What Is Prevention Justice? Why a Mobilization?

— Suzy Subways, Editor, Solidarity Project

November 2007 • Issue 7

Rumor has it that this World AIDS Day, December 1, the Centers for Disease Control and Prevention (CDC) will announce that its estimated number of new HIV infections in the United States each year is higher than 40,000 for the first time since the late 90s – and it may be much higher. Meanwhile, in May, the CDC scaled back its previous goal of reducing annual new HIV infections in half to reducing them by only 10% a year. Is the government giving up on us? Instead of budget cuts that pit our communities against each other, why not add money for interventions that we already know are effective but have no federal funding streams, like syringe exchange and comprehensive sex education? What about studying new ways to fight the epidemic?

The Prevention Justice Mobilization (PJM), initiated by CHAMP in collaboration with SisterLove, the Georgia Prevention Justice Alliance, the Harm Reduction Coalition, the National Women and AIDS Collective, the New York State Black Gay Network, ACT UP Philadelphia, the Center for HIV Law and Policy, and AIDS Foundation of Chicago, is a dynamic force of activists from many communities. We are starting a new conversation in our AIDS service organizations, social justice circles, support groups and homes, and we are telling the CDC at its annual conference in Atlanta in December: We are not going to allow ourselves, as individuals and groups at risk, to be blamed for the consequences of government failures to prevent HIV. To end this epidemic, we have to change the way this country works.

“When people change and systems do not, HIV still thrives,” explains Dázon Dixon Diallo, MPH, a lead organizer of the Prevention Justice Mobilization and founder of SisterLove, based in Atlanta, the first and largest women’s AIDS organization in the Southeast. “We’ve been working under this assumption that HIV transmission is about individual risk behavior, and that’s where all of our resources and our best thinking have gone. But what’s missing from that is an understanding that HIV happens in a larger context. You can be vulnerable to HIV just because of who you are in the world. If you are poor, a person of color, LGBT, disabled, homeless, mentally ill, or dealing with substance abuse, injustices also exacerbate the transmission of HIV. Where are the resources to address those injustices?”

People in groups with higher HIV rates are often no more likely to engage in risk behaviors such as unprotected sex than other groups. But the disparities are just getting worse. Black women today are 23 times more likely to have AIDS than white women, and Latinas are five times more likely. Among white men who have sex with men (MSM), HIV rates have reached 21%, while

The AFIYA Center: La Cisha Crear and Marsha Jones

— Suzy Subways, Editor, Solidarity Project

November 2007 • Issue 7

*Activist Snapshots #3*

When La Cisha Crear and Marsha Jones heard about the Prevention Justice Mobilization, the Dallas activists knew they had to get involved. “Our vision was already based on an HIV prevention justice model,” Crear says. She and Jones haven’t yet quit their day jobs as prevention outreach counselors at Mosaic Family Services, but for the past several months, they’ve been building a new, community-based HIV prevention organization for women of color, called the AFIYA Center.

“I attended the SisterSong ‘Let’s Talk About Sex’ conference, where I was exposed to the reproductive justice model,” Crear says. “If you read Dorothy Roberts’ book, Killing the Black Body, you see that, for women of color, the struggle has always been for the right to control our own bodies. The mainstream reproductive rights movement elevates abortion above everything else, but for women of color it’s about the right to have or not have a child.” Crear is also a member of the All African People’s Revolutionary Party, a pan-African liberation organization that has member groups in Africa, Europe, North America, and the Caribbean. Jones graduated from the African American HIV University, a two-year intensive education and training program on HIV science, prevention education, presentation development, and community mobilization, along with three six-month internships.

La Cisha Crear (left) and Marsha Jones of the AFIYA Center in Dallas

The pair are putting their diverse backgrounds to work at a time when AIDS has become the leading cause of death among Black women ages 25 to 34, and women of African descent are 23 times more likely to have AIDS than white women. But their approach to prevention comes with a sense of thoughtful urgency that is not narrowly focused on the virus. “AFIYA is a Swahili word for health and wellness,” Crear explains. “Our approach is women’s total health and well being. We have clients for whom getting an HIV diagnosis may not be the worst thing that’s happened to them. Yesterday, that woman may have been on a three-year waiting list for housing and couldn’t get food stamps or transportation. If we can address those issues before someone becomes HIV positive, we may prevent them from becoming positive.”

