What Kind of Movement Are We?

"We have to ask ourselves if we care more about our UN badges or about taking a stand for the needs and rights of people around the world."

Those words are a paraphrase of those spoken by a committed South African activist who was encouraging civil society at the 2006 U.N. General Assembly Special Session (UNGASS) AIDS meeting to risk our badges by protesting the disgustingly weak consensus document reached by member nations. (She was successful in getting us to take action. You can read a blog about that protest here.)

I am reminded of her words as I think about how civil society has responded to the PEPFAR reauthorization bill that has now passed both the House and Senate committees and is headed to the floor of both chambers for a vote. I have been shocked over the last few weeks by the number of organizations and prominent individuals who have responded positively, or even neutrally, to the compromise bill. Some who have been through these processes before eagerly remind the more outraged among us that this is how it works: you simply don't make great leaps forward on these issues.

Why have so many of us accepted that the way it has been is the way it has to be? And why wouldn't we exhaust our options before settling? Why are we doing this work if not to demand something other than "business as usual"?

We call ourselves a movement. A movement demands progress; it demands big dreams backed up by big action. And last I checked, a movement does not accept compromise that comes at the price of lives without at least putting up one heck of a fight.

As we approach our last chance to change the PEPFAR reauthorization bill, we must ask ourselves: do we care about claiming a victory on a mediocre piece of legislation (by Congressional standards — it's a horrible piece of legislation by the standards of what is actually needed) and maintaining untainted relationships with Congressional offices, or do we care about taking a principled stand for the needs of people around the world? It is time for our community to face the facts. Not only is this piece of legislation an unacceptable compromise, but that if we so-called advocates do not call it what it is, no one else is going to. If we don't hold lawmakers' feet to the fire, no one else is going to.

When it's time to draw the line in the sand, which side are you on? Are you on the side of a comfortable Washington, D.C. NGO existence that won't push the envelope beyond the agreeable gray area of compromise? Or are you on the side of the billions of people around the world who suffer as a result of (and simultaneously resist) our complacency and tacit complicity in a global system that robs their nations of resources, exploits their labor, prevents access to life-saving medicines and contraceptive supplies, and floods their communities with ideological misinformation about sex and sexuality?

It's time to let go of our delusions about what we continue to permit our world to look like today. It's time that we stand together, knowing that we have let this slide too far, and say in unison: The PEPFAR reauthorization legislation is a sell-out.

You might say I'm overreacting. But give yourself an advocate's reality check. Ask yourself why you do this work – what does it mean for you to be an "advocate"? Then, ask yourself why you are saying that this bill is acceptable (or that it's acceptable for us not to resist it). Maybe you're protecting an organizational position on the issues, Congressional relationships, respectability in the media, or community approval. Or maybe you're protecting your need to believe that the last five years of work to change PEPFAR have paid off.

As the final part of your advocate's reality check, ask yourself what these relationships, this "respectability," approval, or sense of accomplishment are worth if they don't help us challenge the misogynist, racist, nationalist, capitalist, homophobic system that let the AIDS pandemic take hold as it did. Are they worth the lives they cost?

My personal reality check leads me to conclude that it's time to stop deluding ourselves. We need to realize that:

  • An appearance of bi-partisanship is NOT more important than the lives of millions of people separated from us by race, nation, or HIV-status.
  • We will NOT stand by while even the most progressive members of Congress decide to fall into line rather than stand their ground and put up a fight for what's right. We can, and we will, make them accountable for their actions.
  • Money does not solve everything, especially when that money has strings attached, especially when that money ends up lining the pocketbooks of U.S. government contractors and organizations doing the ideological bidding of the Administration, and especially when that money goes to programs that advance U.S. global hegemony.

"Well at least we tried; we'll do better next time" is not something a community caregiver can tell a young man for whom there isn't enough treatment, or a visiting healthcare worker can tell a thirty-year-old woman for whom having another baby may mean death in the face of inadequate healthcare. And it isn't something that we, as a movement, can afford to tell ourselves.

