News Sexual Health

Why Are Sex Workers Being Banned From Participating in the International AIDS Conference? A Call to Action on Sex Work and HIV

Darby Hickey

Sex workers and allies demand US policy change in lead up to the International AIDS Conference.

Part of Rewire’s coverage of the International AIDS Conference, 2012.

In July, the International AIDS Conference is being held in the United States for the first time in over twenty years, after the successful repeal of the ban on HIV-positive foreign nationals entering the US. However, US immigration law still bars entrance to anyone who has engaged in sex work in the past 10 years — even if they have no criminal convictions or work in a country where it is legal. This exclusion will prevent many current and former sex workers from outside the US from attending the conference. Yet sex workers and their clients are two of the populations at greatest risk of HIV infection.

Without the input, knowledge, and resources of those most directly affected by the disease, there is no chance of stopping the AIDS epidemic. To hold the government accountable for its harmful policies and in solidarity with those unable to attend the conference, US-based sex workers and allies collaboratively drafted A Call to Change US Policy on Sex Work and HIV – in consultation with numerous sex workers and sex worker-lead organizations in the US and abroad. We invite all people committed to ending AIDS to endorse this statement.

Structural issues drive HIV within the sex sector — criminalization and stigma compound health disparities already affecting those on the wrong end of racial, economic, and gender inequality. But when sex workers design and lead HIV prevention efforts, receive services and resources, and are supported to address social injustice, sex workers have successfully curtailed the spread of AIDS. For example, a decade of research documents the Sonagachi Project in India as an HIV prevention success story. Indigenous in origin and locally-led, the project is successful because of its focus on principles of empowerment enacted in a multidimensional spectrum — on individual, group, and structural levels — and the underlying premise of sex work as a valid profession.

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Such excellent rights-based efforts are undermined by US policies. SANGRAM is another Indian program working with sex workers — USAID even highlighted it as a best practices model. But SANGRAM has turned down USAID funding because of the Anti-Prostitution Loyalty Oath. This misguided requisite for US global AIDS funding stipulates that recipients condemn prostitution – and prevents them from using best practices such as peer leadership and empowerment programs with sex workers. The US imposes and continues to expand such harmful policies both domestically and abroad, putting sex workers at increased risk for HIV.

The removal of the Anti-Prostitution Loyalty Oath and other AIDS funding restrictions is one of the demands of the Call to Change. These four demands are based on research and the UN’s examination of the US human rights record via the Universal Periodic Review in 2011 – during which the US government agreed, “that no one should face violence or discrimination in access to public services based on… their status as a person in prostitution.”

  • We demand that the US repeal and eliminate restrictions on domestic and global AIDS funds (such as the President’s Emergency Plan for AIDS Relief’s Anti-Prostitution Loyalty Oath) and support evidence-based best practices for HIV prevention, treatment and care targeted at sex workers.
  • We demand that the US repeal the prostitution inadmissibility ground for immigration and provide non-judgmental social services and legal support for migrant sex workers, as part of comprehensive immigration reform.
  • We demand that sex workers not be subjected to arrests, court proceedings, detention, mandatory testing or government-mandated “rehabilitation” programs; the government must institute mechanisms that allow sex workers to find redress for human rights violations and implement rigorous training of law enforcement officials on legal and human rights standards.
  • We demand the US reorient anti-trafficking campaigns to be in line with the standards set by the United Nations and engage sex workers in helping stop exploitation in the sex sector.

These four action points address the different levels at which the AIDS epidemic can be disrupted – from the individual (access to prevention supplies and programs) to the structural (law reform). If the US government were to adopt these demands, it would be a game-changer – helping turn the tide in the fight against HIV.

Evidence-based best practices and human rights principles must inform the global response to AIDS. Please join us in calling on the US government to change its policies and save lives. Your endorsement will help build a movement for change.

Click here to read the Call to Change and endorse.

