure introduced to reduce the transmission of COVID-19. The impact of these social movement restrictions on victims of sexual assault and their access of sexual assault services needed clarity. This study aimed to understand the impact of COVID-19 pandemic lockdowns on: Sexual Assault Referral Centres (SARC) attendance; characteristics of clients; characteristics of alleged perpetrators and nature of sexual assaults. Routinely collected data from the Saint Mary's SARC in the North West of England over two financial years, April 2019–March 2020 (pre-COVID-19) and April 2020–March 2021 (during COVID-19), were analysed. Compared to the pre COVID-19 year, monthly SARC attendance for children and adults decreased during national lockdowns and increased as restrictions lifted. Ethnicity of clients was significantly different during COVID-19 with more South Asian adults and more bi-racial children attending. Attendance of adults aged over 57 years also significantly increased during COVID-19. A significant increase in adults meeting alleged perpetrators online and a significant decrease in alleged perpetrators being a sex worker client were also identified. Finally, a significant increase in not-recorded data for health characteristics of adult and child clients was noted. While this study has illuminated some changes in the vulnerability profile of clients attending SARC during COVID-19 and its associated lockdowns, it has also highlighted shortcomings in changes to usual care introduced in the challenging and changing context of a global pandemic. These findings in parallel usefully recommend areas in need of service improvement.

Association of gender-based violence with sexual and drug-related HIV risk among female sex workers who use drugs in Kazakhstan.

Little is known about the prevalence of intimate partner violence (IPV) or client violence, and associated HIV risk among women who engage in sex work (WESW) and use drugs in Kazakhstan, despite a growing HIV epidemic. Women who reported engaging in sex work and using illicit drugs were recruited from Almaty and Temirtau, Kazakhstan between 2015 and 2017. A cross-sectional analysis was conducted to determine prevalence and correlates of physical and sexual violence perpetrated by intimate partners and clients. Associations between each type of violence with sexual and drug-related HIV risk behaviors were assessed with negative-binomial and logistic regression models, respectively. Of the 400 women, 45% and 28% reported recent IPV and client violence, respectively. IPV and client violence was associated with a greater number of sex work clients [IPV: adjusted incidence rate ratio (aIRR)physical: 1.86, 1.28-2.71; aIRRsexual: 2.28, 1.56-3.35]; [client violence: aIRRphysical: 2.20, 1.44-3.42; aIRRsexual: 2.54, 1.72-3.83], and client violence was associated with greater frequency of condomless sex with clients [aIRRphysical: 2.33, 1.41-4.03; aIRRsexual: 2.16, 1.35-3.56]. Violence was not associated with injection drug use, despite exchanging sex for drugs being associated with higher odds of violence. HIV prevention programs for WESW in Kazakhstan should consider multi-sectoral approaches that address economic hardship and relationship-based components, in addition to violence reduction.

Trans Women’s Body Self-Image and Health: Meanings and Impacts of Sex Work

This paper aims to present and discuss the results of a qualitative study conducted in the city of Porto, Portugal, aiming to understand the self-determination process and the meanings and impacts of sex work on trans women’s body self-image and health. Between January and July 2019, six individual interviews were performed with participants aged between 23 and 57 and then analyzed using thematic analysis. The results suggest that the participants were subjected to several experiences of discrimination and violence since childhood, negatively impacting their health and social integration. In their narratives, a conflict between the idea of an idealized body, congruent with gender identity, and the idea of a profitable body, compatible with the requirements of sex work clients, emerged. As a consequence, several tensions are experienced, both in personal and professional domains. Additionally, the difficulties felt in accessing the National Health System, to receive specialized support and treatment, increase the risk of being exposed to clandestine procedures, which exacerbates their vulnerability. The findings point to the importance of comprehending trans women sex workers’ needs and reanalyzing how their health conditions might be improved.

Redefining the Mode of HIV Transmission through Analysis of Risk Attribution among the Reported HIV Cases from 1993 to 2021 in Bhutan.

