To spark discussion on this question, the Center for Health and Gender Equity (CHANGE), with the Center for Human Rights and Humanitarian Law at American University Washington College of Law, sponsored a symposium two weeks ago to highlight the importance of engaging sex workers in anti-trafficking and HIV/AIDS efforts, and to demonstrate how anti-prostitution policies and campaigns such as those supported by the U.S. government undermine the U.S.'s own policy objectives to end human trafficking and HIV and AIDS.
Sex work is not the same as trafficking in persons for the purpose of sex, and the conflating of the two in U.S. policy has resulted in human rights violations such as "raid and rescues" of women sex workers who were not victims of trafficking - yet the actions were conducted in the name of anti-trafficking.
U.S.
policy over the past decade has contributed significantly to an anti-sex-worker
approach to key health and human rights issues. Both the global AIDS law and trafficking
victims protection law
(both reauthorized in 2008) include provisions that prohibit U.S. foreign
assistance for nongovernmental organizations that promote or advocate
for the legalization or practice of prostitution. One major problem
with the provision is that the U.S. government has failed to define
what is and is not allowed under the policy, leaving implementers and
country missions to guess about what exactly is prohibited from U.S.
funding. As a result, programs that ensure the health and rights
of one of the most marginalized populations at greatest risk of contracting
HIV are under threat of losing funding, censor themselves about sex
worker rights, or have shut down due to loss of funds.
A second provision in the global AIDS policy - yes, it gets worse - is that in order to receive U.S. funds in the first place the respective NGO must have a policy explicitly opposing the legalization and practice of prostitution. How is that for alienating an already marginalized group of people who are key to slowing the spread of HIV? Without access to targeted and carefully implemented prevention programming - provided by people they trust to be looking out for their interests, not U.S. government interests - sex workers will not have access to the information and services necessary to enable them to use condoms consistently and correctly with their partners and clients.
The
Member of Congress who apparently rode in on a white horse to protect
women and children that have become victims of trafficking seems to
have no concern about the impact of these policies on the health and
human rights of sex workers. Christopher Smith (R-NJ) is that
self-appointed guardian of women's morality who has shaped the policies
that equate prostitution with sex trafficking -- although his
efforts would not have gone very far without the help of the Bush administration
and the votes of Democrats and Republicans in the U.S. Congress.
CHANGE seeks to eliminate this pledge legislatively, yet in the meantime the Office of the Global AIDS Coordinator should revise its guidance to ensure that PEPFAR-funded programs aimed at reducing HIV infection among sex workers are not driven by an anti-prostitution ideology, and are proven to respect and uphold the human rights of women, men and transgender adult sex workers.
Despite current U.S. policy, sex workers are organizing to fight trafficking and HIV, and to reform the very policies that disenfranchise them. Four women who work with sex workers shared their stories with the audience at the symposium.
Sara
Bradford, technical advisor for the Asia Pacific Network of Sex Workers
in Cambodia, spoke about the impact of Cambodia's recent anti-prostitution
and anti-trafficking law, which was implemented as a result of U.S.
pressure. The law has had little impact on trafficking, yet a
huge effect on the lives of sex workers. Police take sex workers
forcibly from the brothels in which they work and place them in "rehabilitation
centers" - in some cases with their children - where they are
given little to eat, no clean water, and are denied basic health services,
including access to ARVs for those living with HIV. Women have
also been beaten and sexually abused by the police.
Dr.
Shilpa Merchant is the regional director for Population Services International
in Mumbai, India. Shilpa has worked to provide HIV prevention
services to underserved sex workers and their clients in Mumbai's
red-light district. She has been told by stewards of U.S.-funded
programs that providing condoms to sex workers is in fact promoting
sex work. Despite this, PSI has supported Shilpa in her work with
sex workers and provided sexual and reproductive health services to
them and other marginalized and hard to reach populations.
Sylvia Mollet is a co-founder of DANAYA SO in Mali. A big part of DANAYA SO's focus is on young women engaged in the sex sector. Sylvia spoke movingly about young women who willingly become sex workers for the most basic needs, like school fees, food, and clean water. Sylvia even mentioned a situation where a young woman had exchanged sex for a piece of bread. DANAYA SO has worked to emphasize the need to create opportunities for women and girls so that they may freely choose to remain in the sex sector or turn to alternative life choices beyond sex work. The organization has created special income generation and micro-enterprise opportunities, and through public-private partnerships with pharmacies and health clinics offer full-coverage health insurance, including HIV prevention.
