SILENCE is still death for sex workers: the National HIV/AIDS Strategy Implementation plan

by Penelope Saunders (BPPP), Cristine Sardina (Desiree Alliance), Katherine M Koster (SWOP-USA) and Derek Demeri (NJRUA)

Impassioned community leaders at the beginning of the HIV pandemic took to the streets and called out in policy fora that “SILENCE=DEATH” to ensure that people took notice. They sought to inspire action to address HIV, to seek treatments and to prevent the transmission of HIV among the most affected groups of people, people who happened to be highly stigmatized in other ways because of their sexual orientation: gay men, drug users, sex workers.

As leaders of sex worker rights organizations we applaud the attention that HIV receives on World AIDS Day, we express joy that the United States actually has a national strategy (after decades of not having one) and we celebrate the fact that with medication, comprehensive health care, housing and support that HIV is no longer a death sentence at all.

But a silence continues and that silence is immeasurably harmful. Despite the clear global understanding that we cannot address HIV without sex workers, the United States of America somehow didn’t get the memo. Despite the nearly dozen strong and solid recommendations by US sex workers rights organizations to the Office of National AIDS Policy and Douglas Brooks, our concerns were not included in the national strategy.  Sex work was mentioned only once in the recently updated National HIV/AIDS National Strategy (NHAS), and, was not mentioned at all in the National HIV/AIDS Federal Action Plan released December 1, 2015.  For this sector of society to be omitted entirely limits the scope of HIV and AIDS conversations, discussions, and policies. It is grossly negligent and inexcusable to ignore one of the most vulnerable populations that suffer the consequences of silence.

In the plan, “high-risk populations” are defined as “gay, bisexual, and other men who have sex with men; Black and Latino women and men; people who inject drugs; youth aged 13 to 24 years; people in the Southern United States; and transgender women.” Yet an estimated 20 to 40% of women at high risk of HIV infection in the United States reported having sex in exchange for money or drugs within the past year, and according to current epidemiology women engaged in commercial sex have a higher risk of contracting HIV not only than general population, but also other similarly high-risk women who do not engage in sex work. The plan also makes no mention of trans women who engage in sex work, despite the fact that trans people with sex trade experience are nearly 6 times as likely times as likely to be living with HIV (15.32%) than the general trans population (2.6%) and 25 times as likely to be positive than the general population (0.6%).

Beyond epidemiology, consider the social reality: Not one mention of sex work even though all across the United States sex workers–and people profiled as such under laws and policies against sex work–are detained and searched for their condoms and for HIV medications. Not one mention of sex work even though the most egregious state laws criminalizing HIV are those specifically targeting prostitution. 13 states have laws specifically criminalizing people living with HIV arrested for prostitution-related charges, statutes that can raise penalties to felonies even if condoms are used, even if all the acts are safe with no possibility of transmission. Even if the person’s viral load is zero. Not one mention of sex work even though our community-led research project “Nothing About Us Without Us” we have documented the vast, almost entirely unfunded sector of sex worker-led grassroots outreach initiatives doing the day-to-day work to end HIV and AIDS. Not one mention of sex work, even when sex workers are recognized by other national governments globally and international health organizations like the World Health Organization as a vital partners in order to end the HIV epidemic. Not one mention of sex work, when even international pressure has forced PEPFAR to include sex workers as a key population in the fight against HIV.

Silence still equals death for people in the sex trade who are living with HIV, and unable to access healthcare because they don’t have a home because of prior convictions for prostitution. Silence still equals death when they are turned away from mainstream health care services/providers who discriminate against them because they are “suspected to be prostitutes.” Or, because they can’t walk through the neighborhood safely to reach the clinic because of policing.

We know that with our advocacy there will be change because we refuse to be silent. Tucked away in the “implementation plan” that will guide the coming year’s work on HIV across the country, our community has some pressure points that we can use for change. For example, that by 2020 the National Institute of Health is supposed to “increase awareness of, and build support for, HIV prevention and treatment clinical and behavioral research nationally with specific community engagement and education activities for historically underrepresented communities and populations at greatest risk for HIV infection.” Historically underrepresented communities would seem to include sex workers.

Given the current poor record of HIV policy in the United States, sex worker rights organizations expected nothing significant from the NHAS Federal Action Plan. However, neither elimination nor silence will deter us from being recognized as a voice in HIV and AIDS strategies. We continue to organize with national HIV and AIDS groups that will ensure our place in the next NHAS update in 2020. As we begin to strategize our long-term plans of inclusion and collaborative work with key policy and scientific research stakeholders, sex workers must be at the table in these necessary and pertinent decisions of who is included in the NHAS. Join us and make sure that there is no longer a silence about sex work in the United States. Join us because it is no longer acceptable to silence, harass, arrest, abuse, deny healthcare, incarcerate, make homeless, or murder anyone because they are a sex worker, or because you think they are one. Those days are over.