Empowering Our Generation: Mexico City Youth Pre-Conference

Brian Ackerman

At the Mexico City Youth Force Pre-Conference, we are readying ourselves to fight the battle against HIV and AIDS as our generation matures.

is a rare occurrence, for a 21-year-old, to look around at an international
conference and realize that it is being entirely run by peers of the
same age. More than rare, it is inspiring. The Youth Pre-Conference,
organized and implemented by the Mexico Youth Force, is a bilingual
(English and Spanish) three-day preparation conference for young attendees
of the 2008 International AIDS Society Conference in Mexico City.
Our energy, enthusiasm, and passion for both fighting the global HIV/AIDS
epidemic and supporting those living with HIV and/or AIDS are nothing
short of incredible.

particular, during my first day, I attended a session on being a strong
ally of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities.
Not surprisingly, the room was not filled with heterosexual and cisgender
individuals ("cisgender" refers to those who have the same gender as their assigned sex) , but rather,
with young people that self-identified as sexual minorities from all
around the world. A young LGBTQ activist from Turkmenistan facilitated
the discussion.

the hour and a half allotted for the session, we spent the first 50
minutes simply discussing various terms to explain the expansive array
of sexual and gender identities that are different from heterosexual
and cisgender. We debated the meanings of transvestite, travesti,
transsexual, transgender, bisexual, pansexual, FTM (female-to-male),
MTF (male-to-female), homosexual, heterosexual . . . and many others.
In that discussion, however chaotic it may have seemed, we collectively
recognized the cultural determinants of sexual identity formation and
the social construction of marginalization. We noted that in many
countries with the worst HIV epidemics, being a sexual minority is not
a particularly easy identity to have in society, while in some it is
completely criminalized. We connected social marginalization with
vulnerability to HIV transmission and explored ways in which we, at
our own organizations, could respond to various scenarios involving
LGBTQ youth in need of support.

marginalization of sexual minorities is, to my knowledge, not what most
people would consider breaking news. However, I describe this
session in detail because it effectively illustrates the significance
and meaning of the youth pre-conference overall. While allying
with and between different youth communities can be challenging, when
young people are given the resources needed to have the opportunity
to collaborate with one another in deep discussion and analysis, incredibly
substantive conclusions can be drawn and we can educate one another
based on our experiences on how to overcome daunting sociopolitical

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and bilingual, the pre-conference itself is also what some objective
observers (and participants) might describe as seemingly chaotic.
But judging by the incredible sessions, exchange of ideas, and networking,
we are preparing ourselves quite well for participation at one of the
largest international conferences in the world. We are sharing
with one another our successes and failures in advocating for better
policies and for better implementation of policies. We are
readying ourselves to fight the battle against HIV and AIDS as our generation
. Pretty empowering, no? I think so too.

Commentary Sexual Health

Building Solidarity to Overcome Invisibility: Sex Workers and HIV-Focused Activism

Anna Forbes

Even as federal agencies and public health organizations have taken steps to address HIV in vulnerable populations, sex workers have been left out of the conversation.

Researchers from the Centers for Disease Control and Prevention (CDC) in February published a study of HIV rates among female sex workers in the United States. The authors of the review—which was limited to female sex workers because research on genderqueer, transgender, and male sex workers in the United States is almost nonexistent—acknowledged that the prevalence of HIV in this group is high. They also noted, however, that they had little material to work with: The paper reviewed 14 studies, of which only two were done in the last decade. Thus, the authors note, “The burden of HIV among this population remains poorly understood.”

This shocking paucity of recent data is a result, in large part, of the withdrawal of federal funds for research on “prurient” topics imposed during the George W. Bush administration. That shift to the right had a chilling effect on the federal HIV response as a whole—an effect that has been most enduring with regard to sex workers. Overwhelmingly, even as federal agencies and public health organizations have taken steps to address HIV in other vulnerable populations, sex workers have been left out of the conversation. This omission is one that HIV-focused activists, at the urging of sex worker rights organizations, are starting to notice.

