Faculty Post: The Anti-Prostitution Loyalty Oath Undermines a Key Response to the HIV Epidemic

By Professor Aziza Ahmed

The Supreme Court recently heard arguments in U.S. Agency for International Development (USAID) v. Alliance for Open Society Institute. At issue is a provision of the U.S. Leadership Act on HIV/AIDS, TB, and Malaria, which halts funding to organizations that promote or advocate the legalization or practice of prostitution or sex trafficking. To defund these critical public health organizations for their refusal to pledge allegiance to the misguided and dangerous U.S. government position on prostitution puts many lives at risk.

HIV continues to impact marginalized communities at alarming rates. Public health interventions focusing on sex workers create a safe and empowering space in which individuals can learn how to prevent the spread of HIV, receive life saving treatment, and take advantage of testing and counseling services.

This case focuses on the so-called “anti-prostitution loyalty oath,” compelling all organizations taking U.S. money to uphold the U.S. government position on prostitution and sex work. This oath has already resulted in the defunding of HIV organizations serving sex workers. Further, it conflates all sex work with trafficking. Projects serving sex workers do not see all sex work as trafficking. Instead by recognizing the reality that sex work continues regardless of government attempts to halt it, they seek to make sex work safer. Through utilizing a harm-reduction approach, sex workers are less likely to contract HIV when they have access to condoms (which make them less likely to contract HIV) and information on how to prevent violence from clients.

Organizations focusing on sex workers, and empowering sex workers, in the context of the HIV/AIDS epidemic have been pivotal in lowering rates of HIV/AIDS across the world. In many HIV interventions, sex workers serve as peer educators and program staff. The World Health Organization, United Nations Joint Programme on HIV/AIDS and the recent report of the Global Commission of HIV and the Law have spoken to the importance of empowering sex workers in the context of the HIV epidemic.

Major funders, including the Bill and Melinda Gates Foundation, also make sex workers central to their strategy in tackling the HIV epidemic. Even major USAID contractors (with the USAID and PEPFAR, U.S. President’s Emergency Plan for AIDS Relief, logos emblazoned on the website) feature sex worker projects as case studies for HIV interventions that have “helped marginalize[d] groups help one another” and “… prevent exposure to HIV….” Relying on the public health evidence that encourages a harm reduction approach to sex work and HIV, these agencies and institutions support funding sex worker projects.

The stakes in this case are high, not just for the many sex workers whose lives truly hang in the balance, but also because the outcome will determine the success of U.S. investment in projects and programs designed to stop the spread of HIV around the world.

Aziza Ahmed is an Assistant Professor of Law Northeastern University School of Law. She served on the Technical Advisory Group to the Global Commission on HIV and the Law.

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