Image 1: Social Mobilization at the XVI International AIDS Conference2
Dr. Mark Weinberg, Co-Chair of the XVI International AIDS Conference, joined with dozens of people working in the sex industry (PWSI) and activists who are members of Stella, the Montréal-based sex workers’ rights NGO. Chanting “sex rights are human rights” the rally began in the Stiletto Lounge with loud calls for effective HIV prevention and the rights of sex workers in Canada and abroad. While AIDS is just one of the issues addressed by this social movement organization, t-shirts worn by those attending the rally read “You can’t fight HIV without sex workers. And we can’t fight HIV without worker’s rights” (Stella, 2006).
Globalization poses new health challenges while exacerbating old ones. An epidemic of infectious diseases and overdoses among illicit injection drug users (IDUs) and people working in the sex industry (PWSI) has been observed on a global scale (Bluthenthal et al. 2000; Khosla 2004; Wood et al. 2006). The process of globalization facilitates the spread of HIV and AIDS and other sexually transmitted infections (STIs). Additionally, injection drug use (IDU) and the global sex trade have spread along with the formation of global alliances to combat the related health pandemics. The potential for global health alliances and communities to mitigate the ill-health effects created by the process of globalization3 is unclear. Despite an unprecedented number of global coalitions (e.g. the Global Alliance for Vaccines and Immunization) and declarations (e.g. the Millennium Development Goals) designed to combat issues of ill-health and disease, overall spending for public health remains low (Schwefel, 2004). The relationship between health and poverty has been recognized, varied communities and coalitions have been formed (including Stella and related sex workers rights coalitions), declarations have been signed, but the fiscal commitment of the international community has not been fully shown. Beyond this economic commitment varied “communities” are involved in addressing the “problems” faced by sex workers within Canada: PWSI themselves, women and feminist organizations, religious communities, bureaucratic structures, pharmaceutical communities etc. While these groups may appear to be united under globalization in addressing health problems related to the sex industry one must consider how the “problem” of sex work is defined differently.
I propose that understanding the “problem” being addressed by various communities is essential. For example, what is primarily a “biomedical problem” (pharmaceutical) for one community is a “moral problem” (religious organizations) for another and still a “health and human rights” (Stella and other feminist NGOs) issues for another. In addition to these various groups of actors—communities which are not themselves mutually exclusive—different kinds of activities are used by Stella to build solidarity and awareness to the issues faced by sex workers. These activities will be discussed below within the context of the policy process and the role of bureaucratic structures and civil society. Further, I contend that a gender-based analysis must be applied to Schwefel’s (2004) globalized development perspective. In doing so, the concept of “communities” of PWSI and other activists working under globalization can be examined. Schwefel delineates eleven key issues which he argues work collectively to convey the relationship between globalization and health (appendix 1, table 1).
In this paper I address a tension between the first two broad issues Schwefel explores: 1. the extent to which “globalization endangers health” with risks continuing to spread, and 2. how “global alliances are emerging to protect health” (Schwefel, 2004: 177). Schwefel argues that these processes work simultaneously but does not examine the specific gendered dimensions of this relationship. In this paper one is asked to consider who is impacted by processes of globalization (in relation to health and human rights issues this leaves women disproportionably effected) and how they are impacted (in the case of Stella this involves working in the sex industry and being exposed to particular health risks—risks which are exacerbated by virtue of being female).
Schwefel (2004) does not sufficiently problemitise the notions of united social movements. While Stella has four clear overarching objectives (enumerated in the following section) the organization neither speaks for all women nor all sex workers. Despite the fact that globalization has created new networks and dynamics of participation among PWSI, as the example of Stella illustrates, the extent to which these “communities” successfully (or undividedly) combat health pandemics must be examined. It is also necessary to consider that under economic neo-liberalism and globalization it is women who are disproportionately economically marginalized, work in the sex trade, and become impacted by the spread of disease and other health issues. Women have also been historically marginalized from processes of formal social policy creation and have unequal representation within governmental bodies (O'Connor, 1993). This analysis, through a case study of Stella, will highlight how the “problem(s)” of sex work are defined differently within a Canadian context while illustrating how social movements are neither uniform nor completely united. Communities of PWSI within Canada are examined under globalization to create a nuanced analysis of Stella.
