AIDS Health Workers and Anti-Trafficking Activists – Is There a Conflict?

In the global crisis of violence
against women, there is a heated debate about the best way to approach
the issues at the intersection of HIV/AIDS and human trafficking. The
language used to describe the two differing schools of thought says
it all.  They are the terms "harm elimination" and "harm
reduction."  The former entails the abolishment of sexual slavery,
trafficking, and prostitution. The latter involves working to ameliorate
the HIV/AIDS crisis in a pre-existing negative situation.  Distributing
condoms has been at the forefront of that activity. With the Obama Presidency
on the horizon, advocates for women’s issues are waiting to see what
direction the new players taking over the reins of policy will adopt.  

In March of 2008, I interviewed
a senior State Department Official who discussed efforts to highlight
awareness of the link between sex trafficking and HIV/AIDS.  He
related statistics showing that as customers seek out increasingly younger
girls, the rate of infection for HIV/AIDS for 15-year-olds and under
has jumped to over 60%.  The official supported a victim-centered
approach, with the training of "forensic nurses" to be alert to
the HIV/AIDS and sex trafficking connection.  He believed there
was "a false dichotomy" between the goals of the anti-trafficking
activists and the health community.   

Yet, several NGOs have been
accused of "turning a blind eye to trafficking in brothels." 
Anti-trafficking supporters believe the public health perspective reflects
the given, "This is going to be happening anyway, so there should
be protection."  They pose the rhetorical questions,  "In
an effort to distribute condoms, is the result a form of "collusion"
between public health officials and brothel owners that sends mixed
messages? If a child is in a brothel, can the only concern be if this
child gets AIDS?  Can you fight the spread of HIV/AIDS without
on some level contributing to the problem of forced sexual servitude?" 

For health workers, the core
matter is saving lives through the prevention of spreading AIDS. 
Anti-trafficking activists are goal-driven to free women and children
from conditions where they may be forced to have sex 10 to 30 times
per day.  Katherine Chon, President and Co-Founder of Polaris Project, sees the "harm reduction" methodology
as a narrow policy. She stresses the need for "finding a way to protect
the health of women and girls that also address the systemic issues." 
She observed, "If you are not asking the right questions, you are
not going to get the full picture."  

Taina Ben-Aimé, Executive
Director of Equality
, believes that
many in the HIV/AIDS sector don’t "have a gender perspective"
and are seeing circumstances strictly as "a medical situation." 
She pointed out that distribution of condoms is not foolproof. 
"Clients are willing to pay a higher price in order to avoid use,
and women can be beaten if they insist on use." 

Professor of Women’s Studies
at the University of Rhode Island, Donna
M. Hughes
, PhD.,
told me, "The sex trade is a form of contemporary slavery.  Legal
reforms need to create solutions that assist victims and prosecute perpetrators,
and are based on the premise that prostitution is a form of violence
against women – an extreme form of gender discrimination."  
Hughes feels the burden is "on the policy makers of the NGOs and their
funders."  She is concerned with HIV/AIDS programs solely targeting
disease prevention without pointing to sexual slavery and trafficking
as a primary factor in the spread of HIV/AIDS, and sees short-term solutions
for the AIDS epidemic as outstripping the examination of how to confront
the human rights violations that characterize the slavery of women and
children.  Hughes suggested NGOs "take their budget, and split
it between condom based programming and providing assistance to get

Without Borders
Sans Frontières (MSF), was pinpointed in a February 27, 2003 column
by Hughes in the Wall Street Journal. "Aiding and Abetting
The Slave Trade" questioned why the MSF goal was "not to get the
women or girls out of slavery, (but) only to provide HIV/AIDS prevention
education."  Hughes asserted, "It’s a sad reality that many
seemingly well intentioned NGOs aren’t really about helping victims
of abuse." 

Michael R. Goldfarb, Press
Officer in the New York City office of MSF forwarded me a letter from
the Asian Wall Street Journal (February 2003) in reply to Hughes’s
allegations. Written by the Head of Mission MSF, in Cambodia, Richard
Veerman disputed the claim that MSF had turned "its back on the horrible
plight of women and young girls forced into commercial sex work."
"Nothing could be further from the truth," he said. Veerman wrote
that MSF was cognizant of groups handling advocacy and rescue for those
enslaved in brothels, but was also aware that the women and girls had
no access to medical care.  Based on that rationale, MSF opened
a free clinic in an attempt to "alleviate some of the suffering of
the sex workers."  Veerman maintained, "MSF firmly condemns
the trafficking of women and children." 

Jerome Oberreit, Director of
Operations based in Belgium, explained the two primary concerns of MSF
are to provide emergency medical care and to use their medical activities
to "witness" the plight of the people it assists. Their foremost
responsibility, without judgment, is to the individual.  The mandate
of "witnessing" is constructed to pass on information to local networks,
creating outreach through data.  I received, via e-mail, the names
of the groups that MSF had passed their information on to.  

