1. Introduction

‘...for most people the “L” neighbourhood is a dumpster that has to be cleaned up  but they don’t know that there are families there, there are children, there are women  living there because they have no place else to go.  When the President orders them to clean the neighbourhoods and take back the space  nobody asked us what we think about that.’
Stefanía Vinasco, aged 19 (2013)

2In the project we adopted the definition of sex work proposed by Weatherall and Priestley (2001). These authors defined sex work as one or several services in which sex is exchanged for money or goods. Specifically, sex work comprises, but is not limited to, street work, ship work, parlour work, escort work, working independently, ‘mistressing’, peep-show work, stripping, telephone work, and topless dancing. Of all these types of work, street workers have been most severely depicted as deviant due to them sometimes having drug related dependencies and practicing drug abuse. However, it is a common myth that sex workers fund their drug use through their work. Studies suggest that sex workers are likely to start or increase their drug use in order to deal with distress caused by activities associated with their occupation including social pressure or discrimination (Burnes et al., 2012; Weatherall and Priestley, 2001).

4Stigma is considered to be an attribute that is discrediting for the bearer and reduces him or her to a tainted and discounted person (Goffman, 1963). Moreover, stigma is seen by others as something inherent to the person or inside the person, rather than something that can be placed on that person or imposed by others. Such an attribute is thought to spoil identity and disqualify the person from full social acceptance (Link and Phelan, 2001). Consequently, stigma involves social rejection and negative perceptions both in the public and personal spheres for stigmatized individuals (Sallmann, 2010).

5In the second part of this article, we will expose the particularities of the Colombian sex work context. We will then discuss the ongoing debate on sex work regulation, and how these policies are sometimes a source of stigmatization. Later, we discuss the consequences of stigma on female sex workers’ health. Subsequently, we propose some options for social action based on research and the expected results of our project.

2. Sex Work in the Colombian Context

6Every year, 5 per cent of the gross domestic product (GDP) of Colombia is spent on the victims of violent crime and the direct and indirect costs associated with their treatment in health institutions. Compared to other Latin American countries, Colombia has among the highest health costs due to violence. In Brazil it is 1.9 per cent of GDP, Mexico 1.3 per cent, Peru 1.5 per cent, Venezuela 0.3 per cent, and El Salvador 4.3 per cent. It is important to understand that these figures do not take long-term health costs into account. Research has proven that victims of violence suffer from more mental, behavioural, and sexual problems, together with increased substance abuse linked to violence-related trauma (Pan American Health Organization [PAHO], 2002) generating significantly higher health costs throughout their lives (Buvinic et al., 1999). All of these issues are problems that women who do sex work suffer from because of the stigma associated with their work.

7Colombia is a heteronormative, Catholic, and Christian society with a colonial past that situates women within multiple power imbalances in their homes, work, schooling, and other public and private environments. Despite the increase of women in the labour force, shift durations and levels of education, income, and unemployment mark the most persistent social inequalities in Colombia. For the first quarter of 2012, men had 20.2 per cent higher wages than women and women had an unemployment rate 7.1 per cent higher than men, reaching 15.6 per cent (one of the highest women’s unemployment rates in Latin America). In a male-dominated capitalist society, women within all social categories and classes occupy disadvantaged social and economic positions and seek ways to secure income in these gender-limited circumstances.

8Sex work is legal in Colombia. However, women involved in prostitution do not have their legal and human rights guaranteed (Ritterbusch, 2011). Moreover, the sex workers we have collaborated with belong to vulnerable social groups such as women migrants escaping from rural areas where armed conflict is especially rampant, transgender women, young women, women of ethnic and/or racial minorities, and women escaping from domestic violence and abuse. Along with the stigma associated with their line of work, these socio-economic conditions further impede their access to basic human rights such as housing or education, and health services and other social protective systems (World Health Organization [WHO], 2005).

9There is no reliable data on the sex work population of Colombia. The methodologies that state agents and NGOs use to gather information are usually surveys that use a type of language unfamiliar for the community. These surveys are often too long or concern subjects that are unappealing for sex workers. During writing workshops they have repeatedly acknowledged that they respond to surveys with random answers so they can get the rewards offered (usually condoms or food). Such information is also based only on female sex workers who work out of brothels, since they constitute the easiest population to access. However, the working conditions of different groups of sex workers are, themselves, very different. It has been argued that sex workers who work on the street are the group most vulnerable to violence, disease, and prosecution (Prior, Hubbard and Hubbard, 2013).