Gabriela
Leite is the director of Davida in Brazil. She is an author, self-proclaimed
retired prostitute, and renowned human rights advocate. Gabriela
worked as a prostitute for more than ten years and started a movement
in the 1970s as a response to human rights violations against sex workers
in her country. During her presentation at the symposium, Gabriela
highlighted Brazil's choice to not accept U.S. HIV/AIDS funding through
PEPFAR due to the inclusion of the Anti-Prostitution Pledge. Davida
and the network of sex workers pride themselves on creating partnerships
with government where sex workers are consulted and collaborated with
in the fight against HIV/AIDS. Because of this partnership, Gabriela
mentioned that the HIV prevalence rate among sex workers has declined
significantly in about a ten-year span.
It is committed advocates like Sara, Shilpa, Sylvia and Gabriela, and the women they serve, who are best positioned to identify and assist with eliminating child exploitation and human trafficking for the purposes of sex. Governments should not see the sex sector as something to abolish, but like the government of Brazil, welcome organizations and networks of sex workers as partners in eliminating HIV/AIDS, human trafficking and child exploitation.
For more information about U.S. global AIDS policy and the impact of the Anti-Prostitution Pledge, please visit www.pepfarwatch.org.
]]>Women account for half of all adults living with HIV and AIDS worldwide, and rates among young women are growing steadily. OGAC has responded to the need to address HIV among women and girls by integrating gender strategies into its care, treatment, and prevention programs. The implementation of the strategies is monitored by a gender technical working group, comprised of key staff of the various U.S. government agencies tasked with implementing PEPFAR programs. OGAC has been consistent in reporting on "gender-sensitive" activities since 2005, and reported spending $1 billion on these efforts in 2008. However, because prevention policies fail to meet the needs of women, these strategies are missing the mark at adequately addressing the AIDS pandemic among the female population.
The fight for better prevention policy for U.S. global AIDS programs was lost in the reauthorization process last year. Three key aspects of the law will have a direct and almost immediate negative impact on women in need of prevention and care services. The first is the "balanced funding requirement," which stipulates that if less than 50% of funds for the sexual transmission of HIV is spent on abstinence and fidelity programs, the Global AIDS Coordinator must issue a report to Congress. The second is the retention of the Anti-Prostitution Loyalty Oath, also known as the prostitution pledge, which requires NGOs and service-providers receiving aid through the Emergency Plan to sign an oath opposing prostitution and sex-trafficking. The third is that the bill fell short by neglecting to commit U.S. global AIDS policy to integrate family planning services and HIV/AIDS services, although nothing in the legislation precludes the integration of these services.
The lack in adequately addressing the prevention of the sexual transmission of HIV among women and girls undermines all gender strategies implemented in PEPFAR programs. The fact that most women and young women are contracting HIV within marriage or primary partnerships is a clear sign that focusing on abstinence and fidelity does nothing to empower them in protecting themselves. In environments where male dominance and female inferiority prevail, innovative strategies for prevention that provide women and young women with the tools required to protect themselves need to be emphasized and implemented broadly. The prostitution pledge, which has become a political football used by conservatives to demonize women and young women engaged in the sex sector, has done nothing but stigmatize an already marginalized population and has also caused a number of organizations whose aim is to meet the prevention and care needs of this population to curtail their services. The lack of family planning/HIV integration that is broad and widespread enough to truly impact women and girls will only continue to overburden the health systems and health infrastructures that are already experiencing shortages and pitfalls. Further, the inconvenience for women and young women living within resource-constrained settings forced to visit multiple providers for health care services related to the reproductive system makes no sense for the largest international health program in history.
If the U.S. government is serious about addressing the gender implications of HIV and AIDS among women and young women, it must make prevention a priority in PEPFAR. Adequately addressing the care-giving burdens and gender gaps of the AIDS pandemic depends on it. UNAIDS executive director Michel Sidebé echoed these sentiments in his speech at the CSW and called for new paradigms in gender inequality for women: "...give women and girls the power to protect themselves from HIV...This requires investment in universal access to comprehensive sexual and reproductive health services." ]]>Did Washington lawmakers ignore the evidence that points to the fact that the AIDS pandemic is crippling the livelihoods of women and girls? Did they not hear the countless arguments of courageous global AIDS prevention advocates fighting for real change to impact those at greatest risk for HIV infection in regions like sub-Saharan Africa and Southeast Asia? HIV and AIDS is pressing itself upon women and seeping its way into their lives through vectors like gender-based violence, sexual coercion, and even marriage.
