Condemning Sex Workers is a Dangerous Proposition

On Monday the U.S. Supreme Court heard arguments in USAID v AOSI. Open Society, along with a coalition that includes Pathfinder International and InterAction, is challenging the United States’ anti-prostitution pledge requirement. This requirement states that any organization receiving government money to fight HIV and AIDS internationally must adopt a policy “opposing prostitution.” This sweeping language violates free speech because it forces a policy viewpoint on an organization’s privately funded work—not just the program the government is funding. During Monday’s arguments, Justice Alito expressed alarm that compelling such speech was a “dangerous proposition.”

In reply, the government tried to argue there were limits to the speech it wanted to require—it’s ok to make recipients say something, they suggested, so long as it’s “germane” to the goals of the government program. And they went on to say that opposing prostitution was, after all, an effective response to HIV. But—let’s pause for a moment to ask:

When fighting HIV and AIDS, does it really make sense to condemn the very people you’re trying to reach?

A host of public health school deans, professors, and other HIV and AIDS experts argue that the prostitution pledge flies in the face of effective public health programming. In a collective brief for this case, they state that “the requirement constricts the speech available in the public health sphere, distorts the empirical process of gathering data and adapting best practices, and ultimately harms the very population that [the Government’s] funds were meant to help.”

It must be understood that in addressing the global HIV and AIDS crisis, it is crucial to work in partnership with sex workers. Global HIV prevalence among female sex workers is estimated at 11.8 percent—a rate fourteen times higher than women in the general population. And evidence suggests that male and transgender sex workers may be even more disproportionately impacted by HIV.

Around the world, sex workers are at higher risk of sexually transmitted infections because of unsafe working conditions and the lack of access to quality health services. Evidence suggests that sex workers’ risk of HIV infection is inextricably related to their marginalized and illegal status, which drives their work underground and increases police abuse and exploitation. Even the government’s HIV and AIDS program states that “even where services are theoretically available, sex workers face substantial obstacles to accessing HIV prevention, treatment care and support, particularly where sex work is criminalized.”

Open Society believes that an effective response to HIV and AIDS must address the structural factors that affect sex workers—including the punitive laws and policies that criminalize their work. And we are not alone. The United Nations Development Program’s Global Commission on HIV and the Law calls on States to repeal discriminatory laws that impede the response of countries to the HIV and AIDS epidemic, echoing recommendations to governments from the World Health Organization, UNAIDS, and UNFPA to decriminalize sex work. In fact, in order for the U.S. government to continue to work with some of these frontline organizations, it explicitly—and inconsistently—exempted a few of them from the prostitution pledge requirement.

Ironically, under this policy requirement even the government’s top supporter, the Coalition Against Trafficking in Women, would be prohibited from receiving government funding, since its brief states that it is “firmly opposed to placing criminal penalties or stigma of any kind upon prostituted persons.”

Understanding the pledge requirement in this context, it becomes clearer how un-germane and, in fact, harmful a requirement to oppose prostitution is in the fight against HIV and AIDS. During Monday’s hearing, Justice Alito said that he was not aware of any case where the Supreme Court allowed Congress to “condition Federal funding on a recipient’s agreement with ideas with which the recipient disagrees.”

For the Supreme Court to do so now would be a travesty to both the First Amendment and to public health.

Learn More:



indeed you cannot fight HIV if you condemn the very people who need help

I was present in D.C. for the Oral Arguments on April 22nd, standing with a small group of sex work and harm reduction activists eager to see the pledge overturned. Perhaps you could shed some light on how this article's position is at variance with a statemment from Zoe Hudson, as reported by USA Today, as linked here:

' "Sex work is everywhere. It is a brutal system. It is an exploitative system. Nobody thinks it's OK," Hudson says. "But simply calling for an end to something doesn't help us get there." '

Sex workers don't want stigmatization; we also do not want others defining the essence of our work for us. Not all of us globally experience the field of sex work as brutal and expliotative. We can only hope that Ms. Hudson's comments were those of her own, and not meant to represent the views of OSF. Sex Workers of the world need organizational allies who can speak with consistency and in alignment with the views of the people they serve. Pitying us and our "brutalizing & degrading" work does NOT help us, as this article suggests you do. Please listen to sex workers, ...and learn from our voices. We are not content with letting "helping hands" alone do the work of change that is best done by those who know the work from the inside. We urge you to engage sex workers in this national and global-level conversation about the pledge, and in all future conversations involving us.