10Although some of the information gathered in this way is available, it is also outdated and poor. The lack of data and previous work on the underlying structural and social problems that affect people who do sex work demonstrates the state’s lack of interest in proposing a solution or working to improve the quality of life and work of FSWs (Ritterbusch, 2011). The most recent study conducted by the Social Welfare Department (Departamento Administrativo de Bienestar Social—DABS, 2002), recorded 7,024 sex work establishments and 11,822 sex workers. Within this population 60 per cent work in (more) formal establishments and 40 per cent work on the street. The average age of female sex workers was between 15 and 25 years and the majority of these women are involved in sex work due to a lack of income and formal employment opportunities. Also, most of them come from rural areas, largely due to forced displacement caused by armed conflict or by conditions of extreme poverty. According to Ibañez et al. (2013), structural exclusion suffered by young rural women puts them in a more vulnerable position by forcing them to live in poverty due to their low levels of education, their having several children, and their living as single mothers. In Colombia, such situations are far worst if we take into account that young males are more often killed as a result of the armed conflict the country has endured for the past 50 years (Pan American Health Organization, 2002).

11Talking about sex work in Colombia is an ongoing legal debate. The main norms that refer to prostitution as work are legislative acts 400 of 2001 and 188 of 2002, defining the high-impact zones in the city and the operating conditions, along with the guidelines established in the land use plan. Decree 188 of 2002 modified the former act on location and operation of establishments intended for sex work and other activities related to it. It also introduced conditions of health, social welfare, and environment. Mainly, this law explains that sex work establishments located outside permitted areas should move to any of the legal zones if they wish to continue operating. It also states that it is the health institution’s responsibility to diagnose sex workers with sexually transmitted diseases, and to apply the established management protocol and epidemiological monitoring necessary for the integral treatment and fulfilment of the service (Dirección Técnica de Salud y Bienestar Social Subdirección de Análisis Sectorial, 2004, 15). This places Colombia in the prohibitionist group of countries that only consider sex work legal in specific urban zones but do not have a legal base with which to guarantee sex workers’ working rights (including, for example, those related to health, pensions, and professional risks.). It has been argued that the prohibitionist approach to sex work further increases the vulnerability of those who practice this occupation (Shannon et al., 2008).

12However, Congressman Armando Benedetti has been lobbying for a new law that seeks to guarantee sex workers’ rights. This law could be considered a different approach to sex work, similar to Sweden’s or Canada’s regulation of sex work: legalization (Scouler, 2010).  Recognizing the aforementioned flaws in the existing approach, the proposal attempts to drastically change current sex work policies: project of law 79 of 2013. This initiative recognizes that this is not a job like any other and that it needs special regulation, with specific guarantees to respect the economic, social, and cultural rights of sex workers. It would set the parameters for commercial establishments dedicated to all services related to sex work. Also, the initiative proposes to ensure the same labour and social welfare rights that come with any other job, but with some features addressing the special risks sex work implies. Finally, it attempts to dignify this community by re-establishing their rights as social subjects meriting special protection. Some groups that are against the initiative argue that legalizing sex workers’ roles would lead to unequal gender relations and to women becoming more vulnerable (Benjumea et al., 2013).

13The main argument against the initiative is based on this problematic view of sex work from a moralist standpoint; not only objecting to the application of these changes but also demanding sex work to be considered illegal (Grupo de trabajo sobre la ley 79 sobre prostitución, 2014). Criminalizing sex work, from our point of view — one grounded in our work with the community — creates negative effects for sex workers in many ways. Not only does it introduce limitations on the use of legal tools and on workers’ rights — since they are now felonious; they become much more vulnerable to violence from clients, the police, drug dealers, etc. FSWs would be forced to work in different zones, would be less safe, and would forgo any positive intervention, thus increasing FSWs’ stigmatization problems and impeding their access to basic human rights. Laws need to protect women and the zones they work in, providing them with access to safety and health institutions.

