In our blog for May, Dr. Melissa Ditmore talks about the adverse effects of political decisions on real people.
How countries such as the United States posits its foreign assistance policies tend to have a direct impact on sexual and reproductive health rights and other human rights needs of women and girls throughout the world, especially those in the developing countries. This was more than evident when I was in Southeast Asia to attend a conference organized by the sex worker organization Zi Teng. I met people from many sex worker groups in the region. At the conference, I spoke about US policies that restricted spending related to sex work. This was in the legislation that created the President’s Emergency Fund for AIDS Relief (PEPFAR). Sex workers from Cambodia who attended the conference had already been adversely affected by this restriction.
Everyone I met at that time, with the Asia Pacific Network of Sex Workers and all the member organizations, were amazing and inspiring activists. However, I was particularly taken up by the Women’s Network for Unity (WNU), a group of sex workers from Cambodia. WNU worked for two years to build up networks with existing NGOs in Cambodia. They had a nascent professional network including more than a dozen NGOs working on HIV and on issues of gender and social justice. Their first obstacle had been to be taken seriously as partners. Most of the sex workers were from the lower strata of society, while the NGOs were often started by middle and upper class people who had never experienced life on the streets. They had certainly not earned money selling sex in the parks and karaoke parlors and railway yard brothels.
Suddenly, the position of WNU had drastically changed within their NGO networks. From working in partnership with others, they were shunned. Those who spoke to them questioned why sex workers wanted to represent themselves in an organization, rather than work as they had, without representing themselves in professional networks. NGO staff questioned their abilities after seeing the sex workers develop a democratic structure for their organization that helped educate members about the needs of an organization. Sex workers learned about running an organization, for example learning bookkeeping in order to manage their organization’s small budget. The timing of this change was very particular. The United States, the world’s largest donor, told funding recipients that they had to aver that they were against prostitution. Within days of this new information circulating, WNU found their organization isolated by other organizations. Everyone was afraid to lose funding or lose the chance of obtaining US funding, and without clear guidance people were overly cautious. This policy undermined WNU’s efforts to develop professional networks and even jeopardized their ability to register as a separate organization and act in partnership with other organizations.
WNU is uniquely vocal about the discrimination they experienced. Similar stories were told to me by representatives of sex worker groups around the world. Only overt organizations of sex workers, who had no funding to lose and no aspirations to collect funding with such conditions were able to be vocal, without fear of fiscal retaliation and isolation from partners. In this context, some groups that worked with organizations pushed back against these vague criteria, asking what specifically was forbidden, and what was allowed, did not want to be named or draw attention to their organizations or their work. For this reason, my colleague Dan Allman and I were extremely cautious not to disclose any details about organizations and individuals who told us about their experiences in a paper about the ways US funding restrictions affected sex workers. The policy was deemed unconstitutional and enforcement of this policy is expected to change for organizations with US chapters.
Hearing the ways sex workers around the world were affected reinforced my commitment to support the human rights of sex workers
The sex workers of WNU had faced far greater personal adversity and demonstrated great resilience. Their founding secretariat members included Sou Southeavey, a transgender sex worker who lived through the Khmer Rouge and the civil war in Cambodia. After working with WNU, Southeavey started a human-rights organization and then received the David Kato award in 2014. Another member of the secretariat, Choun Neth, told me about her experiences having been trafficked before becoming an independent sex worker. She wrote a paper with me about unsafe condoms, adulterated to cause pain. Keo Tha , another member, was the most strategic activist I have met. Together they work within WNU that carries on working for the rights of sex workers in an adverse social and political climate marked by poverty, stigma and discrimination. WNU has always included sex workers of all genders, including sex workers who in other situations might be able to retire, and working with sex workers who are parents.
I devoted a great deal of time to learning how sex workers were affected by US funding policy. Just reading the clause on PEPFAR’s anti-prostitution pledge that requires aid recipients to oppose prostitution, I worried that sex workers would be denied HIV-related services, and this happened in some places. As a US national who was very involved in sex worker groups, it was personally important to me to know what was happening on the ground and to try to improve implementation and the policy itself. Hearing the ways sex workers around the world were affected reinforced my commitment to support the human rights of sex workers. Some sex workers benefitted from the HIV medications made available by PEPFAR, even as they were discriminated against sometimes in health care settings where service providers used these restrictions to justify their own moral prejudices. Some were denied services, including health services, by people who used the restriction to discriminate against sex workers. Some programs were able to function because country partners and regional officers enforced PEPFAR’s non-discrimination clause; however, not all were so fortunate. When I was asked by WNU secretariat and members as to why President George W. Bush hated sex workers so much, I found myself asking more questions.
Although, as I wrote earlier in the Journal of the International AIDS Society, things slightly improved under the Obama administration releasing new guidance on the implementation of the anti-prostitution pledge making it less difficult to meet than some of the previous requirements, it still remains that for those for whom declining funding is not an option, the outcome is that organizations will continue to struggle to provide a dignified and effective service to deliver services without stigmatizing their intended beneficiaries.
However, the anti-prostitution clause is not applied exclusively to PEPFAR funding only, but to all the organizations’ funding, and therefore affects education and other programming. In this way, these funding restrictions affect many more programs in addition to HIV-related programming, including programs promoting access to clean water, sanitation, life-saving medicines and medical care. These requirements and the subtle changes to their contract wording have far-reaching implications because they affect the distribution of many millions of aid dollars.
The members of WNU continue to inspire me to stand up for the most marginalized because decisions made in Geneva and Washington, DC, have long-lasting effects on real people around the world. WNU stands out for me, but sex worker organizations are found all over the world. When I feel myself being discouraged, I think of colleagues with WNU and Asia Pacific Network of Sex Workers and become inspired all over again.