Perpetuating the Prostitution Pledge: Allegiance to Failure

In yet another example of the Bush Administration's assault on public health and human rights using the unwieldy club of "morality," it appears that the prostitution pledge will remain embedded in the forehead of U.S. global AIDS policy for several years, unless advocates can muster enough support to pluck it out.

Common sense, respect for human rights, and the urgency of HIV prevention all cry out for an end to the pledge, which requires organizations receiving U.S. global AIDS funds to have a policy explicitly opposing the practice of prostitution.  This policy must apply to all the organization's activities - even those funded by other donors.

The Center for Health and Gender Equity (CHANGE) just released our policy brief that highlights the many legal, ethical, and practical alarm bells raised by the pledge.  Based largely on interviews with people on the frontlines of HIV prevention among sex workers, the brief looks at the pledge's impact on life-saving programs on the ground.

What it reveals is a dismal picture: effective programs suddenly cut off from funding, groups self-censoring messages on sex worker rights, and sex workers with nowhere to go for support or condom supplies.

The good news is that for many U.S.-based organizations, the pledge no longer applies.  It occurred to some people, including judges in two district courts, that compelling U.S. organizations to spout the government line with money they raise from other sources runs into a little problem called the First Amendment.  The Administration is still trying to do an end run around the rulings, but advocates hope that the pledge will soon be history for the large collection of U.S. plaintiffs. (For more on court rulings against the pledge, visit this page.)

But that won't help international organizations overseas.

People who work in these organizations say (and evidence confirms) the most effective HIV prevention programs for sex workers develop trust, affirm dignity and create unity.   You can't reach sex workers if they think you might report them to the police, or if they think you're judging them.  You can't convince sex workers that they should use condoms if they believe their lives aren't worth saving.  No sex worker will enforce condom use with her clients if she thinks everyone else will get more business by not enforcing condom use.

But our report found that the best programs at creating trust, dignity and unity are exactly those most at risk under the pledge.

In Bangladesh, for example, a sex worker outreach program lost money when the international organization that funded them signed the prostitution pledge.  Their drop-in centers - safe spaces for sex workers to gather and access health services - were cut from twenty centers to just four, despite international recognition for their success.  For sex workers there, most of whom are homeless, the loss of drop-in centers meant losing the place where they slept, bathed, educated themselves, and - perhaps most importantly - received condoms.

A big part of the problem is that the policy seems deliberately vague.  The Administration refuses to define what "promoting the practice of prostitution" means in terms of specific activities, although it retains the right to investigate all the activities of funding recipients to make sure they oppose prostitution enough.

As the report finds, the resulting confusion in the field has created a climate of fear and silence, paralyzing organizations that sign the pledge.  We found groups clearing their websites of any mention of sex worker rights, groups avoiding media coverage for fear of drawing attention to their work, and groups no longer engaging sex workers in their HIV prevention efforts because it's simply not worth the heightened scrutiny.

These organizations always have to second guess themselves:  If they empower sex workers to become peer educators on negotiating condom use with clients, is that promoting prostitution? Is teaching them English so they can better communicate with clients promoting prostitution?  If a group organizes sex workers to collectively enforce condom use with clients, and the sex workers start talking about their right to be sex workers, does that group have to give back its money?

So rather than unity, trust and dignity, the pledge has promoted confusion, isolation and shame.  By causing organizations to eliminate, water down, or censor their prevention efforts with sex workers, the pledge has undermined evidence-based best practices in public health.

And the really sad part is this: there is no upside.  The pledge has had absolutely no measurable impact on decreasing prostitution.  Incredibly, that's what the Bush Administration says is the purpose of this policy - to reduce HIV transmission by ending the practice of prostitution.

Does anyone out there think forcing nongovernmental groups to have a policy against prostitution has any bearing at all on how many human beings around the world have sex for money?  Really?

So that's what U.S. taxpayers get for their millions in HIV prevention money: a policy that has no discernible impact on its stated goal, yet causes the best programs to either contort or silence themselves to fit a particular conservative worldview, or risk closure by shunning U.S. money.

Let's hope - no, let's make sure - the next Congress and Administration do better.