The NGO Stella, rooted “radical feminism”, best falls under the category of a social movement organization. Using coalition analysis typologies, Stella can be understood to build upon the “social transformations of the 1960s” and works in partnership with other NGOs and government agencies in Canada and abroad to look at health and social issues3 of sex workers (Pal, 2006: 241). HIV and AIDS policy and harm reduction strategy is a major focus of the individuals who energize this group. Additionally, Stella uses “new dynamics of participation” (Pal, 2006: 241). The interest group organizes sex workers through a myriad of strategies: from street protests and public debates to attending international conferences and hosting online forums for information and coalition building. These activities, along with Stella’s drop-in center, magazine publications (the ConStellation), e-tools for PWSI, and street-work with sex workers, escorts, masseuses and dancers work collectively to address the specific objectives of this community:
In alliance with other organizations5 working towards policy reform in areas related to sex worker rights, I use Stella as an example of an NGO which is part of a burgeoning social movement. It is necessary to consider the extent to which Stella addresses the intersecting issues of health inequality, women, and globalization. The analysis points to a number of conceptual dilemmas and problemitises notions of united health “global alliances” (Schwelef, 2004). A basic overview of the relationship between globalization and women’s health is required6.
The relationship between globalization and women’s health has been explored on varied fronts within the Canadian context. Two complex and multifaceted issues related to women’s health emerge when reviewing literature within Canada and abroad: 1. ideas surrounding bodily autonomy and changing labour patterns, and 2. the emergence of health epidemics (or “pandemics”) relating to STIs, HIV/AIDS, and injection drug use (IDU). While these issues are part of the broad ‘globalization and health’ discourse, in this paper I ground related epistemological and policy-related concepts within the specific “community” of PWSI and activists who from the NGO Stella. Using Stella as an example illustrates how these broad themes are manifested within the specific and localized realities of sex workers. While global processes impact the lived-realities of sex workers, such changes are experienced (and embodied) in individual and specific ways. Macro-focused statistics are relevant and available for the varied “epidemics”7 outlined, being cited within much of the literature reviewed (Bluthenthal et al. 2000; Khosla 2004; Wood et al. 2006 etc.). Here I present a more ethnographic, qualitative institutional analysis.
Talking about any social movement as homogeneous is problematic. Likewise, when examining how the health of various overlapping groups is impacted by globalization (‘women’, ‘People Living with AIDS’ (PLWA), ‘Injection Drug Users’ (IDUs), ‘sex workers’ etc.) it is necessary to examine interacting forces—the complexity of dynamics involved must not be undercut in attempts for conceptual clarity. For example, social work literature highlights how women within the sex industry have specific health risks related to those risks enhanced by economic globalization8: substance use (ATOD—alcohol, tobacco, and other drugs) homelessness, lack of social resources, social isolation etc. (Mancoske and Smith 2004). HIV/AIDS, STIs, and IDU have become areas of concentrated analysis when examining social policy and health policy programs: examining health service delivery programs (Mancoske and Smith, 2004), the role of social workers in response to specific health pandemics (Roe and Ryan, 1998) and the intersecting dynamics of gender, race, and culture under globalization (Hogan, 2001).
While a substantial amount of research has been conducted concerning PWSI within Canada, this research has largely been concerned with the moral and criminal aspects of sex work (Benoit and Shaver, 2006). Prostitution has been defined by three major themes since the nineteenth century: trafficking, slavery, and pathology (Kempadoo and Doezema 1998). This language of “prostitution” is also used within much of the Canadian government literature and religious communities’ response to the issues addressed by Stella. The emergence of new global alliances of sex workers, and a growing discourse surrounding sex workers’ rights over the last two decades necessitates an analysis of how collectives of feminists, activists, and sex workers form. These three categories (which are not mutually exclusive) represent the pluralism and heterogeneity of the dramatis persona within this area.