Thanks for your comments D.J.

As part of a larger conversation, Zoe was talking about the system of criminalization that affects many sex workers around the world as being brutal, exploitative, and far from okay—since it often includes police oppression and human rights abuses. You’re right that this wasn’t clearly represented.

We know this doesn’t describe the experience of all sex workers, but addressing these abuses is a critical part of combating HIV and AIDS.

We also know that the best advocates for sex workers’ rights are sex workers, which is why we continue to support and partner with sex worker-led organizations in the countries where we work. We’re grateful for the chance to discuss this, and we look forward to continued dialogue.

" Open Society believes that an effective response to HIV and AIDS must address the structural factors that affect sex workers—including the punitive laws and policies that criminalize their work" Okay, if OSI really believes this then why don't they ever return our calls for help?

Thanks for raising this question again, Maxine. We know groups within the U.S. need support, as do groups across the world. Because Open Society cannot work in all regions, we must focus our grant making to a limited number of countries.

Just opposing prostitution will not end the crisis rather it will difficult to reach them for safer practices. Side by side alternative skill development will encourage for self employment. What about the customers who visit them for sex!! How to refrain them to have sex with the prostitutes.

Thanks Rachael for sharing this , it’s really sad and hurting that sex worker organisations and countries in Africa such as Uganda, Kenya, Namibia, South Africa and many others are actually being used to implement this fund through the third parties without reading and understanding the content in the agreements they sign, the recipients of USAID funds now are using sex work organisations to betray fellow sex workers. And this is because of limited funding for human right organisations including donors who are willing to support us. USAID funds looks at numbers of condoms distributed to the sex workers Not used and number of sex workers tested But Not treated or had access to comprehensive treatment care service. They really do not care about sex workers lives. We still have along away to go.

HIV Solution is universal testing ,stupid. Sex is basic human right, supply & demand laws govern not God/us.

efforts to fight new HIV infections should not promote actions that poses more risks especially to drunkards whose judgements is always impaired....its appropriate that women in prostitution be rehabilitated and be provided by alternative means of income generation...its shameful for vulnerable women to end in prostitution because of lack of alternative source of income ....the entire international community should collaborate to identify the root causes of prostitution and come up with relevant interventions aimed at improving the lifestyles of these women.


In terms of the question, "Why does it make sense...", you might find it to be of value to look at Jonathan Haidt's work on the Moral Foundations of Politics. I find his model to be profoundly useful and informative. One way of understanding these conflicts is to see that OSI is using the value of Care as a driving force in their work; Conservatives are using the value of Purity and Sanctity. While one group is responding to pain with compassion, the other is responding with criticism to things that they find to be disgusting. A fuller discussion of his work can be found here:

This model can serve to frame the debate and clarify the root causes of the policy conflict.

I totally agree with T Mugo, it is always rational to find the root of a problem, then decide how to deal with challenges posed by such. The basic issue here is poverty. Thus, sex workers need to be rehabilitated and their capacity built - for gainful employment. On the other hand, we should be mindful not to enact/ promote and policy that might further fuel the AIDS scourge.

Make decisions with the Holy Spirit.

It's shameful for people who condemn sex workers.Don't see them under the title of sex workers.Just deal them as
ordinary as you are.Discrimination doesn't work in this age and cause bad results.

Sex work led organizations and their advocates have been accused of promoting women to remain in a dis-empowered position, Such policies have increased stigma and muffled the voices of sex workers and activists both in the biomedical HIV programs as well as structural programs where their meaningful participation is crucial

I wish to quote Abraham Lincoln" An action may be legally correct, but morally wrong" Prostitution is morally and spiritually wrong. I therefore agree with the position of the US Government on this issue

congratulations to all at OSF on prevailing in this case! It is a victor for public health practice at home at around the world!

Add your voice