The Politics of AIDS: Engaging Conservative Activists

Holly Burkhalter

From Foreign Affairs, January/February 2004

Summary:  American evangelicals have put the fight against AIDS on Washington's map, even while clashing with other activists over strategy. Now all must unite behind a comprehensive approach stressing effective practices in prevention and treatment.

Holly Burkhalter is Director of U.S. Policy and of the Health Action AIDS campaign at Physicians for Human Rights.

Conservatives in the House of Representatives, meanwhile, have highlighted another neglected but significant source of AIDS transmission: the violent sexual exploitation of trafficked women and children. The issue is hardly minor: the State Department estimates that India alone has 2.3 million women and underage girls forced into its sex industry, and in Africa AIDS is fueling an epidemic of sexual predation against ever-younger girls as older men seek safe sexual partners. The pandemic is also generating millions of orphans and street children throughout the developing world who are especially vulnerable to rape and to being forced into the commercial sex industry.

Forcibly prostituted women and sexually exploited children are not "sex workers" but victims of crimes, including multiple rapes daily. They are particularly vulnerable to AIDS transmission, but their needs are not addressed by conventional prevention programs, which are designed for voluntary sex workers and stress empowerment, health care, and access to condoms. Reducing harm for trafficking victims involves not encouraging safer sex but removing them from the sex industry and providing them with shelter, rehabilitation, counseling, and health care. The predators who sustain the forced-sex trade and child rape industry, meanwhile -- the traffickers, brothel owners, and complicit police and other authorities -- should be punished severely, with significant jail time.

Yet this almost never occurs, and most trafficked women and children languish in sexual servitude with no hope of release. Many who provide health services to sex workers acquiesce in the forced exploitation of children and women in the brothels where they work because they are unwilling to jeopardize their access by reporting pimps and brothel owners. Several of the most prominent service providers in Thailand, for example, actively oppose rescue and rehabilitation, and some rehabilitation facilities in India refuse to accept child prostitutes who have been rescued.

Hoping to discourage trafficking, Representative Chris Smith (R-N.J.), a conservative Catholic and an anti-trafficking leader in the House, offered a provision to the AIDS bill that prohibited funding to any organization that did not oppose trafficking and prostitution more generally. According to one of Smith's aides, the measure was aimed at service provider groups who were "a little too casual about Sway Pak" -- a notorious redlight district in the Cambodian capital of Phnom Penh that offers very young Vietnamese girls to Western customers. Smith and like-minded religious conservatives are appalled by trafficking and child prostitution and by the notion that prostitution can be a voluntary choice. Their view -- which is hardly limited to the extreme right -- is that prostitution is always a compelled choice, through either violence or destitution, and that glamorizing it as "work" trivializes the harm it does to the women in it.

It is certainly the case that many in the commercial sex industry, whether trafficked or not, wish to leave it and would do so if alternative employment were available. A 1998 survey of sex workers in Turkey, the United States, Zambia, South Africa, and Thailand, for example, indicated that a large majority of them suffered physical and sexual violence and post-traumatic stress disorder and that almost all wished to leave the business. Sexually exploited Ethiopian street children interviewed by Save the Children overwhelmingly disliked prostitution and wished to escape it. All sex workers are at very high risk of AIDS exposure, but children and trafficked women are especially vulnerable, as their ability to negotiate condom use with clients is virtually nonexistent.

Rather than pitting the interests of victims of forced prostitution against those of voluntary sex workers, two distinct strategies to fight AIDS transmission should be developed. Rescue initiatives, shelters, and alternative job opportunities, as well as reform of the police and the judiciary, should be funded to help those who wish to leave brothels. Health care, protection from violence, and freedom to organize should be promoted for those who wish to stay in the trade. Documenting and exposing sexual exploitation is essential, but an ombudsman or specially trained antitrafficking unit is better suited to the task than health workers attempting to disseminate condoms in brothels.

To date, the programs that have most successfully addressed the right of sex workers to health care have been empowerment projects that help sex workers organize around their own needs, such as the Sonagachi program in Calcutta, India. Sonagachi is credited with raising condom use in neighborhoods with organized brothels from less than 1 percent to more than 80 percent, reducing police violence toward prostitutes, and providing services for prostitutes' children. It is true that Sonagachi and similar programs are unabashedly "pro-prostitution" in that they aim to empower women within the sex trade rather than urge them to leave it, but Sonagachi's adult women sex workers are also reported to be vigilant in opposing the presence of children in their brothels. Despite what people on both sides of the controversy might think, there is no reason why this sort of effort cannot coexist and complement well-designed antitrafficking campaigns.

MORAL HAZARDS

The involvement of conservative groups in shaping AIDS policy has been most problematic in the area of general AIDS-prevention strategies, where their distinct sexual mores have led them to dissent from what most others consider medical best practice. For example, since condoms, if used properly and consistently, are at least 90 percent effective in preventing AIDS transmission, the U.S. Agency for International Development (USAID) has quietly provided millions of them annually to AIDS-stricken countries. Now that religious conservatives have taken up the AIDS cause, however, such programs have come under attack. Thus the Family Research Council has insisted that the Bush administration's AIDS plan not become "an airlift for condoms," while conservative religious groups convened by Senator Sam Brownback (R-Kans.) have taken aim at various prevention programs that the plan had considered funding.