Understanding how a community of sex workers has formed by Stella under globalization necessitates a working definition of “community”. For the purposes of this discussion two seemingly opposing concepts of community will be drawn upon: 1. community as an “affect-laden” web of relationships with a sense of solidarity and “mutual commitment” and 2. a neo-liberal view of community which is based upon individualism and more self-serving motivations (Rice and Prince, 2000: 214-215). To place any social movement organization only within the former definition of community would be incorrect. Rice and Prince’s (2000) definitions are not mutually exclusive. A static, categorical definition of “community” or “social organization” is inappropriate and does not reflect how the processes of globalization impact the mobilization of sex workers’ communities. To start, one can take the characteristics of communities used by Rice and Prince (2000): A community is composed of people who are “linked by kinship, locality, shared ideals, or common beliefs” (214). Drawing upon Wharf (1992), Rice and Prince further explain that both patterns of relationship and shared needs are the “essential common denominators of a community” (2000: 214).
Here one can build upon the communities discussed by Rice and Prince (2000) and further explore the extent to which globalization has given rise to new forms of community which are connected through varied networks and power structures. One must consider the common beliefs and aims of, for example, powerful government bureaucrats under economic globalization. In doing so, one must question how the Canadian government understands Stella, communities of sex workers, and the “problem” this community is addressing. This too is a ‘community of shared interests’—both united and pluralistic. Here one also must consider the extent to which more simplistic separations between “community” and “civil society” are made. The conceptual limitation within the concepts of Rice and Prince (2000) becomes further complicated when one examines the implementation of community development and social policies under neo-liberal power structures and globalization. While the concept of ‘community development’ has expanded in its popularity, a central problem remains at the level of implementation (Popple, 2006). Even when articulated within social policies, ‘community development’ may loose (and has lost to some extent) its ability to effectively address needs which are expressed by the communities themselves (Popple, 2006: 333). This leads one to consider the impossibility of Stella, or any community organization, to successfully address all of the community interests of PWSI.
Stella uses this language of “community development” within its literature to address how sex workers themselves are engaging in grassroots community development and health promotion (Stella, 2007). Here is where issues of grassroots mobilization and community development cross, and one must examine the extent to which the voices which populate a specific community are actually considered within policy formation and implementation. Extrapolating upon Popple (2006) one understands that simplistic arguments such as ‘the government doesn’t care’ about the community level or sex workers is not useful. Instead one must examine the extent to which current governmental regimes within Canada disallow for true ‘participatory’ involvement of sex workers. While communities of sex workers have been invited “to the table” on limited occasion, Stella organizers highlight that conservative ideological positions of many government officials prevent the sex worker community from influencing policy (Stella, 2006). Grassroots rhetoric is not useful. Again, here one must examine the extent to which ideological and political frameworks influence this policy arena9.
Many globalization theorists are useful to this discussion of how community alliances work to impact the policy process. Of particular relevance is Castells (1997) popular discussion of the network society. While varied overlapping networks (or communities) exist under globalization these networks have unequal power, access to resources, and ability to impact the formal policy process. As illustrated, Stella works to inform policy and receive workers rights for PWSI. However, it is only through building alliances with those in other communities (e.g. Dr. Mark Weinberg, Co-Chair of the XVI International AIDS Conference) that Stella is able to gain exposure and pressure those within the government. Castells10 (1997) is also useful to this discussion because visualizing these communities as varied networks allows one to consider how the communities discussed—PWSI themselves, women and feminist organizations, religious communities, bureaucratic communities and pharmaceutical communities etc.—fit within this complex web of networks.
While some NGOs may resent being compared to major bureaucratic structures, government agencies, or media conglomerates, one can see that the community of Stella—and the ‘tools of globalization’ used by the NGO to further the causes of PWSI—are directly related to trends of conglomeration and technological innovation. For example, just as the conditions of neo-liberal globalization led to the growing trend of media conglomeration, so to have NGOs centralized and built alliances with other organizations. In addition to the conglomeration aspect, there is also a component of competition which is similar. For example, Stella may be understood to compete for funding to finance activities. Some of Stella’s funding “competitors” are actually part of their network and have similar goals. Consequently, the “business side” of this work is a barrier to true solidarity. Just as the “darker side” of communities is highlighted by Rice and Prince (2000), participatory development-oriented community initiatives must be understood in all of their complexity (219).
