US anti-prostitution pledge affecting HIV prevention

The US government’s “Anti-Prostitution Pledge” is restricting HIV prevention programmes for those it seeks to protect, according to a new review of US HIV/AIDS funding. In January 2003 US president George Bush announced $15 billion [US dollars] would be made available for programs to tackle the HIV/AIDS epidemic. But in order to receive these funds organisations must show they have policies that explicitly oppose prostitution and sex trafficking. This so-called "anti-prostitution pledge" might be creating more problems than it solves, according to an analysis published in the journal PLoS Medicine written by Chris Beyrer, director of the Center for Public Health and Human Rights at the John Hopkins Bloomberg School of Public Health in Baltimore, together with the centre’s senior research coordinator Nicole Franck Masenior.

They analysed the scientific evidence for strategies that effectively reduce rates of HIV among sex workers and found a substantial number of studies suggest the empowerment, organisation and unionisation of sex workers can be an effective HIV prevention strategy. It can also reduce the other risks associated with sex work, including violence, police harassment, unwanted pregnancy and the number of underage sex workers.

But there is evidence that the anti-prostitution pledge has affected several programmes outside the US, such as the Lotus Project in Svay Pak, Cambodia, the researchers say.

The project offered a range of services to sex workers, including primary healthcare and lessons in English and computers. Although the project was funded initially by Médicins Sans Frontières it was handed over to a local organisation funded primarily by the United States Agency for International Development (USAID). But USAID funding from the project was cut after raids by US-funded anti-trafficking groups - despite a study which showed that only a small number of the women felt they had been forced into sex work. This cut in funding led to the project’s closure.

The authors argue that the pledge’s conflation of prostitution and sex trafficking means women and men who voluntarily sell sex could be at risk of further marginalisation and be less likely to get the health, social and education services they need to move out of the industry. Dr Beyrer said: “While sex work may be seen by some as inherently degrading, it’s a fact that in many settings sex workers choose to continue to work and demand prevention and other health services.”

“Building trust and showing care by providing sex workers with tools necessary to stay alive, whether they are condoms, counselling or medical attention, is our duty as health professionals and human beings.”

Although the pledge has been the focus for a number of legal challenges in the US there is a risk that it is also hampering domestic programmes for HIV/AIDS prevention and control, the authors add.

Parallels can be drawn between this and problems implementing HIV prevention programmes for injecting drug users in the US, they say.

There is overwhelming evidence for the effectiveness of needle and syringe exchange programmes as HIV prevention tools. But setting up these schemes in the US has been hampered by the refusal of federal government to support them.