U.S. anti-prostitution stance is not effective at helping to control the global HIV epidemic

In order to receive U.S. funding for HIV prevention or control projects, recipient organizations must take a pledge that explicitly condemns prostitution.

But such condemnation is not effective at helping to control the global HIV epidemic, say researchers in this week's PLoS Medicine.

Nicole Franck Masenior and Chris Beyrer (Johns Hopkins Bloomberg School of Public Health) reviewed the existing scientific evidence on strategies that effectively reduce rates of HIV among sex workers.

They found a substantial body of peer-reviewed published studies suggesting that the empowerment, organization, and unionization of sex workers can be an effective HIV prevention strategy and can reduce the other harms associated with sex work, including violence, police harassment, unwanted pregnancy, and the number of underage sex workers.

"While sex work may be exploitative," say Franck Masenior and Beyrer, "and is illegal in many jurisdictions, sex worker advocates and HIV prevention program leaders generally concur that sex workers themselves need services, protection, peer outreach, and support from health professionals to reduce their risk of HIV infection." The anti-prostitution pledge, they say, places funding restrictions on those HIV programs that have policies calling for decriminalization or legalization of sex work.

The breadth of the pledge, say the authors, and its application to privately funded activities have led to ongoing legal challenges of its constitutionality by a number of organizations involved in HIV prevention and treatment. The findings of Masenior and Beyrer's scientific review were presented in a declaration for the court in the case of Alliance for Open Society International versus the US Agency for International Development.