Fighting from the margins

August 2, 2012

Addressing the global AIDS epidemic requires putting an end to the criminalization of sex workers and drug users, explain Jovanni Flores and Judy Heithmar.

ACTIVISTS CLUTCHING red umbrellas--the international symbol for resistance against discrimination targeting sex workers--disrupted the July 23 opening ceremony of the 19th International AIDS Conference. Chanting "Nothing about us without us," the protesters hoped to shine a light on the absence of sex workers and drug users at a conference supposedly about HIV prevention.

The U.S. was able to host the conference for the first time in 22 years after it finally lifted its ban on granting entry to international travelers with HIV. The conference took place in Washington, D.C., from July 22-27 and brought together more than 20,000 scientists, activists, government officials and journalists to assess the science and determine best practices for reducing the spread of the HIV virus.

But two large groups most affected by the spread of HIV--sex workers and drug users--were left out. "Science is only half the story of stopping the AIDS epidemic–the involvement of key populations including sex workers and drug users is the other half," said organizer Darby Hickey. "We must hold governments like the U.S. and organizations like the IAS [International AIDS Society] accountable for trying to exclude us."

Protesting the opening ceremony of the 19th International AIDS Conference
Protesting the opening ceremony of the 19th International AIDS Conference

Sex workers and drug users from outside the U.S. who wanted to attend the conference faced a dilemma: Lie about who they were, or disclose their status and be prevented from getting a visa. Restrictions targeting "moral turpitude" continue to discriminate against travelers who disclose a history of prostitution or drug addiction. Falsely answering these questions can result in a 10-year blacklisting if discovered.

"This conference should be about reducing stigma," said Alan Clear, executive director of the Harm Reduction Coalition. "Unfortunately, it is perpetuating stigma around drug use and sex work."

A report from the Global Commission on Drug Policy makes its findings clear in its title: "The War on Drugs and HIV/AIDS: How Criminalization of Drug Use Fuels the Global Pandemic." In the report, the commission noted that injection drug use now accounts for one-third of new HIV infections outside of sub-Saharan Africa, including around 354,000 people in the U.S.

Some 34.2 million people worldwide are living with HIV, and 2.5 million were infected last year. Since the first reports of AIDS surfaced 31 years ago, a staggering 30 million people have died from the virus.


SECRETARY OF State Hillary Clinton, who was interrupted by protesters, seemed to welcome the controversy. "What would an AIDS conference be without a little protesting?" said Clinton. "We understand that." Referencing the needs of injection-drug users, she vowed that she is "here today to make it absolutely clear the U.S. is committed and will remain committed to achieving an AIDS-free generation."

But some activists are less than happy with the Obama administration's record on fighting the AIDS epidemic. In the name of austerity, President Obama has proposed cutting funding for the President's Emergency Plan for AIDS Relief (PEPFAR) by approximately $214 million in fiscal year 2013.

In the words of Michael Weinstein, president of the AIDS Healthcare Foundation, which provides free HIV/AIDS medical treatment to some 125,000 people in 26 countries:

With this one stroke, the president seeks to gut the most successful foreign aid program since the Marshall Plan. We simply don't see how the U.S. can increase the number of people receiving treatment by 50 percent while simultaneously cutting the main program by 10 percent.

Further, we are very concerned that shifting funding to the Global Fund, which unlike PEPFAR has had very serious issues of corruption and waste, is a deliberate effort to set the stage for future reductions should the Fund prove to be unable to spend the money effectively. Without increasing funding to levels already authorized by Congress, just holding steady against the epidemic, let alone achieving an "AIDS-free generation," is simply empty rhetoric.

One of five protest marches at the conference took to the streets on July 24 to call for decriminalization of sex work and drugs, arguing that this would lead to the practice of safer sex. This march and four others eventually joined up and then ended with the arrest of 13 people for hanging AIDS ribbons on the White House fence and refusing to clear the street in front of the White House.

Meanwhile, in Kolkata, India, more than 1,000 sex workers from all over the world met for a five-day "Sex Worker Freedom Festival" conference to demand an end to discrimination and to give voice to those excluded from attending the conference in D.C. The festival program focused on several rights that sex workers must be granted, including, "Freedom of movement and to migrate, to access quality health services, to work and choose occupation, to associate and unionize, to be protected by the law, from abuse and violence, and from stigma and discrimination."

AIDS activists gathering in India have denounced conditions attached to global AIDS funding, criticizing policies that marginalize sex workers and damage the response to the epidemic. For example, international organizations that apply to receive PEPFAR funding must sign an "anti-prostitution pledge," which also prohibits them from providing services that could be perceived as supporting sex work.

"We can't even apply for PEPFAR because we wouldn't sign the pledge," said Daisy Nakato, a member of Wonetha, a Ugandan human rights organization founded by sex workers in 2008 to combat abuse and violence against them by the police. Nakato argues that advocacy and funding are key to better health and social and economic conditions for sex workers. According to the UN, less than 1 percent of global funding to prevent HIV and AIDS is spent on sex workers, despite disproportionately high infection rates.

"If you want to stop HIV, you need to engage with and work with sex workers in prevention services and treatment services," said Andrew Hunter, president of the Global Network of Sex Workers Project.


REGRESSIVE AND prohibitionist policies don't just affect sex workers elsewhere in the world. In New York City, women are judged by what they're wearing as well as by what they carry in their purse to protect their health. Tanya B., a Latina transgender sex worker in Queens, testified in a recent report issued by Human Rights Watch:

I was stopped and threatened. The cops said, "Empty your purse." I cleared out everything, but left the condoms at the bottom--I got caught. They said, "How come you didn't pull out the condoms? I can arrest you because of this." I said, "It's not a problem. I have no weapons, no drugs." And the police officer said, "Next time, I will arrest you because this is evidence you are a prostitute." Police are seen by the sex worker community not as protectors but as possible predators.

The war on sex work has endangered public health by denying public services to vulnerable communities. If government policies refuse to protect sex workers from brutality by the police, sex workers have every right to protect their health without it landing them in jail. Likewise, injection-drug users have a right to needle exchange programs that provide clean needles and a right to education about protecting their health.

AIDS activists have worked hard to turn back the tide on the stigma associated with HIV, but the continued criminalization of sex work and injection-drug use will require new organizing. Through actions, education and speak-outs, sex workers and harm-reduction activists are putting pressure on the current administration to live up to its commitments.

This is just the beginning of a renewed fight for resources and public services to end AIDS. HIV is not a crime, but criminalizing it is.

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