Anti-Prostitution Pledge May Hinder Global HIV Control Efforts

The language of an anti-prostitution pledge, required for recipients of U.S. HIV prevention funds, may hinder efforts to control the global spread of HIV, according to a scientific review by researchers at the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health. “The Prostitution Pledge” requires that all grantees receiving U.S. funds must have a policy explicitly opposing prostitution and sex trafficking. Compliance with the pledge also bars activities viewed as supporting prostitution that are funded by private grants. Because the pledge applies to privately funded activities, the researchers concluded that the pledge may restrict HIV programs that have policies calling for decriminalization or legalization of sex work. The review was published on July 23, 2007, in PLoS Medicine.

For the review, Nicole Franck Masenior, MHS, and Chris Beyrer, MD, MPH, analyzed the existing peer-reviewed scientific evidence on strategies that effectively reduce rates of HIV among sex workers. They found a substantial number of studies suggesting that the empowerment, organization and unionization of sex workers can be an effective HIV prevention strategy and can reduce the other harms associated with sex work, including violence, police harassment, unwanted pregnancy and the number of underage sex workers. The researchers found few studies indicating a direct impact of the pledge on prevention initiatives, but they do cite accounts of several non-U.S. programs that were forced to close, such as the Lotus Project in Cambodia. The Lotus Project provided primary health care to sex workers and received U.S. funds for research.

“While sex work may be exploitative and is illegal in many jurisdictions, sex worker advocates and HIV prevention program leaders generally concur that sex workers themselves need services, protection, peer outreach and support from health professionals to reduce their risk of HIV infection,” said Masenior, lead author of the study and senior research coordinator with the Center for Health and Human Rights.

“The evidence suggests that as long as prostitution and sex trafficking remain conflated, women and men who voluntarily sell sex may be at risk of being further marginalized and therefore less likely to receive the health, social and education services they need to eventually move out of the industry,” said senior author Beyrer, director of the Center for Public Health and Human Rights and professor in the Department of Epidemiology at the Bloomberg School of Public Health.

The U.S. anti-prostitution pledge is the subject of an ongoing legal challenge, which claims that the pledge violates the U.S. Constitution’s right to free speech. The findings of Masenior and Beyrer’s scientific review were previously presented in a declaration for the court in the case of Alliance for Open Society International versus the United States Agency for International Development (USAID).

“While sex work my 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, counseling or medical attention, is our duty as health professionals and human beings,” said Beyrer.

Dr. Beyrer serves in an unpaid position on the Global Health Advisory Committee of the Public Health Program of the Open Society Institute, an affiliate of the plaintiff Alliance for Open Society International organization. He was not a member of the committee at the time the amicus brief was written.