15Moreover, many institutional actions working with these communities attempt to ‘save’ sex workers from this line of work by offering training on ‘arts and other crafts’; considering sex work as the only choice left for many vulnerable women with no education; victims of war and poverty, among other things (not taking into account men, transgender sex workers, or consensual sex workers). The Colombian Constitutional Court, in its judgements T60 of 1995, SU–467 of 1997, and C636 of 2009, recognized that prostitution is not a desirable reality and that it violates human dignity. Hence, the most efficient way to deal with it is to discourage sex work and its growth. Prostitution is seen as a practice that prolongs the patriarchal vision of women’s bodies as marketable objects (Benjumea et al., 2013, 7).

16According to the Social Integration Secretariat of Bogotá, one of the only sources of officially available data, more than 60 per cent of sex workers claim to have established working hours, 80 per cent receive payment directly, but only a very small proportion (6 per cent) have a contract. All but 1 per cent have no retirement pension provisions and none have any coverage for occupational hazards, not taking into account the risks they have to deal with daily on their own (Secretaría de Integración Social de Bogotá, 2012). These numbers show the hard reality of only some female sex workers, describing the problem superficially via a small sample of the population. All of the above reflect the exclusion practices, institutional barriers, and limited access to basic rights sex workers endure.

3. Sex Work and Stigma: A Public Health Problem

17Stigma, as relationship and context specific, results from the process of socialization in a specific environment (Reeve, 2013). Thus, the main problem that affects FSWs in the city of Bogotá is the stigma associated with their work intertwined with other features such as sexual orientation and gender (Sallmann, 2010), racial and ethnic background (Burnes et al., 2012), HIV/AIDS diagnosis or Hepatitis C diagnosis (King et al., 2013; Whitaker et al., 2011), or migration status and poverty. We review the types of stigma (enacted sexual stigma, felt sexual stigma, and internalized sexual stigma) that affect women in relation to sex work both within the public and personal spheres; showing the consequences of stigma and how those consequences are inflicted upon vulnerable populations by means of individual, interpersonal, social, and administrative violence and discrimination (Major and O’Brien, 2005).

18Herek et al. (2009) argue that heterosexual masculinity, traditional Christianity, and political conservatism produce especially high levels of social and self-stigma in people perceived as breaking social rules and standards. Additionally, some studies suggest that such gender structure and traditional morality create a widespread acceptance of sexual double standards for men and women regarding sex, making women more culpable than men for participating in commercially motivated sex. Hence, for women, sex work becomes a stigma, an inherent deviant quality, while for men it is a ‘normal’ activity that ends when the sexual transaction is over (Sallmann, 2010). Such mentality emphasizes the belief that only sex in marriage is acceptable and sex work is immoral (Wong et al., 2011).

19Thus, the stigma of FSWs or the ‘whore stigma’ (Pheterson, 1993; Scambler, 2007) derives from popular imaginings of the various ways in which women in general and female sex workers in particular contravene established, socially sanctioned norms regarding women’s expected behaviour, such as having sex with strangers, having sex with multiple partners, asking for money in exchange for sex and, specifically as a woman, taking the sexual initiative and controlling the sexual encounter, being an ‘expert’ in sex, using one’s abilities to satisfy male lust and sexual fantasies, being out alone with the express purpose of attracting male desire and being in situations with undesirable men who can either be handled (by vulgar women) or not (by women who are victims) (Wong et al., 2011). Thus, FSWs are perceived to contravene institutional norms for women. Culturally, this is read as a rejection of mainstream values and norms that justifies violent practices against this population (Reeve, 2013).

20Such perceptions of sex work create a behavioural and moral disposition that leads to the perception that women act in a deviant manner because they are deviant (Reeve, 2013), which socially justifies violence being inflicted upon them. Moreover, discrimination is reflected in language and the ways used to refer to certain types of people (Whitaker et al., 2011). The women we work with persistently complain of the ‘addict’ and ‘whore’ labels placed on them by others, including health-care personnel. Such linguistic practices prevent people from seeing these women as who they are (mothers, sisters, girlfriends, friends) (Ritterbusch, 2013b).

21The term institutional stigma refers to the administrative violence that issues from social organizations or state institutions, limiting social opportunities, obstructing access to health care, excluding the stigmatized from housing or desirable jobs (Herek et al., 2009; Sallmann, 2010). This stigma manifests itself in two ways: i) enacted sexual stigma — a behavioural action of rejection such as overt discrimination and violence, and ii) felt sexual stigma — the constriction of the range of conducts of behavioural options that a person must adopt to avoid being perceived as something undesirable (Herek et al., 2009).