Commentary Sexual Health

Parents, Educators Can Support Pediatricians in Providing Comprehensive Sexuality Education

Nicole Cushman

While medical systems will need to evolve to address the challenges preventing pediatricians from sharing medically accurate and age-appropriate information about sexuality with their patients, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Last week, the American Academy of Pediatrics (AAP) released a clinical report outlining guidance for pediatricians on providing sexuality education to the children and adolescents in their care. As one of the most influential medical associations in the country, AAP brings, with this report, added weight to longstanding calls for comprehensive sex education.

The report offers guidance for clinicians on incorporating conversations about sexual and reproductive health into routine medical visits and summarizes the research supporting comprehensive sexuality education. It acknowledges the crucial role pediatricians play in supporting their patients’ healthy development, making them key stakeholders in the promotion of young people’s sexual health. Ultimately, the report could bolster efforts by parents and educators to increase access to comprehensive sexuality education and better equip young people to grow into sexually healthy adults.

But, while the guidance provides persuasive, evidence-backed encouragement for pediatricians to speak with parents and children and normalize sexual development, the report does not acknowledge some of the practical challenges to implementing such recommendations—for pediatricians as well as parents and school staff. Articulating these real-world challenges (and strategies for overcoming them) is essential to ensuring the report does not wind up yet another publication collecting proverbial dust on bookshelves.

The AAP report does lay the groundwork for pediatricians to initiate conversations including medically accurate and age-appropriate information about sexuality, and there is plenty in the guidelines to be enthusiastic about. Specifically, the report acknowledges something sexuality educators have long known—that a simple anatomy lesson is not sufficient. According to the AAP, sexuality education should address interpersonal relationships, body image, sexual orientation, gender identity, and reproductive rights as part of a comprehensive conversation about sexual health.

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The report further acknowledges that young people with disabilities, chronic health conditions, and other special needs also need age- and developmentally appropriate sex education, and it suggests resources for providing care to LGBTQ young people. Importantly, the AAP rejects abstinence-only approaches as ineffective and endorses comprehensive sexuality education.

It is clear that such guidance is sorely needed. Previous studies have shown that pediatricians have not been successful at having conversations with their patients about sexuality. One study found that one in three adolescents did not receive any information about sexuality from their pediatrician during health maintenance visits, and those conversations that did occur lasted less than 40 seconds, on average. Another analysis showed that, among sexually experienced adolescents, only a quarter of girls and one-fifth of boys had received information from a health-care provider about sexually transmitted infections or HIV in the last year. 

There are a number of factors at play preventing pediatricians from having these conversations. Beyond parental pushback and anti-choice resistance to comprehensive sex education, which Martha Kempner has covered in depth for Rewire, doctor visits are often limited in time and are not usually scheduled to allow for the kind of discussion needed to build a doctor-patient relationship that would be conducive to providing sexuality education. Doctors also may not get needed in-depth training to initiate and sustain these important, ongoing conversations with patients and their families.

The report notes that children and adolescents prefer a pediatrician who is nonjudgmental and comfortable discussing sexuality, answering questions and addressing concerns, but these interpersonal skills must be developed and honed through clinical training and practice. In order to fully implement the AAP’s recommendations, medical school curricula and residency training programs would need to devote time to building new doctors’ comfort with issues surrounding sexuality, interpersonal skills for navigating tough conversations, and knowledge and skills necessary for providing LGBTQ-friendly care.

As AAP explains in the report, sex education should come from many sources—schools, communities, medical offices, and homes. It lays out what can be a powerful partnership between parents, doctors, and educators in providing the age-appropriate and truly comprehensive sexuality education that young people need and deserve. While medical systems will need to evolve to address the challenges outlined above, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Parents and Caregivers: 

  • When selecting a pediatrician for your child, ask potential doctors about their approach to sexuality education. Make sure your doctor knows that you want your child to receive comprehensive, medically accurate information about a range of issues pertaining to sexuality and sexual health.
  • Talk with your child at home about sex and sexuality. Before a doctor’s visit, help your child prepare by encouraging them to think about any questions they may have for the doctor about their body, sexual feelings, or personal safety. After the visit, check in with your child to make sure their questions were answered.
  • Find out how your child’s school approaches sexuality education. Make sure school administrators, teachers, and school board members know that you support age-appropriate, comprehensive sex education that will complement the information provided by you and your child’s pediatrician.

