The theme was “Turning the Tide Together” and there was much celebration of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the HIV prevention and treatment it has made possible all over the world.
PEPFAR has delivered millions of dollars of aid annually since its inception, including 6.4 billion dollars in southern Africa alone since 2004.
What needs to be mentioned, however, is the ways in which U.S. AIDS policy inhibits a true spirit of togetherness when it comes to the critical population of sex workers.
Sex workers are some of the people most at risk for HIV, AIDS and violence. But U.S. funding restrictions have worked against them and hurt the people who could most benefit from U.S. foreign aid, the people who, were they to receive services, are best placed to turn the tide of the epidemic.
PEPFAR includes a restriction against funding for any project that advocates for human trafficking or the legalization of prostitution.
That may not sound bad. HIV prevention programs, after all, should not be about promoting trafficking or sex work. And the law is not so oppressive. A non-discrimination clause binding U.S.-funded projects means that anyone is able to receive services. But the restrictions have nevertheless, in reality, led to the denial of services for sex workers in some places, in part because government guidance on what is allowed has been vague.
That vagueness has given some organizations an excuse to deprive sex workers of life-saving services.
For example, sex workers in South Africa, who are very much at risk of contracting HIV, have been prevented from sharing health information and anti-violence strategies as part of a PEPFAR-funded program and told that the anti-prostitution pledge is the reason for their exclusion.
PEPFAR funding restrictions have been applied more broadly than they were written.
For example, international organizations and governments are not subject to these restrictions, but some governments and U.N. organizations have been asked by PEPFAR implementers to comply with the restriction. Brazil declined $40 million of U.S. aid when the pledge was introduced because of this clause.
The restriction on promoting the legalization of prostitution has been re-phrased in U.S. funding contracts since 2010. This has meant that organizations are no longer required to develop a separate policy against sex work. Some, however, demand that partners develop such a policy before working together.
Vagueness and a lack of guidance have bred uncertainty about whether offering health care to sex workers is allowed or prohibited. This is how Cambodian sex workers were discriminated against and denied health services.
Despite good intentions, and in some places good effects, PEPFAR undermines effective programming with sex workers and contributes to their social isolation and poor health outcomes, especially as it relates to HIV and sexually transmitted infections.