Introduction The detailed risk assessment of the diagnosed HIV cases in Bhutan is an opportunity to carry out the risk analysis to generate evidence of wherein, under what context, and in which population groups most new infections are occurring. The evidence collected will help to test the current assumption of Bhutan experiencing diffused and generalized HIV epidemic. Methods This is a cross-sectional study using a quantitative method to assess the risk behavior of the diagnosed HIV cases from 1993 to 2019. The study also included secondary data analysis of those cases already captured by the routine case-based surveillance from 2020 to 2021. The data collection was done from 1 to 30 January 2022 in all the twenty districts of Bhutan. Descriptive statistical analysis was used to analyze the characteristics of the study population, and relationships were established using the Chi-square Test. We have sought ethics approval and obtained participants' informed consent. Results The risk attribution analysis showed that 81.94% of HIV infection among the reported HIV cases in Bhutan has occurred through high-risk heterosexuals and 8.88% through mother-to-child transmission, and parenteral transmission accounts for 1.58% and then 1.35% through homosexual. Of the 81.94% high-risk heterosexuals, 41.08% acquired through sex workers and clients of sex workers, 27.99% from HIV-infected persons, 12.64% from sex work, and 0.23% from injecting drug use. Conclusions This study has shed some light on a gradual epidemic shift from the current perceived diffused and generalized to the concentrated epidemic among subpopulation groups like female sex workers and their clients.

Prevalence and Correlates of Active Amphetamine-Type Stimulant Use Among Female Sex Workers in Malaysia.

The use of amphetamine-type stimulants (ATS) has been associated with increased sexual risk behaviors and HIV transmission, among other adverse health outcomes. However, ATS use among female sex workers (FSWs) in Malaysia has not yet been characterized. We examined the prevalence and correlates associated with ATS use among Malaysian FSW. Between February and December 2016, 492 FSWs, including cisgender (n = 299) and transgender (n = 193) women, were recruited using respondent-driven sampling in Greater Kuala Lumpur, Malaysia. A structured questionnaire was used to collect demographic characteristics, sexual behaviors, ATS and other substance use, behavioral health issues, involvement in criminal justice, and experience of physical and sexual trauma. Logistic regression analyses were conducted to determine factors associated with active ATS use, defined as ATS use in the last 30 days. Nearly one-third (32.3%) of participants reported active ATS use. In the multivariable model, ATS use was associated with drug use during sex work (aOR = 17.10; 8.32–35.15), having moderate to severe level of substance use disorder (aOR = 3.38; 1.48–7.70), and engaging in sex work with multiple clients per day (two clients: aOR = 3.39; 1.36–8.46; three clients: aOR = 5.06; 1.81–14.10). A high prevalence of ATS use was documented in our sample. The presence of moderate to severe substance use disorder, the use of drugs during sex work activity, and having multiple sex work clients per day were significantly associated with active ATS use. Given these findings, prevention and harm reduction strategies need to be tailored to address the increasing ATS use and the associated adverse health consequences among FSWs in Malaysia.

The national and moral borders of the 2016 French law on sex work: An analysis of the ‘prostitution exit programme’

The 2016 law on prostitution in France introduced the so-called Swedish model approach to sex work, which, at the national level, criminalises those who purchase sex rather than the sex workers themselves. Alongside the repressive character of the law, lawmakers introduced a number of social policy measures through the implementation of a ‘prostitution exit programme’. Whilst some pioneering research has sought to evaluate the impact of penalising the clients of sex workers, no survey has yet focused on the outcomes of prostitution exit programmes. Based on qualitative data, including interviews with sex workers and grassroots organisations, this article aims to analyse how the programme was implemented and its overall outcomes. The interviews we conducted shed particular light on the fact that the implementation of the programme is impacted on by the application of restrictive migration policies.

Seeing pre-screened, regular clients associated with lower odds of workplace sexual violence and condom refusal amidst sex work criminalization: findings of a community-based cohort of sex workers in Metro Vancouver, Canada (2010-2019)

