PEPFAR is the United States President’s Emergency Plan for AIDS Relief. PEPFAR is the aparatus for U.S. funding for global HIV prevention, treatment and care, and disburses ~5-6 Billion USD in global funding annually. 

In 2003, PEPFAR added an “Anti-prostitution Loyalty Oath” to grantee contracts. The devastating effects of the anti-prostitution oath annihilated agencies that depended on the funding to sustain their operations, and more importantly, excluded vulnerable populations in need

2017: The oath continues to harm the global fight against HIV and AIDS. U.S. sex worker rights organizations collectively and vehemently oppose the current restrictions. 

Allied in S/W via SWOP Communication

We recommend the US remove anti prostitution language, and support strategies accepted as best practice in anti-trafficking, women’s development, gender equality, and HIV prevention work.

Sex Workers Are Part Of The Success Of The System!
Sex Workers Are Part Of The Success Of The System!
 I am re/posting our 2015 PEPFAR Policy Evaluation,  an allied SWOP-USA Communications effort on behalf of U.S. sex worker-led networks.  
Why? Well –  There are some potential set backs and cut backs  with the 2017 PEPFAR policies affecting the S/W communities, though looking future forward, I share our 2015/2016 effort as reminder:

We ask you to participate in a civil society consultation on PEPFAR, the U.S. vehicle for global HIV funding. 

November 19, 2015 [5PM EST], 
As the oath continues to harm the global fight against HIV and AIDS, U.S. sex worker rights organizations collectively and vehemently oppose the current restrictions that PEPFAR continues to:

1. Make acceptance of PEPFAR funding contingent on opposition to prostitution for all non-US organizations, excluding the Global Fund to Fight AIDS, Tuberculosis and Malaria; the World Health Organization; the International AIDS Vaccine Initiative; and any United Nations agency. ( “by accepting this award or any subaward, a nongovernmental organization or public international organization awardee/subawardee agrees that it is opposed to the practices of prostitution and sex trafficking.”) See Pg. 243-244 of the 2016 Draft.

2. Require exempt organizations to insert anti-prostitution language into sub-awards or subcontracts with local/national CBOs.

3. Require that no funding be “used to promote or advocate the legalization or practice of prostitution or sex trafficking.”

We would be grateful allied organizations, researchers, funders and advocates to submit feedback regarding the anti-Prostitution language (and any other key concerns for their organizations). 

Sincerely, 
M. Dante – ESPU / Sex Workers Outreach Project-Philadelphia

Derek Demeri & Janet Duran – New Jersey Red Umbrella Alliance

Katherine Koster – Sex Workers Outreach Project

Cris Sardinia – Desiree Alliance

Penelope Saunders – Best Practices Policy Project

Participation – 

If you/your organization is in a PEPFAR-funded region or receives PEPFAR funding: 
Name and describe your organization (or identity as a stakeholder/expert) – 

Ask for the removal of  “PROHIBITION ON THE PROMOTION OR ADVOCACY OF THE LEGALIZATION OR PRACTICE OF PROSTITUTION”  as well as any other concerns.

Explain how the requirement to oppose prostitution affects your organization and the communities you serve or use the talking points below.

M Dante in Harrisburg Learning Pa Policy Procedure
M Dante Learning Policy Process

Engage with PEPFAR in the future by: Communicating with other major donors and key stakeholders, such as the U.S. Presidential Advisory Council on HIV/AIDS, the Global Fund, (for U.S. Residents) your congressmen, and the local Ministry of Health, to align priorities for key populations programming.

Engage with your PEPFAR country team, which can be reached via your local U.S. embassy.  The link to find your embassy is: http://www.usembassy.gov/  

Stay in contact with your PEPFAR country team via email, phone, or ideally in-person meetings to communicate key populations programming and data concerns even after the Country Operating Plan is submitted. Requesting a final version of your country’s most recent COP directly from your PEPFAR country team. 2014 country COP

PARTICIPATE in PEPFAR quarterly review civil society consultations, set to take place every three months starting in October 2015; INSIST that the PEPFAR country team provide key populations data a minimum of 2 weeks in advance of the meeting 

New Jersey and Pennsylvania Learning How to Lead in Allied Health Policy Efforts
New Jersey and Pennsylvania Learning How to Participate and Lead in Allied Health Policy Efforts

Talking points for PEPFAR Feedback

-Leading women’s, GLBT, anti-trafficking, HIV prevention, and development organizations that are supportive to the decriminalization of sex work: including UNAIDS, the World Health Organization, Amnesty International, the International Women’s Health Coalition, the Association for Women in Development, the Global Alliance Against Traffic in Women, the Global Fund for Women, the Elton John Foundation, and the International Community of Women Living with HIV. 

We recommend the US to remove anti-prostitution language and support strategies now accepted as best practice in anti-trafficking, women’s development, gender equality, and HIV prevention work.

Philadelphia Fight 2015 SAFE - SWOP - ESPU - RUA
Philadelphia Fight 2015 SAFE – SWOP – ESPU – RUA

The requirement to oppose prostitution and the ban on funding for advocacy to reduce the criminalization of sex workers is at odds with PEPFAR’s mission of reducing HIV/AIDS. Decriminalization of sex work has been shown as the most effective method for averting new infections in sex workers and clients (modeled 33-46% reduction), more effective than anti-retroviral scale-up, safer work environments, or elimination of sexual violence. (Lancet, 2014)
The Pledge undermines PEPFAR’s own prevention goals and strategies vis-a-vis sex workers detailed in the Guidance. The anti-prostitution requirement undermines not only overall prevention goals but also prevention strategies specific to sex workers detailed throughout the plan. (see p. 33, 44, 102, 105, 232 for details of PEPFAR strategies relevant to sex workers).