Most countries recognize men who have sex with men (MSM), people who inject drugs, and sex workers as their primary “key populations”—defined, in United Nations terms, as “groups of people who are more likely to be exposed to HIV… and whose engagement is critical to a successful HIV response.” The U.S. government, however, recognizes the first two, among others, as key populations, but not sex workers. Virtually no federally funded HIV prevention and care services are targeted specifically to sex workers in the United States, although, ironically, U.S. funding does support some good HIV prevention programming for sex workers overseas.

Here at home, they remain largely overlooked. The CDC’s HIV Behavioral Surveillance System (HBSS) only alludes to sex workers indirectly as a subgroup of “heterosexuals at risk of HIV infection” who “exchange sex for money or drugs”—a designation that, obviously, ignores their diversity on multiple levels.

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Meanwhile, the National HIV/AIDS Strategy Update, a federal blueprint for our national response written by the Department of Health and Human Services’ Office of National AIDS Policy, mentions gay and bisexual men 35 times, youth 23 times, transgender people 19 times, people who inject drugs 18 times, and incarcerated people twice. It does not mention sex workers—as such or by any euphemism—even once.

This virtual invisibility was reflected at this year’s National HIV Prevention Conference in Atlanta, billed as the “preeminent conference for scientists, public health officials, community workers, clinicians, and persons living with HIV.” Of the hundreds of abstracts presented via panels, posters, and roundtable discussions, only four mentioned sex workers as a distinct and relevant population to consider at this conference.

At a “listening session” on the NHPC’s third day, I asked Conference Co-Chair Jonathan Mermin—the director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention—about the lack of data on sex workers and HIV. He acknowledged that the CDC has not collected the kind of data on HIV vulnerability among sex workers that it collects on other key groups.

This lack of inclusion is nothing new. In 2012, when the massive bi-annual International AIDS Conference took place in Washington, D.C., many foreign attendees with sex work or drug-using histories couldn’t get U.S. visas to attend.

Four blocks away from the two adjacent luxury hotels where NHPC was held, the HIV Prevention Justice Alliance (HIV-PJA) convened a free “People’s Mobilization on the National HIV/AIDS Strategy Counter Conference.” Nearly 100 participants signed in at its meeting space—some of them unable to afford NHPC registration and some dividing their time between the two conferences.

In the middle of the NHPC’s opening plenary, AIDS Foundation of Chicago organizer Maxx Boykin walked unannounced onto the stage, along with seven other Counter Conference participants, to protest the omission of sex workers from the National HIV/AIDS Strategy Update. “At this conference we talk about getting to zero new infections and ending the epidemic,” he said, “but we will never get there without tackling sex workers’ rights.” The group left the stage to substantial applause.

In contrast to the NHPC, the Counter Conference offered a striking example of HIV-focused advocacy groups joining sex worker rights organizations to address this exclusion. In the process, the collective also examined how structural factors such as housing, gentrification, and displacement affect people’s HIV risk and their HIV prevention and treatment choices.

Rather than choosing among hundreds of presentations, Counter Conference attendees met in plenary with experts leading discussions on topics that included the intersections of HIV criminalization, mass incarceration, and the war on drugs; the barriers to reproductive and sexual health care facing youth and women living with HIV; the escalating difficulty of getting HIV prevention and care in southern states without Medicaid expansion; the links between unemployment, economic injustice, and disparities in HIV-related outcomes; the health care and quality-of-life challenges faced by transgender people; and the need to develop solidarity between HIV and sex worker rights advocates.

At the latter panel, four leaders in sex worker rights organizations recommended that HIV activists learn more about their local and state laws on sex work. Magalie Lerman, representing the Sex Workers Outreach Project, observed that “the political and social environment in the [United States] contributes to negative outcomes for people in the sex trade” in all kinds of ways.

It is not unusual, for example, for police and prosecutors to use the possession of multiple condoms as evidence of someone’s intention to sell sex. This practice has been exposed and subsequently prohibited in a few cities, but is still a common practice elsewhere. It both discourages condom use—thus heightening HIV risk—and provides another tool for unjustly arresting marginalized people, including sex workers and those profiled as sex workers, which frequently includes transgender women of color.