School Staff and Educators: 

  • Maintain a referral list of pediatricians for parents to consult. When screening doctors for inclusion on the list, ask them how they approach sexuality education with patients and their families.
  • Involve supportive pediatricians in sex education curriculum review committees. Medical professionals can provide important perspective on what constitutes medically accurate, age- and developmentally-appropriate content when selecting or adapting curriculum materials for sex education classes.
  • Adopt sex-education policies and curricula that are comprehensive and inclusive of all young people, regardless of sexual orientation or gender identity. Ensure that teachers receive the training and support they need to provide high-quality sex education to their students.

The AAP clinical report provides an important step toward ensuring that young people receive sexuality education that supports their healthy sexual development. If adopted widely by pediatricians—in partnership with parents and schools—the report’s recommendations could contribute to a sea change in providing young people with the care and support they need.

News Law and Policy

Colorado Law Requires ‘Reasonable Accommodations’ for Pregnant Workers

Jason Salzman

In signing this bill into law Wednesday, Gov. John Hickenlooper added Colorado to a growing list of states that have passed laws requiring worker protections for employees who are pregnant or have related conditions.

Colorado Gov. John Hickenlooper signed into law a bill Wednesday requiring “reasonable accommodations” for workers who are pregnant, recovering from childbirth, or suffer from pregnancy related medical conditions.

The accommodations may include: longer or more frequent breaks for food or water, modified schedules, adjusted seating arrangements, assistance with manual labor, “light duty,” and more. But the law specifically states that an employer is not required to hire, transfer, or fire an employee to make such accommodations on behalf of a pregnant person, unless such actions were already planned or would be reasonable.

The bill, HB 1438, garnered bipartisan support in Colorado’s divided legislature, drawing “no” votes only from Republicans, such as state Rep. Gordon Klingenschmitt (Colorado Springs), state Rep. Stephen Humphrey (Severance), and Sen. Randy Baumgardner (Hot Sulphur Springs).

All house and senate Democrats backed HB 1438.

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The intent of the general assembly, the bill states, is “to combat pregnancy discrimination, promote public health, and ensure full and equal protection for women in the labor force by requiring employers to provide reasonable accommodations to employees with conditions related to pregnancy, childbirth, or a related condition.”

Pro-choice advocates see HB 1438 as advancing reproductive justice in the state.

“Our mission is advocating for reproductive justice and ensuring every woman has the right and the ability make her own health care choices,” said Karen Middleton, executive director of NARAL Pro-Choice Colorado, in a news release. “And when women do choose to have children, workplaces should respect that choice, not discriminate, and accommodate their needs on the job.”

Opponents of the bill worry that the law will have a negative effect on businesses and jobs.

“I didn’t have a tenacious opposition to the bill,” state Sen. Chris Holbert (R-Parker) told Rewire. “But I’m concerned that this is another requirement for employers, making it more difficult for them to hire or keep people employed.”

At least 17 states, including California, New York, and Texas, have passed similar laws providing different levels of protection.

However, a bill this year to provide pregnancy accommodations in Washington state cleared the Republican-controlled senate but died in the hands of GOP house members.

The federal Pregnancy Discrimination Act (PDA) of 1978 clarified that it’s sex discrimination to discriminate based on pregnancy, childbirth, or related conditions. A recent U.S. Supreme Court ruling held that employers are in violation of the PDA if they don’t accommodate pregnant workers as they would accommodate their non-pregnant employees.

Federal legislation with expanded protections and accommodations, called the Pregnant Workers Fairness Act, has stalled in Congress, even though it has some bipartisan support.

In 2015, the Equal Employment Opportunity Commission issued a non-binding guidance on pregnancy discrimination, stating that in the years since the Pregnancy Discrimination Act was passed, charges “alleging pregnancy discrimination have increased substantially.”