ACLU: 'Engaging sex workers in HIV prevention efforts is essential'

Can the global HIV/AIDS epidemic be stopped without directly engaging with sex workers worldwide, essentially ignoring one of the population segments most at risk? Under a 2003 USAID policy, international NGOs have been forced to do just that.

This week the American Civil Liberties Union (ACLU) Women's Rights Project, the New York Civil Liberties Union (NYCLU), and the ACLU LGBT & AIDS Project filed an amicus brief on behalf of the American Humanist Organization and 24 other public health and human rights organizations and experts this week in Alliance for Open Society International, Inc. v. United States Agency for International Development, a case currently before the United States Court of Appeals for the Second Circuit.

Via ACLU.org:

"Private organizations should not be forced to choose between accepting U.S. funding and adopting a policy that alienates and stigmatizes many high-risk communities," said Alexis Karteron, staff attorney with the NYCLU. "Rather than advancing efforts to fight HIV/AIDS, this policy is actually making things worse by preventing organizations from reaching those who need their care and support the most."

At issue is a an amendment to the 2003 President's Emergency Plan for AIDS Relief (PEPFAR) and the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003. The amendment prohibits the grant of funds to “any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking,” and further prohibits grantees from “promot[ing] or advocat[ing] the legalization or practice of prostitution or sex trafficking,” a policy requirement that has come to be know as the "anti-prostitution pledge."

From the brief:

Previously effective, and in some cases internationally lauded, anti- AIDS programs have lost funding, and have shut down or reduced their programs, as a direct result of the Policy Requirement. Such programs include HIV prevention initiatives; clinical services for sex workers; the distribution of condoms, lubricant, and other HIV prevention tools; peer education regarding safer sex practices; and campaigns to end violence against sex workers. In turn, the destructive effects of the Pledge are felt by sex workers to whom local organizations previously provided the knowledge and tools necessary to stay alive. For example, in Mali, one of the poorest countries in the world, and a place where over a third of sex workers are living with HIV, the Pledge has resulted in a condom shortage and price increases, making it difficult for women in sex work to obtain condoms. This has almost certainly exacerbated the Malian AIDS epidemic. In Cambodia, young men engaged in sex work reported that when they requested sexual health information from a clinic funded by the Leadership Act through the United States Agency for International Development (USAID), doctors and counselors simply refused to answer their questions on the grounds that “It’s against the USAID anti-prostitution policy.”

In the brief, the ACLU and amici make two central arguments:

1. That the pledge is a free speech violation, that "Independent NGOs [Non-Govermental Organizations] maintain their first amendment right to speek freely on contested policy matters even when they accept government funding," and that the policy requirement "undermines political accountability by quashing dissent on a matterof public concern."

2. "The pledge requirement is invalid because it advances no legitimate government purpose, instead imposing orthodoxy with respect to a contested policy question," and, furthermore, has measurably impeded global efforts to stop the spread of  HIV/AIDS, effectively ended critical partnerships with international organizations, and stifled scientific and policy discussions among the world's HIV/AIDS experts.

In other words, for the last seven years USAID has been shunning and shedding critical partners in the battle to contain and prevent the spread of new HIV/AIDS infection as a matter of policy, such that less than one percent of global funding to combat HIV is directed toward sex workers, one of the highest-risk populations.

From the brief:

In 2008 an estimated two million people died of AIDS, and another 2.7 million became newly infected with the Human Immunodeficiency Virus (HIV), the virus that causes AIDS. In total, 33.4 million people are now infected with HIV. Because the vast majority of infections are sexually transmitted, the millions of people engaged in sex work worldwide are at heightened risk of contracting HIV. Nevertheless, less than one percent of global funding for to combat HIV is directed toward sex workers, who suffer from inadequate access to prevention, treatment, and other services. Moreover, engaging sex workers in HIV prevention efforts is essential to successfully combating the disease because sex workers can, and in many places do, act as powerful protagonists in the promotion of sexual health. As attested to by United Nations Secretary-General Ban Ki-moon, excluding sex workers and other marginalized groups from HIV prevention programs is both profoundly unethical and harmful to public health.

The full amicus brief can be viewed at: www.aclu.org/hiv-aids-womens-rights/aosi-vs-usaid-aclu-amicus-brief