Tag: National HIV/AIDS Strategy

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.

Letter to ONAP, 2015

Douglas M. Brooks, Director
Office of National AIDS Policy
The White House
Washington, DC 20502
Re: Policy Recommendations

Dear Director Brooks:

We are writing to you to ensure that the perspectives of sex workers and sex worker-led organizations are included in discussion of HIV/AIDS policy nationally, specifically in terms of updating the National HIV/AIDS Strategy. The Best Practices Policy Project is a national organization dedicated to supporting rights based approaches to policy and harm reduction work with sex workers, people in the sex trade and related communities in the United States. We produce materials for policy environments, address research and academic concerns and provide organizations and advocates with technical assistance. Everything that we do is guided by principles that protect the rights of people who engage in commercial sex in all its forms. The Best Practices Policy Project works with a wide network of organizations across the United States. This letter was written in consultation with the New Jersey Red Umbrella Alliance (NJRUA) and Desiree Alliance. NJRUA is a sex worker led group that has a focus area of preventing HIV among sex workers in New Jersey, and Desiree Alliance is a national sex workers rights organization dedicated to the decriminalization of sex work and elimination of ineffective HIV policies by empowering those most impacted to have a voice in the decisions that directly impact them.

We are pleased that the National HIV/AIDS Policy will be soon updated this year and would like to provide our input into the process and be included in forthcoming processes. The current National HIV/AIDS policy makes no mention of sex workers at all, despite the fact that sex workers in many different locales across the country have organized together for years in order to address factors that can increase their risk of HIV/AIDS.

Background and barriers: Across the United States, the harsh policing of anyone assumed to be, or profiled as a sex worker, directly undermines the ability of sex workers to protect themselves from HIV and, in a broader sense, alienates these communities from the support they need to defend their health and rights. Sex workers, and people the police assume to be sex workers, are harassed, assaulted, sexually assaulted, extorted, and falsely arrested by police. The law enforcement practices of using condoms as evidence and/or destroying condoms, confiscating medication(s), and seizing safe sex materials directly contravenes efforts to halt the spread of HIV in the United States. People of color, transgender people, immigrants, homeless people and youth of color are disproportionately affected by these law enforcement activities. People living with HIV who are profiled as being in the sex trade are subject to additional harassment, harsher policing and intensified legal sanctions (including felony convictions) in many jurisdictions across the US.

Different forms of U.S. anti-trafficking legislation and policies affect sex workers in the United States and globally. Federal U.S. anti-trafficking policies undermine the health and rights of sex workers both domestically and internationally by requiring that many organizations seeking funding adopt a policy against sex work (“Anti-Prostitution Loyalty Oath”). This requirement is applied to many seeking funds from the President’s Emergency Plan for AIDS Relief (PEPFAR). Organizations within the U.S. have also been subject to the pledge under the Trafficking Victims Protection Reauthorization Act. These restrictions mean that many organizations are confused about what kinds of services they can provide to sex workers and have, in some situations, lead to shuttering of excellent harm reduction services. New forms of state level legislation to end “domestic trafficking” focusing on “ending demand” for prostitution have been proposed and/or adopted in many U.S. States, intensifying policing of sex workers and their clients. Instead of improving working conditions for sex workers and people in sex trades, these laws lead to more arrests and imprisonment of sex workers, and erode their abilities to utilize tools and strategies they need to keep safe.

1 – In terms of how to reduce new HIV infections in this context, we recommend:

  • addressing the root causes that marginalize sex workers–such as criminalization, stigma, and police violence–from treatment and prevention services.

  • ending the criminalization of condoms for sex workers, trafficking victims and those profiled as such, and ensuring adequate access to condoms for all

  • providing funding for harm reduction and rights-based health care services for sex workers of all genders (including men and women, those who are transgender, and gender non-conforming people,) and all ages

  • Lifting all restrictions on federal funding for harm reduction programs, including the ban on syringe exchange programs, and expanding funding for evidence-based health approaches to drug use, including harm reduction and drug treatment.

2-  In terms of how can we increase access to care & improve health outcomes for people living with HIV, we recommend:

  • training healthcare professionals to end stigma and discrimination against those who are involved in the sex trade

  • providing funding for harm reduction and rights-based health care services for sex workers of all genders and all ages

  • encouraging states to remove laws and enhancements to standard sentencings that criminalize people living with HIV; expunging the records of those arrested and charged under such laws that mandate sex offender registration; and removing people charged under these laws from sex offender registries.  In addition, the U.S. Government should adopt a bill such as H.R.1843/S.1790 REPEAL HIV Discrimination Act, in order to bring the U.S. in line with international law standards to end criminalizing based on HIV status

  • Encourage dialogue between national borders and migrant sex workers to ensure HIV-related health care is provided to those detained in ICE facilities, with a view to ending their detention and ensuring post-release treatment

3 – In terms of how to reduce HIV-related disparities & Health inequities, we recommend:

  • providing support for community mobilization of sex workers to respond to violence and discrimination and urging states to work toward the decriminalization of commercial sex

  • eliminating policies that prevent and hinder individuals with commercial sex- and drug-related convictions from applying for and/or receiving student loans public housing or housing assistance, public assistance, or other government-funded social services.

4 – In terms of how to achieve a more coordinated national response to the HIV epidemic, we recommend:

  • including sex workers as a priority in the National HIV/AIDS Strategy, clearly describing the barriers faced by sex workers and people in the sex trade, and listing these groups in prevention and treatment priorities

  • clearly stating in all policies the needs and priorities of the transgender community and ending the practice of misgendering transgender women as “men who have sex with men” (MSM)

  • improving communications between government agencies working on HIV and communities affected by HIV (recognizing sex workers and drug users in this dialogue), paying particular attention to meaningfully including voices of people impacted by these policies

  • modifying or eliminating existing federal policies that conflate sex work and human trafficking and prevent sex workers from accessing services such as healthcare, HIV prevention and support

  • repealing and removing “anti-prostitution pledge” requirements entirely for U.S. global AIDS funds and anti-trafficking funds.

Thank you for your leadership and consideration of these important matters. We look forward to working with ONAP to expand access to treatment, care and prevention for sex worker communities. We are committed to reducing the number of HIV infections across the United States through prevention and education initiatives. We urge you to adopt these policy resolutions to advance the objective of reducing the HIV/AIDS pandemic.


Best Practices Policy Project

Desiree Alliance

New Jersey Red Umbrella Alliance