22Enacted sexual stigma against FSWs includes daily acts of police violence, harassment, and prosecution. They experience beatings, rape, and theft from clients; they often turn to the streets due to familial and social isolation and face denial of access to health care, child care, social services, and judicial systems within mainstream society (Burnes et al., 2012). Among a sample of FSWs, 60–93.5 per cent admitted being victims of violence perpetrated by clients, partners, and pimps (Rhodes et al., 2008; Sallmann, 2010).

23There are also social cleansing campaigns that target FSWs. Such practices have been present in Colombian society since the 1970s and are directed towards ‘disposable’ social groups: scavengers, thieves, drag queens, transsexuals, homeless people, prostitutes, HIV-positive populations, and those who are drug dependent or drug users, among others (Buitrago, 2009; Góngora and Suárez, 2008; Stannow, 1996). These practices are attributed to criminal organizations, paramilitary groups, allies of state institutions, or citizens who do not approve of sex work and hire professional hitmen to carry out the killings (Buitrago, 2009). Police reports state that these campaigns are often mere acts of intimidation that leave no casualties; however, such statements are contradicted by our experience and by the social groups affected by this type of violence as we have lost numerous peer leaders within the sex work community to social cleansing killings. Social cleansing acts as a way of disciplining a community through violence, and those who support it further argue that it removes the rotten or damaged elements from the social tissue of society.

25These practices respond to stigma, permitting the dehumanization of these social groups and allowing their removal from public spaces on moral grounds. Moreover, institutional stigma exerted by government institutions implicitly backs and enacts stigma discourses. During the demolition of the former ‘El Cartucho’ neighbourhood — known as one of the most dangerous places in Latin America and for high levels of expenditure on drugs and of illegal activities — the neighbourhood was described as the home of rats and burglars; an evil focal point of deviance, drugs, and criminality that needed to be destroyed (Revista Semana, 2012). The logic of modernization underpinning the renewal of this place was based on hygienic, pathological discourses and plans aiming to clean ‘difficult’ urban spots and purge the city of its waste and filth (Corbusier and Sert, 1942). Let us note that words such as cleansing, ‘clean’, and ‘dirty’ are also used by health-care professionals to refer to FSWs (Whitaker et al., 2011).

• 6  These exploratory interviews are part of Amy Ritterbusch’s doctoral dissertation. The NGO PARCES g (...)

‘They began to knock down houses and we began making shacks to sleep in… many people…were forcibly, violently “disappeared”… the disappearances became frequent… this space [the Cartucho] turned into a war zone… with wounded, dead, sick… moreover today this is all the [El Parque] Tercer Milenio’ (Adriana Guarumo, exploratory interview, 31 March 2010).6

26Examples of felt sexual stigma encompass all the behaviours and acts associated with concealing sex work from family members, health-care professionals, and the authorities, among others (Major and O’Brien, 2005). As a result, women may not disclose their involvement in prostitution when accessing service providers and may even avoid accessing services altogether because of the risks that disclosing their occupation entails, including being vulnerable to the loss of such services, removal of their children, termination of parental rights, and expulsion from social support systems (Weiner, 1996). Evidence also suggests that some women are denied services because providers accept stereotypes that portray FSW as addicts (Ritterbusch, 2013a), self-sufficient criminals, or carriers of disease (Sallmann, 2010). Thus, socialized conceptualizations of sex work translate into violent health practices against women and their children, and to the re-victimization and isolation of this group of people (Lazarus et al., 2012).

27Studies reveal, through both quantitative and ethnographic methods, that sex workers experience an array of negative health outcomes but remain untreated by the health sector. In a study by King et al. (2013) in Russia, 31 per cent of FSWs revealed that doctors refuse to treat them and 51 per cent revealed that doctors refuse medical care to intravenous drug users. Also, 95 per cent reported that they do not feel they can openly discuss certain problems with doctors and 49 per cent had never discussed their involvement in sex work. Some 58 per cent admitted that they had missed a health-related appointment because they worried that they would be treated badly and 50 per cent of street-based sex workers reported barriers to accessing health services due to their line of work (Lazarus et al., 2012).