Positive strides in the policy arena related to PWSI in Canada must involve an understanding of the complex interests and intentions at work within the activities of particular communities. While new participatory research approaches and documents such as the Global Standards place emphasis upon “non-hierarchal power relationships” this is much more difficult at the level of implementation (Sewpaul, 2005: 217). In this paper I contend that a disjuncture exists between the as-stated practices of Stella and the institutional practice-as-reality. While the processes of globalization facilitate new opportunities for international collaboration, euphemized definitions of “united” community collaboration fail to recognize the complexity (and bureaucracy) of current neo-liberal structures. For Stella, it is these vary structures which are a large part of the problem and may even be understood as a from of violence.
In one sense all women may be described as being part of a global “community of women”—untied by experiences (for many these may include experiences of relative economic and social discrimination, poor health status, alienation form the formal policy process etc.). This “community” of women may be debated by some feminist scholars but is necessary to consider as one macrocosmic conception of community. Likewise, considering a global community of women in the sex industry is problematic on many fronts: separating women from men with the sex industry, attempting to define what constitutes the “sex industry” and possibly creating a false sense of solidarity and united aims of all women within this community. This being said, it is important to consider how the activities of the NGO Stella—with offices within Canada and grounded to local and specific policy concerns—connects to larger communities and activities of PWSI. This makes “community” a conceptually ‘muddy’ concept. Multifaceted approaches to prevent the spread of HIV and AIDS, other infectious diseases and health concerns among sex workers and their clients is required. Also, the community of women working in the sex industry within Canada are “united” in their heightened vulnerability to HIV infection (in addition to other STIs) due to manifold factors highlighted by UNAIDS (2006):
While new microbicides may offer hope for all women (including commercial sex workers in Canada) to protect themselves from HIV transmission and other STIs without needing the permission of a man (husband, client etc.) these biomedical innovations do not address deeper social issues of systemic violence, the marginalization of women, and policies within Canada which do not view “sex work” as work. Currently in clinical trials, the creams, developed by international pharmaceutical companies, aim to prevent the spread of HIV between sexual partners. This is important but addresses only one aspect of the larger discourse Stella is working to further. Understanding the limitations, motivations, and positions of various communities within this broad discussion is required. In this paper I position that policies must support harm reduction, women’s autonomy, and be based upon evidenced-based medicine and the standpoint of women, as opposed to ideological positionedness. Saying this, it is important to reemphasize that all PWSI cannot be understood as a homogeneous community.
In evaluating issues of decriminalization within the Canadian context, it is vital to recognize that the legal community is quite separate from the activist community and networks to which Stella has access. Furthermore, what the “pharmaceutical community” is developing through microbicides and other pharmaceutical products offers preventative measures without addressing deeper social issues. Medicine is important but is simply not enough to address the needs raised by Stella and other sex worker’s organizations. The community of PWSI must be listened to within this discussion as this is not a “problem” that can be fixed within the bureaucratic channels of the Canadian government nor within the laboratories or boardrooms of the transnational biomedical community. It is in this web of varied communities of actors that one further realizes that the “problems” being addressed by these groups are quite different. While Stella is supportive of microbicides, for example, this is not the solution. Further, despite the fact that decriminalization of sex work (and related worker’s rights) are a major component of Stella’s community activities, these policy strides would still not be enough. Instead, examining the community initiatives of Stella highlights how the social movement organization is dedicated to act as a locally-based “global alliance [working] to protect health” (Schwefel, 2004: 177). Stella, like globalization itself, works in terms of “processes” while encouraging discourse, creating community, and challenging hegemonic power structures.