Lack of funding for sex worker-specific HIV prevention and outreach work is another issue where joint advocacy is needed. Lerman urged HIV-focused organizations to “deal us in on HIV prevention funding streams” and collectively demand resources to support local, peer-led empowerment programs that have proven effective in reducing HIV rates. Such projects received less than 1 percent of all HIV prevention funding worldwide in 2009, the most recent year for which data is available. Domestic data on funding for this is, of course, nonexistent.

Another high priority was staff training and program adaptations to make HIV service agencies more accessible to sex workers. Panelist Deon Haywood represented Women With a Vision, a New-Orleans based organization providing harm reduction and HIV prevention services to Black women since the 1980s. She mentioned the need to “make the people running the organization look more like the people coming through the door.” She said this could be done by hiring peer counselors with lived experience in the sex trade and ensuring that their jobs were designed with room for advancement.

Panelist Cassie Warren from Chicago’s Howard Brown Health Center, meanwhile, talked about how agencies could expand their hours, locations (using mobile van services), and strategies to reach street-based youth engaged in survival sex. While the process of investigating and resolving existing barriers to care is labor-intensive, she said, HIV-focused service providers can’t expect to engage with high-risk youth without doing such work.

Building cross-sectoral communication and trust is another major challenge. Panelist Stella Zine, founder of the peer-driven support group Scarlet Umbrella Southern Art Alliance, pointed out that sex work can be a “heavy term” for some people. She urged participants to learn how to talk about HIV and sex work carefully, using language acceptable to people who need services but do not self-identify as sex workers.  

When working with organizational partners rather than clients, on the other hand, Haywood cited a willingness to name the issues on the table explicitly—and to point out incidents where issues are misnamed or avoided—as essential to solidarity building. For example, Haywood commended the Counter Conference for bringing an explicit racial analysis to its discussions, an aspect she found missing at the NHPC.

The central theme of the session was “nothing about us without us.” Having been ignored and forcibly silenced in so many other settings, the panelists emphasized that sex worker rights advocates will partner with allies willing to ensure that sex workers are at the table whenever funding, policy, and strategy decisions affecting sex workers are under discussion.

After the sex workers panel, some of us walked back to the NHPC to attend the “listening session” mentioned above, where I raised the issue of sex worker invisibility. Dr. Mermin responded by acknowledging the gap and advised us of the CDC review published in February. He warned us, however, that this new paper would not contain the kind of key population data on sex workers that is being collected in other countries.

Indeed, the CDC’s website currently states that “there are few population-based studies of sex workers in the United States or globally” (emphasis added) due to their illegal status. In international terms, that assertion is badly outdated. A plethora of studies on sex workers and HIV have been published in the last five years, showing clearly that punitive approaches to sex work exacerbate HIV spread. Public health and rights-based approaches, on the other hand, not only reduce HIV rates substantially, but are cost-saving to boot.

Silencing groups by excluding them from pivotal conferences and omitting them in national strategic planning are forms of overt discrimination, as is simply refusing to include them accurately in population surveys. If uncounted, they do not officially exist and do not have to be served. This political decision results in an absence of much-needed evidence.

Dr. Mermin added, however, that we don’t have to wait for solid numbers or data to increase national efforts to deliver services successfully targeted to sex workers. Was he signalling a federal shift, at last, toward the public inclusion of sex workers in our national HIV response? Hard to tell—but the odds of that occurring are undoubtedly better if pressure for such inclusion escalates.  

Commentary Sexual Health

LGBTQ Youth Deserve ‘Real Education’ About Sexuality

Gloria Malone

The lack of LGBTQ-inclusive, comprehensive, and medically accurate sexual and reproductive health education is a public health concern that many lawmakers, educators, and doctors are letting slip through the cracks.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

A recent study published in the American Public Health Journal found that New York City youth who identify as lesbian, gay, or bisexual were more likely than heterosexual-identifying youth to experience a pregnancy. This research comes at a time when many cities are facing sexually transmitted infection (STI) outbreaks. Taken together, these data show widespread need not only for comprehensive sexual health education, but LGBTQ-inclusive sex ed in particular.

The lack of LGBTQ-inclusive, comprehensive, and medically accurate sexual and reproductive health education is a public health concern that many lawmakers, educators, and doctors are letting slip through the cracks.