28A severe consequence of such a restriction of the availability of health services is the limited access that FSWs’ children enjoy, thus affecting their health and well-being. Although they are not the target population of stigma, these children inherit the violence that such stigma entails. This is the reason stigma is associated with infant mortality and health-care problems in children aged 0‒5 (WHO, 2005). Many FSWs avoid taking their children to health-care institutions for fear of discrimination, termination of parental rights, or removal of their children. Violence and hostility are also present in the language used in everyday life: ‘Son of a bitch/whore’ or ‘Bastard’.

29Perceived self-stigma enhances when FSWs face drug consumption and HIV-positive diagnoses in their lives or the lives of loved ones. HIV-related stigma is also, for this population, a barrier to accessing health services (King et al., 2013). However, Lazarus et al. (2012) report that in Canada in a sample of 252 women, 141 (55.9 per cent) reported occupational sex work stigma (defined as hiding occupational sex work status from family, friends, and/or home community), while 125 (49.6 per cent) reported barriers to accessing health services in the previous six months. Moreover, qualitative research with FSWs in Dublin, Ireland revealed that drug users who engage in sex work tried to hide their drug use due to felt stigma and that this stigma was reinforced by the language used by health-care professionals (Whitaker et al., 2011). Further, UK sex workers’ narratives reveal that fears regarding privacy and the disclosure of their sex work status, including distrust of authority and fear of prosecution, further prevents these workers from accessing and using health services (Day and Ward, 1997).

‘[…] and they took me to the hospital; “Culi”, she was the one that took me there, when they said “Oh no, we don’t accept junkies here” and I said “What? What do you mean, ‘no’!?”’ (Andreina Francisca, exploratory interview, CESED, 2012).

30Stigma has also been related to poor mental health, physical illness, academic underachievement, infant mortality, low social status, poverty, financial concerns, and lack of safe sex practices (Burnes et al., 2012; Major and O’Brien, 2005). Also, internalized stigma may cause feelings of despair, depression, anxiety, and powerlessness (Burnes et al., 2012). In general, members of stigmatized groups are at a greater risk of mental and physical health problems, which include hypertension, coronary heart disease, and stroke (Krieger, 1990). There is also a growing body of evidence suggesting that stigma itself can be an important contributor to ill health in individuals and to the production of health disparities in populations.

31It is in this sense that these multiple lived experiences of stigma continue to further increase gender-based and socio-spatial inequalities between different populations in the city. Promoting gender equality in society is of the utmost importance in terms of meeting the gender-oriented Millennium Development Goals in general and of formulating and advocating for public policy that conceptualizes empowerment and the improvement of the quality of life and work of women as progress and as a fundamental component of economic development and productivity in the labour market. As stated in the World Development Report 2012: ‘Economic development alone is not sufficient for the reduction of gender inequality: it is necessary to articulate corrective policies that specially tackle the persistent gender inequalities within society’ (World Bank, 2012). This approach takes stigma as the point of departure for combating the deepest and most persistent gender inequalities experienced in society.

Addressing the Structural Nature of Stigma

32Based on the above, the most appropriate approach to fighting stigma appears to be structural in nature considering that the following interrelated components coincide with stigmatization: i) people distinguish and label human differences; ii) dominant cultural beliefs link labelled persons to undesirable characteristics; iii) labelled persons are placed in distinct categories so as to accomplish some degree of separation of ‘us’ from ‘them’; iv) labelled persons experience status loss and discrimination that lead to unequal outcomes; v) the act of stigmatizing is entirely contingent on access to social, economic, and political power that allows the identification of differentness, the construction of stereotypes, the separation of labelled persons into distinct categories, and the full execution of disapproval, rejection, exclusion, and discrimination. Accordingly, stereotypes and stigma are often ‘automatic’ (Fiske, 1998).

33The structural nature of stigma must be addressed relationally, as part of a social world inhabited not just by the stigmatized but also by those who exert the power to label and discriminate (Rao Biradavolu et al., 2012). It requires a pro-active, multilevel approach to advocacy for sex workers’ health that involves responding both to immediate health needs and to the social and structural problems that perpetuate barriers (Wong et al., 2011).