Social change is not accomplished overnight and it is not accomplished through one piece of legislation, but it is also most certainly not accomplished by backing down. If we don't fight this fight here, no one will. If we're not willing to fight back, then our silence will mean death and the U.S. Congress and the Bush Administration will not be the only ones to blame.

Having worked through my own reality check, I conclude that it is time to act decisively and aggressively; it is time to commit ourselves to changing this bill before it is signed into law.

If your reality check leaves you where mine has left me, then let's start acting like a movement. Let's stop putting off until tomorrow (a day that, conveniently, never comes) the real change we believe in. Let's do something NOW to change PEPFAR reauthorization. If we don't we will have to admit that we did not do all we could to end the AIDS pandemic, that when push came to shove we weren't willing to put up the fight necessary, and that we let a movement with real potential fizzle because we were too jaded to believe we might be able to accomplish more. I'm not ready to do that. I hope you aren't either.

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  • scott-swenson

    Healy, on behalf of many HIV positive people (and people who proper prevention could keep HIV negative) who should be the focus of this debate, thanks for not mincing words. I hope the stakeholders, from small donors to large, who are following this debate see through the politics as usual as you do and realize that more than just our government must change if we are going to make progress on AIDS.

    Be the change you seek,

    Scott Swenson, Editor

  • invalid-0

    So what should, and can, we do now to help?

  • invalid-0

    This is a timely and much needed article. I am outraged by the compromise bill and motivated to take action. As an advocate not working in D.C. what can I do? Can you give your outraged and motivated readers a 5-point action plan?

  • http://www.apnsw.org invalid-0

    This article is excellent.

    One point it fails to make is that a lot of INGO’s won’t
    oppose the bill or take any stand (especially the
    inclusion of the anti-prostitution pledge) because to do
    so puts them in jeopardy of not getting huge contracts if
    the pledge is still included.

    The big question is why are so many activists willing to
    sell out millions of (mainly) women in sex work??

    And the big issue for sex workers is that the continued
    inclusion of the anti-prostitution pledge is a signal to
    the anti-prostitution industry (the ones who call
    themselves antitrafficking activists) that their current
    global campaign to recriminalsie sex work and to
    criminalise the purchase of sex has U.S support.
    It also signals the Bush administration to refund these
    organisations with 100’s of millions of dollars for their
    fight against prostitution and the organised sex worker
    movement. Money which is used to send armed violent men
    into brothels to illegally kidnap and imprison (rescue)
    sex workers.

    The inclusion of the anti-prostitution pledge will also
    encourage the new anti-sex work stance of UNAIDS and UNFPA
    leading to more mis-spending of many more millions of
    dollars on anti-sex work programs and risking the failure
    of many national HIV prevention programs through UNAIDS
    failure to recognise it’s own data showing that reaching
    60% of sex workers with condoms and prevention education
    is essential for reversing (most) national HIV epidemics.

    Andrew Hunter
    Asia Pacific Network of Sex Workers

  • hthompson

    Thanks to those of you who have read and/or commented. The questions about what we can do are great and important and they're ones that I think the advocacy community needs to work out together. There are groups (although far too few) who are actively working on this and my hope is that the rest of the movement will join with them to figure out what we can do together.

    My hope with this blog was to create a space where the question "Ok, so what do we do?" would actually be asked by the organizations and individuals who had decided not to ask that question before. Now, we need some more groups to answer that question and then we need folks to get together to answer it!

  • invalid-0

    Thanks, Healy. I hope this helps everyone reassess what is possible for themselves and for the movement. The time is now.

  • jodi-jacobson

    Many are rightly asking….what can we do about this legislation given where we are….