BackgroundResearch that accurately represents how characteristics of sex work clients relate to sex workers’ labour conditions is crucial for informing evidence-based legislation which upholds sex workers’ human rights. As little quantitative research has examined how seeing regulars (repeat clients) impacts sex workers’ occupational safety, particularly under ‘end-demand’ criminalization in Canada, our study aimed to explore how seeing mostly regulars shapes workplace sexual violence and client condom refusal.MethodsWe drew on longitudinal data from a community-based open cohort of 900+ sex workers in Vancouver, recruited via time-location sampling during day and late-night outreach to indoor, outdoor, and online solicitation spaces. We used logistic regression analyses and multivariable GEE confounder models to 1) describe correlates of seeing mostly pre-screened, regular clients, 2) identify associations between seeing mostly regulars and odds of experiencing occupational outcomes of workplace sexual violence and client condom refusal, and 3) examine the interaction between seeing mostly regulars and work environment on workplace sexual violence and client condom refusal.ResultsParticipants’ median age was 35, and 55.6% had completed high school. Over the 9-year study (n=925), 20.9% (193) experienced 282 events of workplace sexual violence and 40.2% (372) faced 702 events of client condom refusal. In multivariable GEE confounder models, seeing mostly regulars was associated with reduced odds of sexual violence (AOR 0.73, 95%CI 0.53-1.02, p=0.067) and client condom refusal (AOR 0.70, 95%CI 0.57-0.86). In multivariable GEE confounder models examining the additive interaction between seeing mostly regulars and work environment, participants who saw mostly regulars and primarily worked in outdoor or informal indoor venues faced significantly lower odds of experiencing workplace sexual violence (AOR 0.69, 95%CI 0.49-0.95) and client condom refusal (AOR 0.64, 95%CI 0.52 -0.80) relative to those who worked in the same venues and did not see mostly regulars.ConclusionOur findings highlight protective effects of seeing pre-screened regulars within a criminalized setting. Removal of ‘end-demand’ client criminalization is needed to enable sex workers to effectively screen clients, support HIV/STI prevention, and advance sex workers’ human rights.

Sexually Transmitted Infections and Associated Risk Factors Among Male Clients of Sex Workers: A Cross-Sectional Pilot Project in Antwerp, Belgium.

IntroductionPrevalence of sexually transmitted infections (STIs) is increasing in Belgium in recent years. Clients of sex workers form a key population for acquisition of STIs, due to their sexual relations, with or without a condom, with sex workers. STI testing uptake is low among clients of sex workers, and prevalence of STIs remains to be investigated in Belgium. Therefore, we offered STI-testing to clients of sex workers during outreach sessions in Antwerp.MethodsTime location sampling (TLS) was used to improve representativeness of the sample during ten test sessions in the red light district, Antwerp in May and September 2019 by using a passive approach. Individuals that were interested to get tested for STIs could enter the study. Participants completed an online survey and samples for STI testing were collected. Testing included HIV, syphilis, Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng). Test results were communicated via a cell phone message (for negative test results) or by phone (for positive test results).ResultsIn total, 154 male clients of sex workers with a median age of 38 participated. A total of eight Ct and one Ng infections were detected. TLS analysis revealed a Ct/Ng prevalence of 8.2%. No new HIV nor syphilis infections were detected. Using univariate analysis, testing positive for STI was associated with younger age and anorectal sex with a sex worker. Using multivariate analysis, an STI-positive test result was associated with being younger, having non-Belgian nationality, and being in a relationship.ConclusionOur study found a substantial prevalence of Ct/Ng which highlights the need for sensitization and facilitation of STI testing among clients of sex workers. It is difficult to compare results due to the lack of reference material. Moreover, our relatively small convenience sample limits generalizability of results. However, phone counseling (for positive test results) was accepted, linkage to care was provided, and partner notification was facilitated.

Contraceptive choice and power amongst women receiving opioid replacement therapy: qualitative study

Background Women receiving treatment for opioid use disorder have low levels of contraception use and high rates of unintended pregnancies, abortion and children being adopted or fostered. This paper aims to understand the relationship between contraceptive choice and power amongst women receiving Opioid Replacement Therapy (ORT). Methods During 2016/17, semi-structured interviews were undertaken with 40 women (aged 22–49 years) receiving ORT in the South of England. Data relating to the latent concept of power were inductively coded and analysed via Iterative Categorisation. Findings Power manifested itself through six interconnected ‘fields’: i. ‘information about fertility and contraception’; ii. ‘access to contraception’; iii. ‘relationships with professionals and services’; iv. ‘relationships with male partners’; v. ‘relationships with sex work clients’; and vi. ‘life priorities and preferences’. Each field comprised examples of women’s powerlessness and empowerment. Even when women appeared to have limited power or control, they sometimes managed to assert themselves. Conclusions Power in relation to contraceptive choice is multi-faceted and multi-directional, operating at both individual and structural levels. Informed decision-making depends on the provision of clear, non-judgemental information and advice alongside easy access to contraceptive options. Additional strategies to empower women to make contraceptive choices and prevent unplanned pregnancies are recommended.

