Jamaican Health Official Calls for Sex Work Decriminalization

Danielle Toppin

A senior public health official in Jamaica recently called for decriminalization and taxation of commercial sex work. Other government officials decried the proposal, but have few effective suggestions of their own.

When I was a teenager, some of
my male friends (with me in tow) would, on occasion, drive through the
dark streets around Barbados’ horseracing track in search of prostitutes.
For us it was a joke to drive by these women and try to see their faces.
I don’t think that at any point I ever saw those women as human, but
rather as mythical figures that represented the ultimate taboo.
The silhouettes of these unknown women standing on the side of the streets
and looking defiantly at a group of obviously bored teenagers was
like our venture into an unknown and highly forbidden world, a world
that I personally found both captivating and scary all at once.

For many people, prostitution
still maintains that almost-mythical status, a practice that many see
as the ultimate representation of the under-bellies of our societies.
Despite the pervasive nature of commercial sex work , which is
commonly referred to as "the oldest profession in the world," the
pracitce typically remains hidden. As with most hidden acts, in particular
those of a sexual nature, attempts to bring them to light are met with vehement opposition from moralists, who fear the impact that
such exposures will have on already "decaying" societies.

We saw this dynamic play out recently in Jamaica, following the assertion by Dr. Keith Harvey, a senior public
health official,
in the Government
that prostitution should be decriminalized, and further, that commercial
sex workers should be taxed as a means of generating income to
promote sexual health care.

As expected, the suggestion
that the taxation of sex workers could provide much-needed funds to support
education and rehabilitation programs to improve the sexual health
of vulnerable groups, such as sex workers themselves, has been met with strong opposition.
Responding to the proposal, leader of the Opposition
Party, the People’s National Party (PNP) Portia Simpson-Miller forcefully stated that sex workers need more skills training opportunities, calling on the government
to invest its energy in this area rather than in the decriminalization
and regulation of sex work.

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Similarly, the Jamaican
Prime Minister, Bruce Golding, has openly condemned the statement made
by Dr. Harvey, assuring the public that his government
has no such intentions. Golding also went a step further to warn
that in the future, public officials can face
serious sanctions
if they
make public statements that run "counter to Government policy."

The suggested decriminalization
of commercial sex work was proposed as a viable form of regulating the now-unofficial
industry, potentially bringing in approximately up to JMD 3 billion
(approximately USD 428 million) annually. These much needed resources
could then be used to educate sex workers about effective condom use, and also
towards the facilitation of a safer, regulated sex work environment, thereby
reducing the transmission of HIV and other STIs within this vulnerable
group.

This comes against the
backdrop of a political and policy environment in which there has typically
been "little support…for messages of intervention dealing with
risk reduction and increased access to treatment and care targeted at
certain at risk groups, among them sexually active minors, men who have
sex with men, incarcerated men, commercial sex workers and those in
places where other forms of transactional sex are practiced."

The absence of an enabling
environment has translated into inefficient support to make substantial
changes in protecting the rights and lives of those who fall within
these groups.

Admittedly, Jamaica, with
its strong presence of a vocal fundamentalist Christian society, is
not a country in which I can see the legalization of sex work happening without a fight. However, with research showing that (i) one in every four HIV-positive
poersons reported having had sex with a sex worker at some point, and (ii)
that the rate of infection in the sex industry is three times that of
the general population; it would be remiss of us as a society to ignore
the urgent health care challenges that the lack of regulation presents.

It is one thing to criticize
the suggestion to decriminalize and regulate the commercial sex work industry, but the
lack of strong alternative solutions to protect the lives of this vulnerable
group becomes a glaring shortfall in the arguments put forward by moralistic
factions. If not regulation, then what? The recent debate has
highlighted the need for wide-scale consultations that will address
alternatives. We cannot stand on moral principles alone. Let’s face
it; such approaches have not typically had a strong history of success
in protecting the lives and liberties of vulnerable groups, who by their
very existence challenge the status quo.

News Law and Policy

Obama Administration Once Again Steps Up for Transgender Rights

Jessica Mason Pieklo

A regulation to be published this week mandates all employees and visitors at federally operated facilities have access to restrooms that align with their gender identity.

The Obama administration this week made another push for advancing transgender rights, announcing a new regulation that requires all people at federally operated facilities, whether an employee or visitor, have access to restrooms consistent with their gender identity.

As reported by Buzzfeed, the regulation, which will be posted this week in the Federal Register, will affect thousands of people and about 9,200 properties operated by the federal government. Those facilities employ roughly 1 million federal civilian workers.

The regulation makes clear that transgender people do not need to complete any medical procedure to qualify to use the restroom that aligns with their gender, nor can transgender people be restricted to single-occupancy restrooms.

This is the latest move by the Obama administration to advance transgender rights in both the workplace and schools. Federal agencies such as the Equal Employment Opportunity Commission and the U.S. Department of Education have issued guidances that state discriminating against transgender people by mandating they use restrooms and facilities that align with their biological sex rather than their gender identity violates federal civil rights laws.

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More than 20 states run by Republican lawmakers have pushed back against the administration’s efforts to protect transgender people from discrimination at work and at school, filing a federal lawsuit arguing the Obama administration has overstepped its authority in issuing the guidance. Those lawsuits argue that legal bans on sex discrimination do not cover transgender rights.

That question—whether existing civil rights laws and their prohibitions on sex discrimination prohibit discrimination against transgender people—could be the next big civil rights case to land before the Supreme Court.