    Here are some concrete ideas. If you live outside the"beltway," ORGANIZE NOW! get your friends, colleagues, fellow students, family members and others to tell your Senator or Representative not to pass this bill unless they do the following:


    • Remove language restricting the participation of family planning organizations not compliant with the global gag rule in HIV prevention, counseling and testing. these organizations are the first responders for women and youth–the two groups at greatest risk of new infection. Language conditioning the participation of family planning programs does not apply to any other program linkage.
    • Remove onerous reporting requirements on programs for prevention of sexual transmission. such requirements are NOT applied to any other programs.
    • Strike the prostitution pledge. As Andrew Hunter and others have pointed out, this pledge is having adverse effects on the rights and health of women and men in sex work for survival.  Sex workers are human beings with human rights.  The silence from *some* sectors of the AIDS advocacy community and the willingness to let this slide is truly mind-boggling.  Clearly too few of those inside the beltway have spent much time trying to understand the plight of people in sex work and the fact that this restriction does in fact limit their access to services in many settings.
    • Proactively and strongly support funding of all organizations–family planning, maternal and child health, child survival, youth organizations–willing and able to provide comprehensive prevention information, services, and methods to all in need.
    • Proactively and strongly support the availability of family planning information and commodities in ALL programs serving HIV positive women.
    • Ensure that reproductive and sexual health concerns are part of the core training of all health workers trained by PEPFAR. You can not combat a sexually transmitted infection the risks of transmission of which are heightened by other sexually transmitted infections and the conditions under which women now live without understanding reproductive and sexual health concerns. This is a core aspect of basic health care and can not be ignored.


    Prevention is ESSENTIAL. Over the past 5 years and with $19 billion in US dollars spent we have provided 1.5 million people with access to ARVs. This is critical and we should continue expanding access to treatment. But during that same period we have seen at least 12.5 million NEW infections. We must dramatically step up prevention programs or face the fact we are never going to get ahead of this epidemic no matter how hard we try.

    So write letters to the editor, organize call-in days to your Congressperson, circulate petitions, organize a protest, write the Majority Leader in the Senate and in the House….tell them no more money without getting rid of these restrictions. We simply have to take a stand.

    We do NOT have to pass this bill now without further changes and we can write a better bill next year. Despite the hype and the dire threats of programs being underfunded, we do not have to pass this law now as the back story is that the hype is not true. The real story behind the story is that global AIDS will NOT be defunded if we do not pass this bill this year and will all know that. All the providers I have talked to know this. Most of the advocates in DC will tell you that in an aside even when publicly saying otherwise. We do not need to pass a $50 billion dollar bill using US taxpayer funding that writes into law new restrictions on family planning organizations, or pass a law containing old restrictions on sex workers or prevention programs, or pass a law that no where acknowledges the rights of HIV positive women to essential reproductive health services.

    We can simply say no. The reason we are here right now is that some advocates refused to, as Healy said, put up a fight when we had the chance. You don't fold your cards until you put up a fight. Some advocates caved immediately to the tyrannical mis-charachterizations and outright lies put out about programs by those in the far far right who in every single case seek to undermine women's access to life-saving reproductive and sexual health services, *even in this epidemic where the vast majority of new infections are sexually transmitted.* This is not the global movement that i have known. we need to stand up and fight.


    So call your Senator, Congressperson, Talk to people at your church, synagogue, mosque or other place of worship; talk to fellow students, colleagues, or anyone who will listen and tell them that we need a sane and evidence-based policy.


    Tell the Dems and the Republicans you want an effective global AIDS policy, not just a pot of money to throw at the problem.


    If you are inside the Beltway, take a stand now. Realize that we can and must do better. Realize that we can and should fight for funding for good programs through appropriations this year while writing a better bill next year. There is no excuse for writing into law a 5-year piece of legislation that will NOT address the core issues inherent in transmission of new infections.


    In the end it is simple: Act up and be heard.


    Jodi L. Jacobson

    Director of Advocacy

    American Jewish World Service

    1413 K Street, NW

    Washington, DC


    202 408-1380

    301 257 7897

  • scott-swenson

    This Action Center can be found at PEPFAR Watch.

    Be the change you seek,

    Scott Swenson, Editor

  • invalid-0

    The “no promotion of prostitution pledge” is NOT a gag rule. It is a requirement that government funds not be used to fund pimps and prostitution directly. NGOS that sign on to the pledge can AND DO still provide condoms, education and other assistance to sex workers.