Community-Based Strategies for Harm Reduction Among Sex Workers in Kolkata, India

Research conducted with diverse groups of sex workers in India as well as around the globe have shown that decriminalizing sex work can promote the health, safety, and security of sex workers. Nonetheless, in many countries, including India, legislations criminalizing buying of sex—that is punishing clients of sex workers—have gained momentum with the accompanying rationale of rescuing/saving women trapped in sex work. Such legislations ignore the reality that sex work is an economically viable vocation for a majority of women, men, and transgender people in India—especially when compared to low-paying jobs with long, fixed hours of work. Consequently, such legislations have also not deterred people from choosing sex work as a livelihood option. In addition, little information is available about the community-based harm reduction responses. We as scholars—who have separately conducted field-based ethnographic research with diverse groups of brothel- and non-brothel-based sex workers in Kolkata India between 2009 and 2016–-share our findings about the impact of criminalization on varied groups of sex workers in India. In addition, we provide a critical analysis of the several community-based strategies—ranging from self-regulatory boards, stakeholders-NGOs negotiations, NGO-police partnership, and drop-in-centers—adopted by the sex worker organizations to mitigate the harms associated with sex work in Kolkata, India.

Conflicted masculinities: understanding dilemmas and (re)configurations of masculinity among men in long-term relationships with female sex workers, in Kampala, Uganda

This ethnographic study explores the experience of men in long-term relationships with sex workers and their construction of masculine identities in Kampala, Uganda. Data were collected in 2019 and comprise in-depth interviews with 13 male partners and two group discussions of women with long-term male partners. Thematic analysis used an intersectional lens to frame reconfigurations of gender and masculinity in the context of relationships with sex workers. All men had been clients of sex workers before progressing to become long-term partners. We discuss the complex ways in which men participated in value systems of respectability and reputation to (re)configure gender relations that made sense of their long-term relationships with sex workers. Men viewed their relationships with women through the normative lens of traditional masculine roles associated with monopoly over a partner’s sexuality, provider and father. However, poverty, HIV, the failure to have exclusive sexual rights over a partner, and the shame associated with sex work intersected and disrupted masculinities. Despite this, men found meaning in these relationships through the woman’s commitment to the relationship, her financial support, her help in accessing HIV services, and the children from the relationship, thereby attaining respectability and avoiding a crisis of masculinity.

HIV Sentinel Surveillance Survey 2019/ Prevalence and Characteristics of HIV Cases in Sri Lanka; Experience from Sentinel site Surveillance 2019

<strong>Introduction: </strong>Sri Lanka remains a low-prevalent country for HIV/ AIDS over last few decades, according to the reported cases to the National STD and AIDS Control Programme. Even among high risk population groups, the HIV prevalence remains low. It is very important to monitor HIV prevalence trends among these population groups as risk behaviours are changing and HIV prevalence might rise in escalating levels needing urgent action. <strong> </strong> <strong>Objective: </strong>The objective of the survey is to assess the prevalence of HIV infection among the subpopulation groups at risk for HIV infection and to monitor the trends of the HIV epidemic. <strong> </strong> <strong>Method: </strong>As a regular process, 14th round of HIV sentinel surveillance survey was conducted during the period of 3 months starting from 01st October to 31st December 2019. A survey protocol was developed in 2019 including same sentinel sites, modified sentinel groups and testing algorithms. The nine provinces of the country were identified as 9 sentinel sites and sentinel groups include Men who have sex with men (MSM), female sex workers (FSW), Clients of sex workers, Transgender women and people who inject drugs (PWID). <strong> </strong> <strong>Results: </strong>Prevalence of HIV was highest among MSM (1.46%) followed by transgender women (1.35%) and clients of sex workers (0.09%). The prevalence among FSW was 0.07%, and there were no HIV positives among the 70 PWID enrolled in the study. <strong> </strong> <strong>Conclusions: </strong>MSMs appears to be the highest risk group for contracting HIV and active syphilis in Sri Lanka. This trend should be taken into account when planning interventions to achieve programme objectives.

Peer Association and Routine Activities in Sex Worker Patronage among Male Migrant Workers

ABSTRACT Studies of people who buy sex often focus on psychological and personality factors with less attention paid to the role of social contexts. This study integrates the two lines of inquiry, routine activity theory and peer deviance, to examine the social process of paying for sex. We argue that deviant peer association may shape buying sex due to peers’ role in shifts in the three components of routine activity theory: motivation, targets, and lack of guardians. With rich information on sexual behaviors from the China Migrant Sexual Health Survey (n = 1,521), we conducted a series of regressions and structural equation models on commercial sex behaviors among male migrants. Our findings demonstrate that having more peers engaged in deviance is significantly associated with buying sex; the three routine activity components are also significantly associated with buying sex; the peer effect on buying sex is significantly (39% of the variance) mediated by routine activities. These results help understand the role of routine activities in mediating peer association and buying sex, and also contributes to the literature of sex work on the less-studied population of sex work clients in China. Theoretically, the results provide evidence for the role of peers in shaping routine activities.