The anti-prostitution requirement and ban on funding for sex worker advocacy directly contradict PEPFAR’s understanding of how stigma, discrimination, and laws and policies undermine HIV responses among key populationsIn particular: “Stigma and discrimination as well as harmful laws and policies reduce access to and use of essential health services and undermine efforts towards effective responses to HIV/AIDS. PEPFAR is committed to joining others to end stigma and discrimination against people living with HIV/AIDS, vulnerable and key populations and to increasing their access to, and uptake of, HIV prevention, treatment, and care services…” (p. 33) and the HVOP goal of “[e]ngagement with the government and civil society organizations to reduce criminalization of key populations.” (p. 173)

-Ban on direct or indirect funding (through sub contracts) to community-based organizations that do not oppose prostitution undermines access to and meaningful inclusion of sex worker populations.  Local, community-based organizations that provide services to sex workers through peer-led, harm reduction, or empowerment frameworks are categorically excluded from directly or indirectly receiving PEPFAR funding. These organizations often already have access to and trust of marginalized sex worker populations. These organizations are well-equipped to support data collection/population surveillance, STI testing, community education around prevention, linkage to care, and linkage to job training and other resources to support exit from the sex trade. The explicit ban on partnerships with these community-based organizations (through sub contracts) is extremely detrimental to PEPFAR’s objectives regarding sex workers.

The anti-prostitution requirement undermines PEPFAR’s goals for sustainable HIV prevention funding and the integration of PEPFAR funding into existing healthcare delivery systems. It does so by prohibiting grants to existing national and local healthcare delivery programs engaged in harm reduction programming with sex workers. Our concern is that this programming will be carried out by large international development organizations that are exempt from the anti-prostitution pledge and thus threaten national and local NGO ecosystems, increasing reliance on international funding and programming.
Discriminatory Exemptions from Anti-Prostitution Pledge. The policy exempts the Global Fund to Fights AIDS, Tuberculosis & Malaria, World Health Organization and any United Nations agency, so it is condescending and offensive to suggest grassroots organizations, who are at the forefront of the fight against HIV/AIDS, cannot come to similar conclusions.
Brazil refused to sign the pledge in 2005, resulting in rejection of $40 million in HIV funding.

Inaccurate Portrait of Prostitution and Determinants of Sex Trafficking: The U.S. government’s policy is based on the assumption that “[prostitution is] inherently harmful and dehumanizing, and contribute to the phenomenon of trafficking in persons.” This contradicts the knowledge of leading global, European, and U.S. anti-trafficking networks, including the Global Alliance Against Traffic in Women, La Strada International, and the Freedom Network-USA as well as the experiences of organizations working with people in the sex trade.

Sex Workers are Key Populations Globally. Sex workers are internationally recognized as a group that must be interacted with in order to achieve the goal of zero transmissions which is impossible to do if particular policies alienate this very community. PEPFAR recognizes this and it is difficult to understand the continued contingency of funding receipt to anti-prostitution beliefs.

– Pledge violates the Human Right to Bodily Autonomy. Almost every international human rights convention that the United States has agreed to recognize the Right to Bodily Autonomy, including the ICCPR; the anti-prostitution pledge is a direct violation of this internationally recognized human right.

Impedes HIV Response in Nations Disproportionately Impacted by HIV/AIDS. According to the UNAIDS 2016-2021 Strategy Plan, in East and South Africa, MSM, Female Sex Workers, IDU and transgender people contribute to 12-30% of all new HIV infections in PEPFAR-funded countries, including Kenya, South Africa, Mozambique, and Swaziland, yet these populations “remain underserved, under-involved and underrepresented in the response” to HIV.

Impedes HIV Response vis-a-vis Sex Workers in Regions Reliant on PEPFAR Funding. In West and Central Africa, reliance on “international funding (Global Fund and PEPFAR) is at 70%.” While HIV prevalence among FSW is exponentially higher than the general population, targeted interventions as well as extremely limited HIV surveillance among sex workers in the region is inhibiting the regional response to HIV, and it is imperative for PEPFAR as a major contributor to the HIV response in this region to support evidence-based programming for reducing HIV prevalence in sex worker populations. 
Problematic  and inconsistent United States definition of trafficking into HIV Prevention Guidance.  PEPFAR definitions (see pg. 244) “for purposes of this provision: Commercial sex act means any sex act on account of which anything of value is given to or received by any person. Sex trafficking means the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act. This definition is not in line with international standards and agreements on what constitutes trafficking because it fails to include elements of “force, coercion and fraud.”

PEPFAR should include the communities it sets to serve. Shouldn’t it?

We recommend the US remove anti-prostitution language and support strategies accepted as best practice in anti-trafficking, women’s development, gender equality, and HIV prevention work.

Philadelphia 2015
Philadelphia 2015

https://www.pepfar.gov/documents/organization/267809.pdf
https://www.pepfar.gov/documents/organization/267809.pdf