One must consider that the vary concept of “community” has changed drastically under globalization. As previously stated, Stella uses “new dynamics of participation” (Pal, 2006: 241). One aspect of the community created by and for sex workers involves e-communities and electronic sources for distributing information. These include web chat rooms for discussing health, policy, and legal issues, a comprehensive website which links to dozens of partners at the local, provincial, national, and international level, and information videos which circulate on varied highly viewed websites such as YouTube. Stella’s most highly watched online video is Live eXXXpressions (can be viewed in two parts: part 1 and part 2). These communities highlight how globalization facilitates an erosion of boarders allowing sex workers and policy activists to communicate in new and innovative ways. Further, examining these kinds of web communities offers the possibility to explore new kinds of e-discourse which are fostered. Posting pages on these video sites are just one source I refer to as “e-discourse”11.
Even these methods of communication—which seem to bridge communicative chasms—are flawed and do not unite all sex workers under globalization. For example, while these innovative strategies may help some sex workers access information and foster healthy discourse many within the sex trade do not have easy access to computers. In addition to this technological problem, language barriers exist as electronic information provided by Stella is only in French and English. While Stella clearly recognizes sex workers struggles on a transnational scope, it seems that immigrant populations and those who do not speak the two official Canadian languages will not have access to necessary information.
The health and social issues addressed by Stella have also “galvanized the politics” of other groups including the gay community (Silversides, 2003: 37). I position this paper as being part of a broader discourse of how specifically “vulnerable” populations are using the tools of globalization to find voice and challenge policies. The process of globalization facilitates the demand for commercial sex work, needs for engagement within the industry, and the possibility of contracting HIV and AIDS, STIs, and involvement in related activities such as IDU. The number of PWSI is growing by all accounts. With a focus upon community mobilization activities, Stella represents a Canadian NGO working to create innovative kinds of “community” which defy traditional boarders. Looking at how Stella contextualizes the “problems” faced by sex workers challenges conceptions of social policy while raising notions of morality and “kinds of people”. For Stella, “sex work” itself is not the problem. Instead, issues such as discriminatory public policy, health policy and social policy must be addressed. As Stella organizers state: “sex work is work” (Stella, 2007). While the tension highlighted by Schwefel (2004) is important—how “globalization endangers health” while “global alliances are emerging to protect health”—specific struggles, activities, alliances, and communities of women must also be recognized (177).
Using concepts of globalization and network creation allows one to understand how global processes are linked to the health of PWSI: from technological innovations in industry to epidemiological breakthroughs in research and demographic patterns of the labour movement. While I have highlighted how Stella forms community in innovative ways to challenge current Canadian policies, I have also considered the limitations of such methods and the “darker side” of communities (Rice and Prince, 2000). Clear areas for improvement exist to achieve increased networking capacity and access among PWSI. These “future strategies” for building global alliances mirror many of the key messages enumerated by Kerr (2003, see appendix 1, table 2). No amount of condom distribution, sex education, discourse creation (via forums, meetings, or virtual communities) or legislation will be adequate if the systemic and pervasive problems of poverty and gender discrimination are not made a priority.
1. In keeping with current literature dealing with health issues and community mobilization, the following text has many embedded hyperlinks which may be accessed when viewed electronically. These hyperlinks will take the reader to related websites, chat rooms, electronic resources pages, and documentary videos all accessible online. Just as Stella makes use of many of the ‘tools of globalization’, so do I within this paper.
2. The above photograph was taken by the author at the XVI International AIDS Conference in Toronto, 2006.
3.
In line with previous papers and presentations concerned with the relationship between globalization and health, in this paper I use a broad reading of the term “globalization” drawn primarily from Barnett and Whiteside (2006), summarizing the process as:
a. the intensification of global linkages across a wide sphere—across transnational corporate business structures, international finances, people mobility (migration, tourism), global cultural exchange, global environmental issues, and technology and electronic communication;
b. not only the economic processes or the development of economic institutions, but also describing the interconnection between individual life and global features; the process of increasing economic, political, and social interdependence and global integration that takes place as capital, traded goods, persons, concepts, images, ideas and values diffuse across state boundaries; and
c. not as new phenomenon—as historians note that both the 16th and late 19th centuries are both characterized by the development of communication, transportation, and production systems—but instead as an understanding that the present era has distinctive features: shrinking space, shrinking time and disappearing borders are linking people's lives more deeply, more intensely, more immediately than ever before.