As Reuters Health reported, the study’s researchers reviewed information from roughly 10,000 ethnically and racially diverse high school students in New York who had sex with a member of the opposite sex. Among other things, they found that “about 13 percent of heterosexual females and about 14 percent of females who only had male sexual partners had been pregnant, compared to about 23 percent of lesbian or bisexual females and about 20 percent of girls who had male and female sexual partners.” Additionally: “About 10 percent of heterosexual males and those who only had female sexual partners experienced a pregnancy, compared to about 29 percent of gay or bisexual males and about 38 percent of males with female and male sexual partners.”

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While the study does not represent all lesbian, gay, and bisexual youth—only those who have had sex with someone of the opposite sex—it should give us youth advocates cause for concern. For starters, we know that curricula in half the states in this country stress abstinence. Unsurprisingly, many students aren’t following this advice, and since these students are not prepared for sexual encounters, there have been a number of outbreaks of various STIs nationwide, from California to Montana to Texas. Advocates for comprehensive sexual health education have long said that abstinence-only sex education is not adequate enough. This new study adds to a growing body of evidence showing the price generations are paying for limited access to information about sexuality and contraception.

Health-care professional Dr. Tonia Poteat was not shocked by the results of the American Public Health Journal’s research findings. She told Rewire (Rewire), “people make assumptions based on identity and not behaviors. This type of thinking informs the type of sexual health education we give.” Abstinence-only education, for example, puts an emphasis on hetero- and cis-normative language, which can have the effect of stigmatizing anyone who doesn’t fit neatly within the gender binary.

Dr. Poteat added that some youth might feel pressure to “find the right person to ‘fix’ them” and that this might lead to some of the unintended pregnancy outcomes.

As Nicole Cushman, the executive director of Answer, explained in a recent Rewire article, “deeper discussions in classroom environments are necessary to help students develop a more thorough understanding of sexual orientation and gender identity …. This understanding is essential in creating inclusive and safe school environments for all students.”

Sadly, as Colored Girls Hustle founder and Echoing Ida writer Taja Lindley has pointed out, the dearth of information on safe sex for LGBTQ youth extends beyond the classroom: In her experience, which she wrote about here, even at the doctor’s office the needs of LGBTQ youth are not acknowledged or addressed in a responsible way.

LGBTQ-inclusive education wouldn’t just help prevent unintended pregnancies; it would also help educators, policymakers, parents, medical professionals, and young people better understand the complexities of sexual orientation and gender identity.

A complete overhaul of the sexual health education in the United States is integral to helping society at large better understand individuals who identify differently than they do. Advocates see the Real Education for Healthy Youth Act, which has not yet reappeared in Congress since its introduction in 2013, as a step toward filling this gap in sex education on a policy level.

The Real Education for Healthy Youth Act calls for sexual health education to discuss healthy relationships, reproduction, sexuality, and consent in addition to safer sex information with LGBTQ-inclusive language. Not only would LGBTQ-inclusive sexual health help reduce unintended pregnancy and the growing rates of STIs among young people, it also helps to inform youth about sexual health earlier on since the act supports K-12 training for sex educators. In addition, early education can help fight stigma on a cultural level.

When asked what LGBTQ-inclusive sexual health education would look like, Quita Tinsley, a queer activist and youth organizer for SPARK Reproductive Justice Now, explained to Rewire, “Sexual health education should provide anatomically accurate information without [an explicit focus on] gender roles or the gender binary. In doing so the education can help affirm students’ gender identities and sexualities.”

Tinsley also suggested it include “forms of protection outside of latex penis condoms, it would provide information on sex outside of vaginal penetration, it would include information on masturbation, and it would include gender-neutral language.”

Tinsley’s suggestions would directly address sexual health disparities between heterosexual and LGBTQ youth. Because sexual health education is geared toward a hetero- and cis-normative audience, LGBTQ youth are not receiving the information they need to protect themselves from all sexual activities and to enjoy the wanted experiences they do encounter. As a country, we cannot continue to discuss the need for medically accurate comprehensive sexual health education without talking about LGBTQ inclusive language, strategies, and curricula. Our LGBTQ brothers and sisters need it.