Director of the Center For
Battered Women’s Legal Services at Sanctuary
For Families
, Dorchen
Leiderholdt, believes "when health care workers encounter trafficking
victims they have an obligation to take measures to protect those people
from abuse."  Holly J. Burkhalter, Vice-President of Governmental
Relations for International Justice Mission, sees it differently. "It’s
asking health workers to also play the role of law enforcement," she
said. Burkhalter believes those in the health movement do understand
the importance of the anti-traffickers concerns, and that the two advocacy
interests must work together. 

Wenchi Yu Perkins, former Vice
President of the Human Rights Program at Vital
Global Partnership,
does not want to see "harm elimination" and "harm reduction"
as mutually exclusive. "Everything comes down to reality…what works
and what doesn’t.  People are finding the common ground is much
bigger than we thought."  Yu Perkins said unequivocally, "There
is no such issue as consent for girls under eighteen in brothels. The
priority is to get them out." Young girls, with immature immune systems
who experience vaginal bleeding and forced abortions, are more vulnerable
to higher rates of HIV. 

the United
States Government

has taken a stand that they will not give funding or support to any
NGO that says prostitution is a form of work. When the Obama team presents
their approach to eradicating the crime of modern-day slavery while
fighting HIV/AIDS, it will set the tone for the rest of the world. 
Hopefully, they will be at the forefront of building a global coalition
to mobilize a comprehensive approach to the problem. 

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  • invalid-0

    I think that both efforts are toward the same goal, helping victims in the sex trade. There is no reason why rescuing of these people who are being trafficked is exclusive with distributing condoms/education.

  • jodi-jacobson

    In this blog, Katherine Chon is quoted assaying  "If you are not asking the right questions, you are not going to get the full picture."  The blog however conflates nuanced debates and issues, and by doing so leaves readers without the full picture.


    Trafficking of anyone against his or her will into any situation is horrific. Trafficking is common across many categories of labor and slavery—even today we know that children, women and men are trafficked into bonded labor in south Asia; child soldiers are trafficked throughout the war zones of Africa; people are trafficked for agricultural labor; and women, girls, and young/adolescent boys are trafficked into sex work in many places.  These and other forms of trafficking constitute gross violations of human rights, and are held together by a common thread of abuse, violence (including sexual violence) and the theft of self-determination.  All are forms of slavery–rooted in dire poverty, inequality and corruption–and should be abolished. 


    But that is easier said than done and so we are obligated to work over both the short and the long term to change both pervasive conditions and immediate realities.


    To end trafficking we have to promote economic development and trade policies that “eliminate" the vulnerability to being trafficked in the first place.  We must also reduce the harm people experience for their own sake and that of their families.  And yes, programs to identify and help victims of trafficking in the here and now are important, though simply “rescuing” people without attention to the conditions of dire poverty, stigma and discrimination from which they originated has often resulted in their subsequent return to the very situations out of which they have been rescued. 


    This is where the blog falls short. It conflates trafficking with sex work on every level, painting a diminished picture of both the “problem” and the “solution.” We may not like sex work, we may be offended by it.  Whatever "we" think, there are women and men throughout the world who have entered sex work “voluntarily” because they either are so destitute they have no other alternative or, by their own free will have decided that the indignities we perceive they suffer as sex workers are vastly less offensive to them than what they suffer in other areas of employment available, if any are in fact available at all.  Last year, colleagues from Cambodia and India told me stories of women choosing sex work after the collapse of garment or mining industries that left their villages with no means of survival; of women choosing sex work as an alternative to “the factory job in which they were subject to daily abuse, lacked toilet facilities, were sexually harassed by their bosses, and were unable ever to take a day off torest, all while making one-tenth or one-hundredth of the money they could in sex work."   These are rational economic choices made by rational people in the context of their reality.  To ignore this is to further marginalize them.  And yet, what US global AIDS policy and US trafficking policy for much of the past 8 years has done is to conflate these issues, deny the human rights of sexworkers, and further marginalize them in part by denying them access to harm reduction programs.  Ironically, these policies have adversely affected programs, like that of Sangram in India, in which sex workers themselves banded together to end trafficking into their community, ensure healthful practices among sex workers and clients, and address gender-based violence.  How often do we ask sex workers what their priorities are?


    In short, these are complex issues with complex solutions that can only be achieved through substantial shifts in policy and funding streams, vast amounts of political capital and years of determined work.   We do not need to be divided to recognize that reducing harm immediately and reducing vulnerabilityfor the long term are mutually supportive approaches.  We should similarly not be divided over the basic rights to self-determination of all persons. No one condones trafficking persons into sex work, or any other sector.  No person should be held against his/her will for any reason. But trafficking is not the only reason people end up in sex work.  If you have never sat down with members of a sex work collective, then please do not judge their own choices.  These are individuals, each of whom wants to make their own decisions about whether and when to leave sex work, what their own needs are and how to organize for their own rights.  Presupposing for them further robs them of their rights and dignity.  Let’s work to reduce vulnerability through fair trade policies, effective and equitable economic development strategies, securing labor rights and establishing livable wages.  And while we do this, let’s save  lives.