The Supreme Court's Chance to End the Anti-Prostitution Pledge, Save Lives, and Help End HIV/AIDS

In early January the Supreme Court agreed to decide whether the U.S. government can require that the domestic and foreign groups it helps fund to educate about HIV and care for people with the virus worldwide have a policy "opposing prostitution."

The Obama administration has urged the court to support their view that the government should be able to compel those it funds to support the message it intends to send.

The federal policy has a troubling history. President George W. Bush in 2002 first issued a National Security Presidential Directive proclaiming that "The United States opposes prostitution and any related activities." After Bush's major new $15 billion President's Emergency Plan for AIDS Relief (PEPFAR) was created in 2003, Congress went far beyond Bush's mere proclamation opposing prostitution.

In May 2003, Congress passed the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act, aka the Global AIDS Act. It pointed out the well-known fact that prostitution and sex trafficking contribute to the spread of HIV. Rep. Chris Smith (R-NJ) authored the language of the Global AIDS Act and a related second law in December 2003, the Trafficking Victims Protection Reauthorization Act, which funded anti-trafficking activities. Both acts stated that no government funds could be used to promote or advocate for the legalization or practice of prostitution.

In short, Republicans--with strong support from the evangelical right wing--believed they could actually eradicate prostitution. They saw their golden opportunity in prohibiting the U.S. government's billions of dollars for HIV/AIDS prevention and care from supporting NGOs working to protect the safety and rights of women and men working in the world's "oldest profession."

At first, only global organizations--except a few including the Global Fund to Fight AIDS, TB and Malaria, the World Health Organization, and the International AIDS Vaccine Initiative--had to abide by what was referred to as the "Anti-Prostitution Pledge." But by June 2005, the U.S. Agency for International Development (USAID) required all non-governmental organizations (NGOs) to sign the pledge.

Early protests against the pledge

The case to be heard by the Supreme Court, brought by New York-based Alliance for Open Society International, is only the latest in a long line of protests against the policy/pledge. The Alliance's lawyers told the court, "Successful efforts to fight HIV/AIDS often involve organizing and working cooperatively with marginalized 'high-risk' groups, such as prostitutes." They argued that a public policy which condemns prostitution is likely to keep sex workers away from the testing and treatment they need, defeating their efforts to prevent HIV-related illness and new infections.

This is the latest protest against the counterproductive law. As early as February 2005, the non-profit NGOs affected by the Anti-Prostitution Pledge protested the policy. In a letter to Randall L. Tobias, the former CEO of the pharmaceutical company Eli Lilly whom President Bush appointed his first U.S. Global AIDS Coordinator and head of USAID, and a subsequent, stronger letter to Bush, hundreds of organizations worldwide stated that the pledge "makes it extremely difficult, if not impossible, to establish the trust necessary to provide services to these hard-to-reach groups."

Not to be outdone, an August 2005 letter arrived on Bush's desk supporting the anti-prostitution policy, signed by more than 100 organizations, including Concerned Women for America, Family Research Council, Focus on the Family and the National Association of Evangelicals--none of them known to have any expertise in public health or even HIV/AIDS, beyond their well-known condemnations of other Americans affected by the disease.

A personal protest

In late 2002, while I spent two weeks in Nigeria, to train my in-country colleagues on how to report and document their work for our global USAID-funded HIV/AIDS project, I got to know a lot of prostitutes.

Each night at the outdoor poolside bar of my hotel on the Atlantic coast of Lagos, beautiful young Nigerian women gathered. I soon realized what was up as I saw the women mingle with the few white men who were there from other parts of the world.

Over the time I was there, I came to relish my conversations with these young ladies, and got to know a few by name. Because I'm gay, I wasn't interested in having sex with them. But I regularly bought drinks and food for them. Everything was so cheap, compared to Washington, D.C., where I lived then, or anywhere in America for that matter.

And I was interested in the women, their stories--who they were, where they came from. I also asked whether they were regularly using protection with their customers.

The stories I heard always boiled down to growing up in a tiny village, wanting a better life but having no education or marketable skills, and coming to the big city where all kinds of opportunities were abundant. One young lady told me she was paying for her younger sister's university education so that she would never have to do what her older sister was doing.

Their stories broke my heart. They also opened my eyes. I understood now that no woman or man wants to be a sex worker, a prostitute (I hate the word). But we all do things we never imagined when it comes to the choice to eat or starve, to have shelter or be homeless, to be desired or be shunned, to live or die.

End the moralizing and just save lives

Even at the time I knew the money I spent on the ladies, the hugs and words of encouragement I gave them, were my own way of defying the anti-prostitution pledge that was about to be codified into American law.

Ironically, U.S. Global AIDS Coordinator Randal Tobias, the man tasked with enforcing the anti-prostitution pledge, resigned his position in 2007 after being linked with a prostitution ring in Washington, D.C.

It's high time for the high court to end the counterproductive anti-prostitution policy, and allow those with the access and ability to use taxpayer funds as effectively as possible to reach those at greatest risk for HIV/AIDS.

Prostitution won't be eradicated until the conditions that lead people into it are eradicated first. Where it comes to fighting HIV/AIDS, the federal government should use our money to fund reality-based interventions proven to work, not to advance moralistic agendas.

The only message the government should be sending is that it is committed to saving lives and supporting those who are working to bring an end to the HIV/AIDS pandemic. That is a moral agenda worth advancing.