34Additionally, the success of sex work collectivization and empowerment in reducing HIV risk in some developing countries has been attributed in part to an ability to confront social stigma (Halli et al., 2006; Jana et al., 2004). Furthermore, the precaution-adoption process model (Bartholomew et al., 2006) argues that different tactics are needed in different stages of change. When people and social institutions are unaware of the problem, as in the Colombian case, media messages about the hazards of the problem and the precautions to be taken are pertinent and useful. This approach is relevant due to the invisible and naturalized state of stigmatization and discrimination. By giving visibility to stigma, social groups are able to understand their own behaviour in a different light. Such a strategy is especially effective when attempting to reach resistant groups, as might be the case with health professionals and Colombian society as described earlier.

4. Options for Social Action

35Informed by our work on this project and as members of the NGO PARCES, while we mainly agree with the law initiative currently being debated, we think that the manner in which these policies are grounded, and society’s cooperation regarding possible future changes, would both be more accurate and successful if participatory methods were included from the start. Getting FSWs involved at the start of the process (from the design of research instruments to the analysis of data and the development of policy) is crucial to creating coherent, feasible, and effective change. It is not possible to understand the complex situation in which FSWs live without actually getting involved with the community and observing reality from their point of view; academics, policy makers, institutions, and sex workers have to join forces.

36We came to this conclusion based on our work with the community. Its members frequently expressed that they felt that organizations were working over them, offering them choices and ‘help’ that were far removed from their actual needs. For example, one of the PAR leaders told us that, as part of a district programme, she was offered a job as an alternative to sex work. The problem she had was that she had to travel a very long distance from her home to the work place and she, hence, never arrived on time (either due to Bogotá’s public transport issues or because she did not have enough money to travel) and was fired. In another case, a sex worker said she was offered a scholarship to finish secondary school as a part of an NGO programme, but due to drug dependency issues she could not finish her courses. Even though these programmes offer things FSWs need, the lack of articulation between them renders them inoperative; hence, an integral solution is needed.

38Such access to technology continues to benefit these populations even after projects employing this work methodology have ended, by sustainable empowerment but also by assembling different social actors in the course of the projects and by guaranteeing of basic human rights and social mobilization processes (see footnote 8). Furthermore, access to technology endures in terms of the social influence it achieves. The social exposure that aims to mobilize empathy and ethical care can call into question the health barriers that FSWs and their children encounter on a larger scale. Also, it generates awareness in popular and elite spaces by informing people of the problem of stigma.

39True inclusiveness, though, is not so easy to apply. Different social science disciplines enable vulnerable groups to speak for themselves through media and research technologies that prioritize experience, such as ethnography, community photography, and video (Das, 2004; Greenhouse, 2002). However, such attempts at representation fail if the intention to capture individual voices ends up merely representing the generalized discourse of ‘vulnerability’ and ‘victimization’ related to poverty, hunger, and violence. Such discourses further victimize people that have been forced to endure, and live through, difficult situations, as is the case with FSWs.

40Mass communication media such as radio, the Internet, and television are the major conduits via which FSWs’ discourses are represented. The hegemonic and discriminatory narratives that endorse stigma are still common and active within Colombian society in the form of journalism, documentaries, photography, and academic research. We, however, believe that ‘…the human cannot be captured through the representation, and we can see that some loss of the human takes place when it is “captured” by the image’ (Butler, 2004, 145). Journalism and mainstream media feed stigma by a lack of analysis of the social causes of poverty and exclusion, thus creating a naturalization of violence and a miscomprehension of the violent dynamics imposed on women.

41To avoid the normalization of the crisis discourse and the ‘invisibilization’ of the complex factors behind places such as the ‘El Cartucho’ neighbourhood and social groups described as ‘disposable’ (a common term used in Bogotá to refer to homeless, poor, or low social status individuals and groups) (Jimenez, 2008), we propose using hegemonic tools that thus far have been used to reproduce stigma and turning them into means of empowerment and participatory praxis. Photography and video have the capacity to make those lives and voices excluded from institutional and social discourses known and heard using technology and social media (Butler, 2004).

42A photographer is in a privileged position of control over the action, the stage, and the framing of a picture. A photographic representation reflects aesthetic decisions by means of composition: a person, an angle, a reproduction. A photograph is interpreted by those who come into contact with it and such interpretation is built on what is known. This process of interpretation affects what is represented and how it is interpreted. Hence, through a picture, the complex relationship with what is observed becomes altered (Berger, 1977, in Bleiker and Kay, 2014).