How did it come to this? Both the House (H.R. 5501) and Senate (S. 2731) versions of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 continue the legacy of the extremely harmful abstinence-until-marriage funding directive by imposing a confusing reporting requirement on countries that spend less than 50 percent of sexual transmission funds on abstinence and faithfulness prevention programs. The bills also fail to strike the anti-prostitution loyalty oath, discounting one of the most vulnerable populations at-risk for HIV infection and in need of prevention services.
Regarding the integration of services that women use the most, H.R. 5501 would grant HIV and AIDS funding to family planning programs wishing to also provide women with HIV testing, counseling, and education services. Yet these family planning programs must already receive U.S. funding for population services and therefore must be compliant with the Mexico City Policy. S. 2731 totally neglected the issue of integrated services for women by failing to mention family planning in the context of HIV and AIDS altogether.
While conducting those "secret" conversations and compromises in the eleventh hour, it seems as though Washington lawmakers forgot about the women and girls who are virtually voiceless when it comes to their sexual and reproductive health. They forgot that abstinence, fidelity, and faithfulness messages in HIV prevention neglect to consider the life circumstances of those most vulnerable to HIV infection. They forgot that the integration of sexual and reproductive health/family planning and HIV and AIDS services is one of the most cost-effective and efficient ways to get ahead of the HIV epidemic among women and girls. In the end, political expediency was the most important objective -- not the promotion of evidence -- based prevention for populations vulnerable to HIV infection, especially women and girls.
The purpose of the Caucus for Evidence-Based Prevention is to highlight and defend the importance of evidence and science in determining what works best to prevent HIV infection. Watch out for the next blog from the Caucus! Coming soon, SIECUS's Bill Smith will introduce the Caucus, comprised of many of the United State's major organizations leading the fight against HIV/AIDS.
The opinions of the author do not necessarily represent those of The Caucus for Evidence-Based Prevention.
Related Posts
According to the National Institutes of Health Office of Vaccine Research, a vaccine "teaches" the immune system to recognize and defend against a virus (such as HIV), bacteria or other disease-causing agent. A preventive HIV vaccine could divert millions of deaths. Developing safe, effective and affordable vaccines that can prevent HIV infection in those who are uninfected is the best hope for controlling and ending the AIDS pandemic. And women are one sect of the population in dire need of prevention technologies due to the impact of HIV/AIDS on this vulnerable group.
The Centers for Disease Control and Prevention has found that women represent 27 percent of the estimated 40,000 new HIV/AIDS diagnoses in the United States. Of this, African American women account for 64 percent of new AIDS diagnoses and Hispanic women account for 15 percent. A more staggering conceptualization rests as one considers the harsh reality that African American women are about 24 times more likely to contract HIV than white women, and Hispanic women are 6 times more likely to contract the infection than their white counterparts. Globally, women account for about half of all HIV/AIDS infections worldwide. The overwhelming majority of these women contracted HIV through unprotected sex with infected men.
HIV interacts with women's reproductive health on many levels. The virus is transmitted more efficiently from men to women during sexual intercourse, and having another sexually transmitted infection (STI) may increase the risk of contracting HIV. Conversely, women with HIV are at increased risk for contracting other STIs. It is widely known that achieving good reproductive health remains a precursor for preventing HIV/AIDS. Integrating reproductive health and HIV/AIDS services makes sense and it is cost-effective. Ultimately, this integration may also lead to a reduction in stigma and increased access to care and treatment among resource-constrained populations.
A number of new HIV prevention technologies are in the late stages of clinical research. The trials particularly beneficial for women include those testing cervical barriers, HIV preventive vaccine trials and microbicide trials. Microbicides are topical creams or gels to be applied prior to sex in order to prevent HIV transmission and the transmission of other STIs. Clinical trials cannot thrive without the participation of volunteers. Throughout the trials' process, volunteers are counseled on how to reduce the behaviors that put them at increased risk for HIV transmission and other STIs. Volunteers are also fully informed of the process, the vaccines and other technologies being tested, and possible health outcomes. Volunteers who agree to participate in a trial conclude the preliminary consultative process by signing an informed consent document.
