Sex workers have long struggled to be regarded as leaders in the prevention of HIV, not as vectors of disease from which the public must be protected.  This challenge extends to the few counties in the United States where prostitution is regulated and permitted under law -- in rural Nevada, where the possible expansion of the brothel industry has US sex workers hoping at last to be given a central role in governing their own industry, rather than being seen as at-risk women who require protection from themselves.

In January, the key lobbyist for Nevada's legal brothel industry, George Flint, obtained the backing of state Senator Bob Coffin for a bill to impose a statewide tax on Nevada's 25 legal brothels.  Flint's aspirations are two-fold: gain the favor of Nevada citizens who face bracing budget cuts, and reinforce the status of brothels as legitimate businesses contributing to the economy and community welfare. His tax proposal also has the support of Las Vegas Mayor Oscar Goodman, who has asked Flint to work on a model bill to create highly regulated legal brothels in Las Vegas, where prostitution is currently illegal.  While Senator Coffin intends to hold public hearings on prostitution at some point through the Senate Taxation Committee, Flint's proposal is due to be heard by the state legislature this month.  All of this has sex workers and advocates wondering: if the brothel business is going to be taxed and  expanded, who will be involved in developing new regulations?  Will it be sex workers?

Sex worker advocates' concerns about brothel regulations go back to the early days of the HIV/AIDS pandemic, when Nevada's current system of mandatory HIV/STI testing and quarantining brothel workers from the public were put into law without the consultation of the workers themselves. Nevada state law mandates that sex workers in the legal brothels must undergo monthly HIV and syphilis tests and weekly gonorrhea and chlamydia tests.  In addition, some county and municipal codes stipulate that sex workers may not leave the brothels for more than 24 hours without being tested again.  Some brothels do not permit workers to be off-premises at all in evening hours, unless accompanied by a chaperone. "Girls do leave all the time, to go to town, to get their nails done," said George Flint, "but I'm a huge fan of girls staying on-premises. Without the controlled environment that the brothel provides, they may turn tricks outside without safety things [condoms]."

Sex workers don't object to being tested for HIV and STIs on principle, sociologists Barb Brents and Kate Hausbeck of the University of Nevada - Las Vegas found in their research with brothel workers. But workers and health advocates argue that regulations governing their workplaces were put into place as a reaction to public misperceptions about HIV, and that these practices have not been updated now that more accurate information on HIV transmission and prevention has emerged.  "The current system is old and ineffective," said Amanda Brooks, who has worked at a legal brothel in Nevada. "It's time for the brothel industry to enter the 21st century." 

The Nevada brothels' mandatory HIV testing laws were established in the mid-80's, in response to concerns that tourism dollars would be lost in the panic over HIV.  State law stipulates that all new workers to the brothels must test negative for HIV as part of a pre-employment screening conducted at approved testing sites, in addition to testing every thirty days of continued employment.  Even as these regulations were first adopted into law, the state Department of Public Health maintained that the compulsory testing was passed "as a symbolic gesture," said Barb Brents.  "It was a gut reaction to the AIDS crisis."  In a 2006 interview, Rick Reich, Communicable Disease / AIDS Services Supervisor for the Clark County Health Department, said of the mandatory testing law, "[W]e test these people so often, it's almost like we over-test them. That doesn't stop the infections from coming into the brothels by the customers.  That's where the mandatory condom use comes in."

The one existing Nevada brothel regulation that effectively keeps sex workers safe was pushed for by workers themselves -- a statewide mandatory condom policy.  Sex workers had been demanding that condom use be made mandatory across the brothel system in order to make uniform the safety practices they already knew worked best, but it wasn't until 1987, after compulsory HIV/STI testing had been adopted into law, that brothel owners realized their competitive advantage was at risk unless a statewide condom policy was in place. "In my understanding, it was the workers that wanted [mandatory condoms]," said Cheryl Radeloff, assistant professor of Women's Studies at Minnesota State University - Mankato, who has studied the Nevada brothels. "They were scared of being exposed to HIV," which testing the workers alone cannot prevent from occurring.  The practice remains effective, both for prevention and to demonstrate what workers can accomplish collectively.  As Radeloff observed, "the workers all bought in to this law because it was the workers who most wanted it."  

Sex workers have also questioned the messages about testing and the sexual health information they receive from their employers.  Amanda Brooks, who worked in a brothel this summer, wrote that she was told by the health care providers referred to her by the brothel that she would not be tested for hepatitis because "Mexicans and Asians carry hepatitis" and she appeared to be white.  Said Brooks, "We weren't given accurate basic health information at my brothel."

"Look at the tests that are pushed," said Cheryl Radeloff.  "We can't use throat and urine cultures for testing gonorrhea and chlamydia because the law stipulates a cervical specimen is to be taken.  And with HIV - we can't use rapid tests, because there's no provision for them in the law. There's a lag between the law and best practices." In addition to the weakness of relying on twenty year old laws to set current public health standards, sex workers have not yet been considered to be important in the design and implementation of brothel health policy. Asked Radeloff, "Where's the advocacy for workers within the brothel system to take roles as peer advisors and mentors?" 

"As workers and health advocates, we can push for an update to the current system, for an assessment of best practices in brothel health," said Naomi Akers, executive director of St. James Infirmary, a peer-run occupational health and safety clinic for sex workers. Akers also worked in the Nevada brothels for several years. Currently, brothel workers are responsible for the costs of their own tests.  Additionally, if a worker leaves the brothel for more than twenty-four hours, she must be re-tested for HIV before being allowed to return to work.  However, the brothels currently use the ELISA HIV test, which may not detect the antibodies that cause HIV for up to three months.  "If you leave the brothels for just twenty four hours, it doesn't make any sense," said Akers. "The RNA PCR test is what we offer for HIV screening in our clinic. It has a shorter window period for detection, and tests for the presence of the virus itself."

As brothel workers carry the cost of their own test, this twenty-four rule may have more to do with encouraging workers to stay on-site and work continuously rather than pay to be tested and lose work while waiting for results.  Said Susan Lopez, director of the Sex Workers' Outreach Project-Las Vegas, "Sometimes it feels like they just want to keep the ‘dirty whores' out of the city so that they don't infect the public," and even with overwhelming evidence that sex workers are not any more responsible for the transmission of HIV, these attitudes remain.  In fact, there are sex partners involved in the Nevada brothel system who aren't tested: the clients. "I'm sure over the years, statistically speaking, that I had a client who was HIV positive," said Akers.  "And still, with condom use, it's entirely possible for workers to remain HIV negative."

"The rhetoric that needs to be crushed right off the bat is that women need to be confined," said Brents. "There is just an acceptance of this being the way things are. But to hear George Flint talk, there's the sense that now that we could do it right." Now that Flint needs to convince legislators to support his bill giving even more legal status to prostitution in Nevada, shifting the public's perception of brothel workers -- from that of outsider threats to contributing members of the community - could not be better timed.            

To date, no sex workers have been included in the brothel regulatory boards, though Flint said he is open to this.  But as sex workers and advocates have said, being willing to listen to sex workers is not enough.  Rather, ensuring sex workers have an equal voice in lobbying for policy based on evidence over unfounded fears should be his first step in proving his commitment to a better brothel business.