Anti-Prostitution Loyalty Oath Undermines HIV Fight

In times like these, there is no denying that white supremacy, racism, and criminalization put Black, Brown and transgender people at severe risk of violence. The COVID-19 outbreak has disproportionately impacted Black and Brown people. Counties with higher populations of Black residents accounting for 52 percent of coronavirus diagnoses and 58 percent of coronavirus deaths nationally, according to a recent amfAR study. 

And, following the murder of George Floyd, the Black Lives Matter movement has once again demanded an end to the systemic inequalities and senseless violence against Black people by law enforcement. 

The life-or-death impact of hate and discrimination doesn’t stop there. When it comes to sex workers in the U.S. and around the globe, many of whom are Black, Brown and transgender, discrimination and criminalization of sex work have put them at a high risk of violence, contracting preventable diseases like COVID-19 and HIV, and have exposed them to police brutality. Yet the U.S. continues to weaponize life-saving global AIDS assistance programs against sex workers by demanding recipients of PEPFAR funding to officially adopt a position opposing prostitution and acquiesce to the U.S. conflation of sex work and trafficking. 

The Supreme Court has just ruled in favor of the Anti-Prostitution Loyalty Oath (APLO), a provision in the 2003 United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act, that required all recipients of funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) to “have a policy explicitly opposing prostitution.” The policy goes on to conflate consensual sex work with human trafficking, and refuses funds to non-U.S.-based organizations that do not have a policy explicitly opposing “prostitution and sex trafficking.” While a prior 2013 decision ruled that the APLO is unconstitutional as applied to U.S.-based organizations, Monday’s ruling declined to extend those protections to their foreign affiliates, a ruling that will further divide and hamper the global AIDS response. 

The APLO is and always has been a bad policy. There is no evidence that the policy improves health outcomes. In fact, there is evidence that it hurts them. 

Since the policy’s inception 17 years ago, the provision has done nothing to advance its stated goals of defeating HIV and AIDS and the trafficking of persons. 

This is despite the consistent and vocal leadership of members like Rep. Barbara Lee, who have consistently fought the dangerous, counterproductive, and inefficient aid conditionality of the APLO. 

Whereas there is no evidence that proclaiming opposition to sex work is an effective public health intervention, there is evidence that decriminalization of sex work would have an astounding impact on reducing the HIV epidemic, averting between 33-46 percent of new infections over a decade. Yet the APLO directly blocks organizations from halting the spread of HIV. 

Sex workers are disproportionately impacted by HIV and AIDS globally. Halting the spread of HIV simply cannot happen without trusted engagement and leadership from sex workers. Over the past 17 years, the policy has promoted stigma and discrimination of sex workers. It oftentimes blocks sex workers from engaging in the design, development, implementation, and assessment of HIV and AIDS programs and services. HIV prevention and treatment programs are more successful when they include sex workers involvement and leadership. For some organizations around the world, working with sex workers while declaring opposition to sex work feels hypocritical. It was for these reasons that Brazil rejected $40 million in U.S. global AIDS money in 2005, noting that such restrictions undermined the very programs responsible for Brazil’s success in reducing the spread of HIV. 

International health and development agencies including UNAIDS, UNFPA, UNDP, the WHO, and the World Bank have recognized the role that decriminalization of sex work plays in advancing public health outcomes while also advancing the human rights of sex workers. 

In conclusion, APLO is a punitive rule that makes it difficult for sex workers to access comprehensive, accessible and affordable health care. But everyone deserves access to quality care. Social stigmas that disproportionately impact and undermine the sexual and reproductive health rights of people across the globe do not belong in our nation’s foreign aid programs, and nothing should change that. 

Serra Sippel is president the Center for Health and Gender Equity.