Willingness to Use HIV Self-Testing and Associated Factors Among Transgender Women in Malaysia.

Background: While global research on the implementation of HIV self-testing (HIVST) has increased exponentially, few studies have assessed information on HIVST uptake factors (i.e., willingness, preferences) in transgender women (TW) and none in the Malaysian context. We therefore sought to assess willingness to use HIVST among this understudied key population. Methods: A cross-sectional survey was conducted among 361 HIV-negative Malaysian TW in 2017. Participants were recruited using flyers, announcements through social media, and direct referral from staff members of the community-based organizations serving the TW communities. Multivariable logistic regression was used to identify correlates of willingness to use HIVST. Results: Nearly half of the participants (47.6%) reported that they would be willing to use HIVST. Multivariable analysis showed that willingness to use HIVST was positively associated with having experienced sexual assault in childhood (adjusted odds ratio [aOR]=3.239, p<0.001), having ever used mobile phone or apps to find sex work clients (aOR=1.677, p=0.040), and having engaged in condomless sex in the past 6 months (aOR=1.886, p=0.018). In contrast, living in Kuala Lumpur (aOR=0.559, p=0.032), having higher number of sex work clients per day (aOR=0.927, p=0.004), and current depressive symptoms (aOR=0.576, p=0.026) were negatively associated with willingness to use HIVST. Conclusions: Findings in this study suggest that TW in our sample were moderately willing to use HIVST. Especially important here is the increased interest in HIVST among TW who are at higher risk for HIV infection. Overall, our findings underscore the need for additional research on how to most effectively implement HIVST for key populations, including TW, such that uptake and retention in regular HIV screening is sustained.

Do you know how to Cheong? Neutralization techniques adopted by new clients of sex workers

Summary Sex work in Malaysia is seen as a deviant activity that is socially frowned upon. Malaysian laws aiming at curbing sex work has not been effective in eliminating sex work in Malaysia, instead it has pushed sex work underground where it thrives. New Internet technologies have been adopted by clients of sex workers to access hidden commercial sex venues that authorities have tried to suppress and keep away from the view of the public. This study examines the discourses of male clients of female sex workers and the application of Sykes and Matza (1957) techniques of neutralization used by male clients to normalize their ‘deviant’ activities. Part of this study examines the discourses of members from two Internet forums, where members assist other members in uncovering the hidden areas of sex work through their discussions and sharing of commercial sex experiences online. This study suggests that these discourses aim at inculcating a sense of normalcy to their ‘deviant’ activity as suggested by Sykes and Matza. This qualitative study of 35 Malaysian men obtained through snowball sampling from 2015 till 2018 explores their usage of online information in assisting with the purchase of female sex workers; examination of these men's offline discourses and behaviours when purchasing sex workers was conducted through face to face intensive interviews and participation observation. Participants use techniques of neutralization to overcome fear and societal distain when participating in commercial sex activities.

HIV control strategies for sex worker-client contact networks.

Controlling the spread of HIV among hidden, high-risk populations such as survival sex workers and their clients is becoming increasingly important in the ongoing fight against HIV/AIDS. Several sociological and structural factors render general control strategies ineffective in these settings; instead, focused prevention, testing and treatment strategies which take into account the nature of survival sex work are required. Using a dynamic bipartite network model of sexual contacts, we investigate the optimal distribution of treatment and preventative resources among sex workers and their clients; specifically, we consider control strategies that randomly allocate antiretroviral therapy and pre-exposure prophylaxis within each subpopulation separately. Motivated by historical data from a South African mining community, three main asymmetries between sex workers and clients are considered in our model: relative population sizes, migration rates and partner distributions. We find that preventative interventions targeted at female sex workers are the lowest cost strategies for reducing HIV prevalence, since the sex workers form a smaller population and have, on average, more sexual contacts. However, the high migration rate among survival sex workers limits the extent to which prevalence can be reduced using this strategy. To achieve a further reduction in HIV prevalence, testing and treatment in the client population cannot be ignored.