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