Those Left Behind: PEPFAR's Missed Opportunity to Aid Sex Workers

by Margo Kaplan

The 2008 reauthorization of the Presidential Emergency Plan for AIDS Relief (PEPFAR) is an important step in the United States’ effort to become a leader in combating the global epidemic. However, while PEPFAR makes enormous resources available to HIV treatment and prevention efforts, the strings attached to these resources often undercut the most critical components of these endeavors. Most notable are PEPFAR’s provisions that require organizations receiving funds to adopt a policy explicitly opposing prostitution and sex trafficking and prohibiting organizations from using funds to “promote or advocate the legalization or practice or prostitution or sex trafficking.” These requirements exclude organizations that are most effectively promoting the rights and health of sex workers and preventing trafficking and exploitation.

Women and men engaged in sex work are clearly among the most at-risk communities. In addition to the physical risk that accompanies sex work, sex workers are severely marginalized in most societies. This marginalization prevents them from obtaining adequate health, social, and legal services and makes them more vulnerable to exploitation. Organizations with the most effective anti-AIDS and anti-trafficking strategies build trust and credibility among sex worker populations that enables them to work with sex worker populations. Effective strategies often use peer educators to earn the trust of sex workers, reduce their marginalization in society, and empower sex workers to demand condom use and prohibit trafficking. Indeed, the most successful efforts are often lead by sex workers seeking to protect themselves and each other from HIV and exploitation.
PEPFAR’s requirements essentially prohibit these tactics in favor of ones that further stigmatize sex workers. Since 2005, when USAID issued a directive applying the requirements to all programs receiving funds, the effects have been felt worldwide. In Cambodia, NGOs discontinued plans to provide English language classes for sex workers for fear that such programs would be interpreted as “promoting prostitution” and thus jeopardize their funding. Other organizations have been forced to forego U.S. funds altogether, such as SANGRAM, an Indian sex worker intervention that has been recognized as a “best practice” by UNAIDS. The Brazilian government recently rejected $40 million in Global AIDS money on the basis that the restrictions undermined the very programs responsible for reducing the spread of HIV in Brazil.
By maintaining the anti-prostitution requirements, the United States missed an opportunity to demonstrate a characteristic of true leadership: the ability to learn from past mistakes. Sadly, it will remain the most marginalized and vulnerable groups who pay the price.