Diversity is desperately needed among these volunteers, and researchers have been actively recruiting women of color for both domestic trials as well as international trials. However, more must be done to increase awareness and education among this group. As researchers continue to seek out new and innovative prevention technologies for HIV/AIDS and other STIs, they must continually consider the inclusion of the communities most impacted by the disease. HIV/AIDS has proved itself to be an epidemic ravaging black and brown women across the globe. Because women of color may respond differently to both therapies and vaccines for these conditions, their participation in clinical trials is essential.
]]>Today women represent almost half (48%) of all adults living with HIV/AIDS worldwide. In the United States, HIV/AIDS is the leading cause of death for African American women aged 25-34 and the 4th leading cause of death for Hispanic women aged 35-44. In Sub-Saharan Africa, 76% of young women, aged 15-24, are HIV positive. As you can see, the numbers among women are staggering. However, gaps in care, treatment and prevention persist within this population. The AIDS Institute has recognized these gaps and the importance of linking the social and economic issues that attribute to the incidence of HIV/AIDS. In order to fully address this pandemic, issues as such must be integrated into policy and research efforts. The AIDS Institute will attempt to stem the tide of HIV/AIDS among women with the development of a new program entitled The WIN Project—"Women Informing Now"!
The WIN Project represents an international and domestic effort that highlights the critical issues for women impacted by HIV/AIDS. The aim of this program is to direct targeted resources around HIV/AIDS that specifically address the needs of women and their families. In the process, we will educate Congress, the Administration, and communities about the issues that pervade women.
The response to the HIV/AIDS epidemic among women has been limited. The WIN Project will attempt to provide a gateway for other national and international organizations with the goal of addressing women's issues in the policy arena. The Project will promote policy initiatives that involve the interests of women on the state, national, and global level. Where appropriate, the issues that further implicate HIV transmission among women and girls will be linked to broader societal ills. For example, global funding for HIV/AIDS has increased over time. However, resources still fall short of the burgeoning epidemic and projected need. The result is that millions still lack access to care, treatment, and prevention. The President's Emergency Plan for AIDS Relief (PEPFAR) is the main source of programmatic funding for global programs within 15 foreign countries hardest hit by HIV/AIDS. The unfortunate reality of funding for PEPFAR programs is that they are subject to a number of directives. The most harmful of these directives lies within prevention funding.
Twenty-five percent of PEPFAR dollars are allocated toward prevention programs in the 15 countries aforementioned. Thirty-three percent of these dollars must be used, as codified in the authorizing legislation, for abstinence-only programs. How can abstinence-only programs protect girls from HIV transmission? I encourage you to consider this question in the framework of countries where child marriage and inadequate education of young girls are prevalent. Within these countries, young women also have limited access to condoms and other means of contraception. And where condoms are available, negotiation in condom use and other methods is also highly unlikely. All of this is the result of the societal, continued subjugation of women and girls. The ideological framework behind abstinence has been substituted in policies developed by the United States government. These policies have been extremely harmful for women and girls on a global scale. As The AIDS Institute lays the policy foundation for the WIN Project, I sincerely hope that we will successfully advocate for striking this abstinence-only earmark in prevention funding as part of PEPFAR, and influence Congress to develop evidence-based prevention programming for the countries in which it provides assistance to combat AIDS. Prevention programming is desperately needed that reflects the special needs of women and girls. The increasing number of women and girls living with HIV/AIDS proves it.
Aside from faulty, ideological policies falling short to address HIV/AIDS among women and girls, structural issues also call for our attention. Issues like poverty and access to care and treatment all prevent HIV positive women from leading healthy lives. Adequate funding in programs that provide medicines for those who cannot afford them is a must in the overall development of the world economy and global health. Additionally, linkages must be made between reproductive health and HIV/AIDS. HIV interacts with women's reproductive health on many levels. In fact, the virus is spread more efficiently from men to women due to our biological make up. Congress must consider invoking broader attention to reproductive health as they tackle providing avenues to care and treatment for women living with HIV/AIDS.
I could go on and on with the various issues that saturate the HIV/AIDS epidemic among women and girls. With the institution of The WIN Project, The AIDS Institute will spark conversations that have been historically dismissed, and form partnerships that have been neglected or inhibited. Women spend most of their lives considering others and ensuring the well-being of others. It is time for the world to return the favor and give women the same care and hospitality ... it is time for the world to take in hand HIV/AIDS for women and their families.
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