Highlighting the process as such allows one to see clear links to the sex industry within Canada and abroad. Further, this definition also helps one understand that while the organization Stella can make use of the ‘tools of globalization’ the speed and ease with which health pandemics spread under globalization make the tasks of such social movement organizations more difficult.
4. As previously stated, Stella works to create community consciousness around issues of IDU as related to PWSI. One of the ways they encourage community discourse and individual education on issues of drugs, safer sex, and other social issues is with published guides available free of charge. For example, Stella produces and distributes The Dope Guide which “covers the various drugs that are on the market, and suggests ways to reduce the risks that come with using them. The guide also provides crucial information if you want to avoid getting pregnant, or if you want to give birth to a healthy baby and keep custody of it once it's born. It also contains information about the law and on your rights with regard to dope. And lastly, you'll find information that may be helpful if you decide to make changes to your drug use or quit entirely” (Stella, 2006). While this guide is limited in terms of language availability, it is published in French, English, and Inuktitut.
5. One of the main ‘tools of globalization’ used by Stella concerns the method by which the NGO makes information available both to sex workers, their clients, and other NGOs with similar policy and health goals. For example, Stella is aligned with many partners to create information brochures and forums for discussion. This is both an effort to share recourses and a seeming fiscal necessity with limited resources. Five informational brochures are produced in hard-copy and are available on line for PWSI in the areas of Dancing, Health, Law, Money and Security Matters. The material represents how a community of sex workers is working to use globalization tools to give tips and advice for “deal[ing] with the most common health and security concerns raised by sex workers” (Stella, 2007). The partners involved in this project include STAR (Sex Trade Advocacy and Research), Maggie's, the Exotic Dancers' Alliance of Canada and the Region of Peel Health.
6. Review of the Stella website and related links to other communities of actors further illustrates how this social movement organization uses the ‘tools of globalization’ to combat the negative health effects the process of globalization has upon PWSI. Stella’s website explains: “Stella favours empowerment and solidarity by and amongst sex workers, since we are committed to the idea that each of us has a place in society, and human rights worth defending” (Stella, 2007).
7. For example one may consider varied “epidemics” within popular writings and academic literature: “epidemic of poverty” and “epidemic of violence against women” to the “epidemic of AIDS” and “epidemic of injection drug use”—these concepts, and the related “wars against” these epidemics (i.e. the “war against drugs”, “war against AIDS” etc.
8. It is important to note that while economic variables are identified within Mancoske and Simth’s (2004) discussion of practice issues, the extensive text makes no mention of globalization. This paper interprets Mancoske and Simth’s discussion and applies this to a discussion of how globalization (with economic, cultural, and social dimensions) contributes to the “economic forces” identified (2004: 29).
9. This relationship is highlighted within international examples pertinent to this focus on globalization and community formation. For example, in addressing the changes of New Labour policies within the UK the relationship must be examined between communally-focused development and more individually-focused policies surrounding development (Rice and Prince, 2000). While these are not strict binaries the tension remains a useful tool for this discussion of PWSI.
10. For Castells (1997) “globalization” is a complex, dynamic process, formed by networks of systems (including the mass media, a tool used by Stella) which are “pervasive, interconnected, and diversified” (Castells 1997: 1).
11. Posting videos (such as the hyperlinked Live eXXXpressions) allows people to anonymously post comments both about the video itself and in response to other comments. For example, Cybermind posted the following in response to the international Stella documentary: “this is the kind of job where ur choice of clients will reflect the kind of life and experience you live. if you do this, you will spend time with people who are abusive and will be in pain. you know this as workers yourselves. i hope you guys get some brains soon and do something productive instead of sucking off losers with money to burn. thanks for listening, i know you agree if you are a sex worker” (Live eXXXpressions, part 1 and part 2).
For Schwefel (2004), eleven key issues illustrate the relationship between globalization and health:
(Schewefel, 2004: 177, emphasis added)
Kerr (2003) itemizes 5 key themes within her article:
(Kerr 2003: 24-25)
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