William Smith's excellent piece on the impact the PEPFAR prostitution pledge is having on HIV/AIDS prevention work in Kafue, Zambia made me wonder how my home city of St. Louis, Missouri, would respond given the same conditions and limitations. Would an HIV/AIDS service organization (ASO) err on the side of caution or the true fulfillment of their mission? And what impact would those choices have on my community and my city?
HIV/AIDS is a global disease and St. Louis, like all cities, has residents at risk for HIV/AIDS infection and residents who are HIV positive or have AIDS. Also like most cities, St. Louis has prostitution.
Remove Zambia and insert America…remove Kafue and insert St. Louis…and the PEPFAR prostitution pledge still won't make sense because building a program that says people will have access to HIV/AIDS education, prevention and contraception unless they are prostitutes will never make sense regardless of where those people live.
I can't figure out if, by denying funds to groups that provide prevention outreach to sex workers, PEPFAR is trying to punish sex workers or terrorize people considering becoming sex workers. Either way, the prostitution pledge assumes that sex workers are less than human and outreach promotes prostitution. Both assumptions are wrong. Sadly, it is all too easy to attach different standards to the care of strangers far away in Africa. But Americans don't have to travel to examine the impact and need for outreach to commercial sex workers communities.
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I reached out to two local St. Louis ASOs, St. Louis Effort for AIDS and Williams and Associates, Inc., to find out what kind of HIV/AIDS prevention outreach they are doing to commercial sex workers and what they think of the prostitution pledge recipients of PEPFAR funding have to take.
Williams and Associates, Inc. seeks to "provide preventive health education, disease prevention, health promotion and care services that address the health disparities of minorities in the St. Louis Bi-State region, with particular regard to African-Americans." African-Americans comprise 51 percent of the population of St. Louis city and the offices of Williams and Associates, Inc. are located in the heart of predominately black North St. Louis city. The organization is funded by private foundations and receives some federal funds indirectly through the state.
Since being founded five years ago, Williams and Associates, Inc. has done outreach to the sex worker community. With a staff of four and several local volunteers, the program provides information on the importance of negotiating safer sex with clients. They provide testing and condoms and recruit people to participate in group programs designed to build self esteem.
When I asked Chief Executive Officer Erise Williams for his thoughts on the importance of HIV/AIDS prevention outreach to the sex worker community he said, "I think prevention is very vital. When we talk about HIV prevention we are really talking about risk reduction. I think it is very effective for this population because each time they engage in sex they are putting themselves at risk. You have a group of people who are putting themselves at risk more so than the average person. Any prevention we can do to reduce risk, change behavior and change lifestyle is a good thing. It has become more challenging because HIV prevention has become more political."
And then I asked Mr. Williams how he would feel if he were told that he could not do prevention outreach to the sex worker community or that doing such work would put his funding at risk.
"It would be suicide to be asked to not do outreach to sex workers. True, we have a significant number of HIV cases in St. Louis but I think it would be worse if we did not do prevention outreach."
St. Louis Effort for AIDS is the most comprehensive ASO in the metropolitan St. Louis area. Founded in 1985 by a group of concerned volunteers, Saint Louis Effort for Aids (EFA) provides education on the prevention of HIV/AIDS and comprehensive support services for those affected by the disease. Cyrano Jones of EFA works with commercial sex workers in St. Louis three days a week using a mobile testing unit. The unit varies the days of the week and strives to provide services during the day, afternoon and evening.
Jones says that most mobile outreach clients depend on prostitution as their sole source of income. If they have a substance abuse problem EFA will try to lead them to treatment. If they are in need of treatment services, EFA will provide them, and if they need assistance developing life skills, EFA will also help with that too.
Most importantly, EFA creates a risk reduction plan to help empower individuals to seek safer and healthier lifestyles.
"I feel I'm making a difference," said Jones, who has been doing prevention outreach to commercial sex workers since 1989, "The numbers are coming down and people are more educated about the virus and protection."
The women of my family have a saying that no cook should take a dish to a potluck she wouldn't serve her own family. Similarly, the US should not require pledges of organizations in other countries it wouldn't require of organizations here at home. The prostitution pledge only works to stigmatize sex workers and keep them separate from their communities and the HIV/AIDS service organizations there to serve them. People are not empowered through condemnation and communities are not empowered by this pledge. It's time to remove the limitations of the prostitution pledge and allow for comprehensive prevention outreach to commercial sex workers abroad.