    The only NGO refused funds because it refused to sign the pledge is run by a pornographer, Philip Harvey, who SELLS (rather than gives) condoms to people in poor countries via DKT International. He was involved in promoting in brothels abroad, and therefore could not sign the pledge. He gives a lot of money to the ACLU, but he’s still a guy who makes millions off the sex trade, and maybe you think that is okay, but surely you understand that many politicians from both parties do not. Read more about this here:


    and here


  • scott-swenson

    Dear Anonymous,


    First, the only time we delete comments is when they are outside the bounds of propriety and/or stigmatizing to marginalized populations. Many of our readers actually encourage us to delete far more comments than we do. Unlike many web sites, we encourage respectful dialog on these sensitive issues. If your comments have been deleted, there was good reason, not because we disagreed.

    As to the anti-prostitution pledge, the reality of the US government's policy has been a sharp reduction in outreach efforts through PEPFAR funded programs to this most vulnerable population. This report says it best,

    How has the pledge requirement actually affected programs? While we found few published studies, several cases do suggest possible implications. In our view, the pledge has the potential to restrict programs for those it seeks to protect. Changes in policy have forced some non-US-based projects, such as the Médecins Sans Frontières–run Lotus Project in Svay Pak, Cambodia, to close [24]. Interviews with some 100 women in Svay Pak revealed that only a small number felt they had been forced into sex work, and a significant percentage sought to improve working conditions and safety. The Lotus Project began by offering a range of services to sex workers, from primary health care to English and computer lessons, while receiving funds from USAID for operations research. Within two years after the project's launch, Médecins Sans Frontières handed it over to a local organization, whose funding came primarily from USAID, in an effort to ensure sustainability. Around the same time, the Lotus Project had come on the radar of US activists working on human trafficking issues. After a number of raids on brothels in the area by US-funded anti-trafficking groups, sex workers experienced severely restricted mobility, resulting in limited access to health care and a reduced ability to earn a livelihood. The project's ability to respond effectively to the new situation was hindered by fear of being seen as promoting prostitution. Their freedom to deliver services based on best practices was limited. Eventually, funding from USAID diminished and the Lotus Project closed [24]. The experience of the Lotus Project contradicts a principal argument used in a friend of the court brief in support of USAID. This argument stated that “Organizations can oppose the prostitution industry without stigmatizing the individuals bought and sold in it‥Helping victims while opposing the industry that exploits them is the best way to prevent HIV/AIDS, the best way to advance human rights, and the best way to fulfill the intent of the Act” [25]. We agree. Yet we would argue that the evidence suggests that as long as prostitution and sex trafficking remain conflated, women and men who voluntarily sell sex may be at risk of further marginalization and may, as witnessed by the Lotus Project, be less likely to receive the health, social, and education services they need to eventually move out of the industry. In this polarized debate, neither side has been ready to surrender what it believes to be the best approach to HIV prevention among sex workers. Public health professionals have an obligation to demand that funding be driven by evidence-based strategies for addressing health and social problems, but evidence does not function in a political vacuum. The history of HIV prevention is all too full of programs that have proven to be politically unfeasible in the US despite overwhelming scientific evidence in their favor, such as the efficacy of needle and syringe exchange programs as HIV prevention tools for injecting drug users. The Federal Government continues its ban on federal funding for this intervention, despite endorsements from the Institute of Medicine, the US Surgeon General, and all of the major health professional associations [26]. These political realities have complicated responses to HIV prevention for sex work as well as for injection drug use. While sex work may be seen by some as inherently degrading, it is nevertheless the case that in many settings sex workers choose to continue to work and to demand preventive and other health services. The provision of support, goods, and services to sex workers who want and need them is a compelling ethical and public health priority. Building trust and showing care by providing sex workers with the tools necessary to stay alive, whether they be condoms, counseling, or a safe place to receive medical attention, is our duty as health professionals and as human beings. Whether these goals can be met if we must “oppose prostitution” is actively being argued in the courts, and perhaps more vitally, in the many settings where sex workers provide services societies continue to disdain and demand.



    Be the change you seek,

    Scott Swenson, Editor