Enforcing a Stigma Hurts HIV Prevention Efforts

cross-posted from The New York Times

By Serra Sippel, President of the Center for Health and Gender Equity (CHANGE)

Sex workers worldwide are disproportionately affected by H.I.V. because of the stigma and discrimination they face, which makes the U.S. Anti-Prostitution Loyalty Oath (A.P.L.O.) particularly egregious and offensive.

The oath is a legal provision that requires foreign organizations that receive H.I.V./AIDS funds from the U.S. to “have a policy explicitly opposing prostitution.” Not surprisingly, the oath did not emerge as a public health response to H.I.V. It arose when some U.S. legislators saw an opportunity to enforce ideological purity about sex work through our global AIDS program.

Sex workers are excluded from some organizations that fear that any engagement could put funding at risk.

It’s not just a mere inconvenience to be told what you can and cannot believe as an organization fighting H.I.V. Being able to find a solution to the H.I.V. epidemic means being able to implement best practices in public health, to explore new approaches, to talk to anyone and everyone about risk and prevention. Engaging sex workers to stem the spread of H.I.V. requires building trust and ending stigma and discrimination. It is counterintuitive, irresponsible and dangerous to exclude the contributions of people affected by a pandemic.

Studies have shown that the pledge results in the exclusion of sex workers from some organizations that fear that any engagement could put their funding at risk. And it led the country of Brazil to reject much-needed U.S. funding. Clearly, the oath hinders the U.S. government from realizing its own global health goals.

Amnesty International, the U.N. Program on H.I.V./AIDS, The Lancet, WHO and multilateral agencies like the U.N. Population Fund have concluded that decriminalization of sex work and promotion of H.I.V. interventions for sex workers can help this population overcome barriers to H.I.V. prevention and treatment.

If decriminalization can help turn the tide on H.I.V., the U.S. must re-evaluate its love of ideology over science. Yes, it will take an act of Congress to eliminate the oath from law but until then the U.S. must take steps to ensure the law is implemented with the rights of sex workers front and center. A good start would be for the government to explicitly acknowledge the rights of sex workers and allow groups receiving U.S. funds to participate in public debates and efforts to decriminalize sex work and promote sex workers’ human rights and dignity as citizens.

Laws and policies that perpetuate stigma and discrimination have no place in the global H.I.V. response.

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