A Virginia county school board adopted a policy that mandates students in their schools use restrooms that align with their biological sex rather than gender identity. Gavin Grimm, a Virginia student, challenged the policy, arguing it violated his civil rights.

Both a federal court and the Fourth Circuit Court of Appeals agreed with Grimm and blocked the school from enforcing the policy. The Roberts Court this month stepped in and ruled the policy should take effect while the Court considers the school board’s request to take Grimm’s case next term. In the meantime, Grimm will start the school year with his school’s policy in place.

News LGBTQ

Dignity Health Sued Over Refusal to Offer Insurance Coverage for Transition-Related Care

Imani Gandy

“I was shocked when Dignity, which is supposed to be in the business of healing and holds itself out to the public as a bastion of ‘human kindness,’ told me they would not authorize insurance coverage for my doctor-prescribed treatment,” Joe Robinson said in a statement released by his attorneys at the American Civil Liberties Union (ACLU).

Joe Robinson, a transgender man and operating room nurse at a Dignity Health medical center in Arizona, has alleged in a lawsuit filed Monday that his employer’s insurance policy of depriving coverage for gender dysphoria is discrimination on the basis of sex, in violation of Title VII of the 1964 Civil Rights Act.

Because Dignity Health, which operates the fifth-largest health-care system in the country, excludes insurance coverage for gender dysphoria—or “sex transformation surgery,” as the insurance policy states—Robinson has borne the cost of his transition treatment. This included hormonal therapy and a double mastectomy. According to Robinson’s complaint, he requested coverage for phalloplasty, but his claim was denied; he says he cannot afford to pay for that surgery out of pocket.

“I was shocked when Dignity, which is supposed to be in the business of healing and holds itself out to the public as a bastion of ‘human kindness,’ told me they would not authorize insurance coverage for my doctor-prescribed treatment,” Robinson said in a statement released by his attorneys at the American Civil Liberties Union (ACLU).

“All I want is the same health benefits other, non-transgender Dignity employees receive, which is coverage for medically necessary treatments,” he continued.

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On May 16, the Equal Employment Opportunity Commission (EEOC), the federal agency tasked with enforcing workplace anti-discrimination laws, determined that Robinson could proceed with a lawsuit against Dignity Health. That lawsuit, which was filed in federal court in California, alleges that Dignity Health’s policy singles out transgender employees employees for unequal treatment.

In response to Robinson’s original EEOC complaint, Dignity Health claimed that its policy was not discriminatory because “health benefits under the Dignity plan are not provided for any personality disorders, including sexual/gender identity disorders and behavior and impulse control disorders.”

Robinson counters that the medical community does not consider gender dysphoria to be a “personality disorder.” His complaint notes that insurance companies have previously excluded coverage for transition-related care based on the erroneous assumption that such treatments were cosmetic and experimental—assumptions, he says, that have no basis in medical science today.

The World Professional Association for Transgender Health has published standards of care for gender dysphoria that have been recognized as authoritative by leading medical organizations, the U.S. Department of Health and Human Services, and federal courts, according to the complaint. Under those standards, it reads, medically necessary treatment for gender dysphoria “may include hormone therapy, surgery (sometimes called ‘sex reassignment surgery’) and other medical services that align individuals’ bodies with their gender identities.”

In September of last year, Robinson’s fiancée, who also works at Dignity Health, emailed Dignity Health’s CEO, Lloyd Dean, to ask him to remove the “sex transformation” exclusion from the company’s health plan so that Robinson could receive coverage for his medically necessary care, according to the complaint.

Nearly two months later, the complaint continues, Dignity Health’s chief human resources officer informed Robinson’s fiancée that Dignity Health had found no evidence of discriminatory practice in the administration of its health plan.

Robinson’s lawsuit comes at a crucial time in the legal battle for transgender rights. The primary focus of that battle has been on bathrooms, with states and school boards across the country rushing to propose discriminatory legislation that prohibits transgender people from using the bathroom that aligns with their gender identity.

Eleven states and state officials in late May filed a joint lawsuit challenging the Obama administration’s “Dear Colleague” letter sent to public schools nationwide, arguing that the letter, which says Title VII and related statutes protect transgender people from discrimination under the federal definition of “sex,” is beyond the scope of the administration’s authority.

North Carolina, meanwhile, is embroiled in a pair of lawsuits with the Department of Justice over HB 2, the recently enacted legislation that forces transgender North Carolinians to use the bathroom that does not align with their gender identity in public buildings and schools. Gov. Pat McCrory (R) sued the Obama administration for its “radical reinterpretation of Title VII of the Civil Rights Act of 1964 which would prevent plaintiffs from protecting the bodily privacy rights of state employees while accommodating the needs of transgendered [sic] state employees.”

Also in North Carolina, Joaquín Carcano has sued the state, alleging that HB 2 discriminates against him and all transgender people on the basis of sex in violation of Title VII and Title IX of the U.S. Education Amendments of 1972.

Robinson’s attorneys see his lawsuit as complementing the ongoing lawsuits regarding bathroom discrimination.

“Transgender people continue to face discrimination in a wide array of contexts, including employment, housing, education, healthcare and more,” ACLU staff attorney Joshua Block wrote to Rewire in an email. “In each of these contexts, as courts are recognizing that discrimination against transgender people is discrimination on the basis of ‘sex,’ transgender people are finally able to fight this discrimination as a violation of our civil rights laws.”

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