43According to Bleiker and Kay (2014) there are several photographic methods that can be used with vulnerable populations. The first is a naturalistic one that claims to be neutral and devoid of imposed values by providing an objective representation of what is photographed. However, pictures are taken at a certain time and with a certain frame that composes the essence of the photograph. Another method is the humanistic approach that tries to capture shocking scenes of suffering in order to induce compassion in the audience. Although compassion can be a positive engine for change, humanistic photography methods conceal colonial features of representation that produce more shame than compassion, in addition to connoting a distance between the observer and what is observed (Bleiker and Kay, 2014). As a result, the audience reverts to apathy by interpreting the crisis and misery in question as totalizing experiences that cannot be altered.

44Colombian journalism has used mainly humanistic photography methods to represent FSWs. With these images, the focus is mainly on the misery, not on the achievements and accomplishments, of vulnerable groups that prevail in spite of violence and build empowerment (Patton, 1990 in Bleiker and Kay, 2014). Images of suffering also connote moral judgments, resentment, and fear, reminding the audience of the distance that separates it from other social groups. By representing the consequences of social exclusion as something distant, stigma becomes further endorsed (Bleiker and Kay, 2014).

45However, Bleiker and Kay (2014) propose an alternative method for working with social groups, one based on pluralism. Such a photographic method, called pluralistic photography, aims to represent multiple examples of social knowledge and praxis by breaking down the hierarchies and power relations that are pervasive in social media. This method proposes giving the camera to the ‘represented’. By enabling FSWs, as members of a vulnerable community, to explore their experience through pictures, a political, ethical, social, and psychological dialogue is built with the observer of the photographic records. This method of representation transfers agency to the FSWs and forces others to see what they wish to show and how they wish to be represented. The result is the exposure of the violence they endure, but also of what allows them to resist and empower themselves as women and members of a vulnerable community (Bleiker and Kay, 2014).

46With the necessary precautions, this method brings with it certain benefits: i) local validation of knowledge, ii) increased self-worth, iii) improvement of gender equity indicators, and iv) social reflection and group solidarity in defence of others’ rights (Prins, 2010). Hence, this photographic method helps communities counteract the negative effects of stigma on personal and social levels. Human relations are embedded in power relations but pluralistic photography minimizes the oppressive effects of these dynamics by problematizing representations. The collaborative character of this project can provide several ways of making visible and validating the perspectives of FSWs who have been stigmatized.

47Pluralistic photography can be used to work with FSW participants to create a photographic record that acknowledges and represents who they are, the troubles they encounter, and the health rights violations they and their children have to endure due to discrimination based on the three types of stigma previously described. Hence, pluralistic photography’s objective would be to expose a problem ignored thus far by social and governmental institutions. Also, pictures can enable a dialogue between the observer and the observed, making possible identification with ‘the other’; humanizing what social cleansing discourses, discrimination, and stigma have naturalized. As we stated above, pluralistic photographic methods have been used before with FSWs in Bogotá with very positive results, and as such use has been at their suggestion, it is possible to conclude that it would be well received by community members and peer leaders (Ritterbusch, 2011). Additionally, pluralistic photography is the first step towards FSW empowerment and providing them with access to technology by enabling them to represent themselves as they wish to be perceived.

49In sex work markets internationally, particularly establishment-based sex work environments, environmental–structural interventions that combine peer-based sex work initiatives (such as sex work unions and cooperatives) and socio-legal policy reforms have increasingly proved to be effective in promoting safe sex work environments through the mediation of macro- and meso-level barriers (Shannon et al., 2008).

5. Conclusion

50Sex workers in Colombia face many obstacles to being recognized as citizens with the same rights and access to welfare as the rest of the population; most of these problematic situations come from deeply moralist views ingrained in Colombian society. As long as stigma prevails over the exercising of FSWs’ basic rights, every intervention, be it at the policy-, programme-, or humanitarian aid level, falls short of bringing about significant change. We believe that the only way to generate change in a feasible, efficient, and coherent manner is to include the population at every stage of the process: research, analysis, data collection, policy making, and so on. Participative methods not only offer deeper insights from research, they are also a dignifying and efficient manner of getting the community involved in producing long-lasting results.