It’s Bigger Than You and Me: Institutional Racism and Sexism

The AFIYA Center – and women’s AIDS organizations like SisterLove, Women Alive, and WORLD that paved the way for them – are up against deep-rooted systems of racism and sexism. A November 2006 National Minority AIDS Council (NMAC) report on AIDS and health disparities in Black America by Dr. Robert Fullilove of Columbia University’s Mailman School of Public Health reviews extensive data and observes that HIV rates in both urban and (mostly Southern) rural Black communities are “a function of the same set of forces that create residential segregation, the concentration of poverty in segregated communities and the geographical concentration of health disparities.”

SESA WO SUBAN “Transformation”

Dr. Adaora Adimora, associate professor of medicine at the University of North Carolina at Chapel Hill, digs even deeper for the structural roots of racism and its links to HIV risk. In a July 2006 Sexually Transmitted Diseases article titled “HIV and African Americans in the Southern United States: Sexual Networks and Social Context,” she and her colleagues report “extensive economic injustice and racial discrimination…such as preferential hiring and job advancement of whites, blacks’ inability to obtain mortgages, and academic tracking of black youth in schools.” This institutional racism was linked to HIV risk in several ways. Poverty and unemployment disrupt stable relationships, and discrimination can affect health planning and services. Looking at STD rates, the researchers found that “Southern counties with high syphilis rates tended to have worse race relations, with exclusion of minorities from positions of influence such as the county commission or board of health, lack of employment opportunities for minorities, lack of minority-owned businesses, and in some cases, evidence of systemic economic oppression.”

The Global Impact of the U.S. Anti-Prostitution Pledge

Ideology Continues to Trump HIV Prevention

SEP. 2007 • Issue 6

The gag rule. The loyalty oath. Where did it come from and what does it mean to people at risk for HIV?

In 2003, Congress passed the Global AIDS Act and the Trafficking Victims Protection Reauthorization Act (TVPRA), which bar the use of federal funds to “promote, support, or advocate the legalization or practice of prostitution.” These laws require any organization applying for or receiving U.S. funding to combat global HIV/AIDS or human trafficking (forced labor) to sign a statement that it “does not promote, support, or advocate the legalization or practice of prostitution” – parroting the lawmakers’ words.

Organizations that distribute U.S. funding to sub-grantees must ensure that those groups also comply with the oath. Organizations that have to adopt the policy include foreign non-governmental organizations (NGOs) receiving U.S. HIV/AIDS funds and U.S.-based NGOs working abroad.

These funding restrictions are in line with similar – and ever-increasing – efforts to force organizations working in public health to comply with ideological litmus tests that often actually hurt public health practice – and betray human rights standards.

With this policy, the U.S. government has increased stigma and discrimination against sex workers in their home countries. In Thailand, for example, it has led to the breakdown of successful activist coalitions and joint HIV prevention efforts, as groups that were previously allies will no longer work with sex worker groups. Lost funding worldwide has led to serious condom shortages for sex workers. Veteran activists against forced labor within sex work are tarred as supporting human trafficking. And drop-in centers that provided many homeless sex workers with a place to bathe, nap, and find a sense of home and family have closed due to the loss of funds. Their families have been torn apart. People who were active in community HIV prevention can no longer find each other.

U.S. policies run contrary to best practices in public health and undermine efforts to stem the spread of HIV and forced labor.

Thanks to the Center for Health and Gender Equity (CHANGE) and “Taking the Pledge”

Kumjing’s Activist Passport: Migrant sex workers in Thailand become HIV prevention leaders, despite U.S. groups’ attempts to “rescue” them

By Suzy Subways, with additional reporting by Darby Hickey

SEP. 2007 • Issue 6

When the Thai sex worker activist group EMPOWER traveled to Toronto for the International AIDS Conference last year, one of its most vocal representatives was a puppet named Kumjing. EMPOWER works with many women who come to Thailand from Burma for health care, a way to support their families back home, and freedom from Burma’s military regime. They also come from Burma illegally – which means they cannot attend international meetings as other activists do.

EMPOWER’s Kumjing puppets represented migrant sex workers who could not speak on a panel for fear of deportation at the XV International HIV/AIDS Conference in Bangkok, Thailand

“Think about a poor Burmese travel[ing] from one country to another,” says Noi, an EMPOWER activist. “How would she be treated at the immigration authority? When Kumjing was invited to the Toronto AIDS conference in 2006, we took her like a human being, like an art masterpiece made by migrants… The puppet of human life is telling her story from home, in the journey and in the meeting room – on the panel discussion.”

EMPOWER Foundation was started by sex workers and activist allies in 1985 and produced Thailand’s first HIV educational materials. Now EMPOWER runs its own bar, “Can Do,” collectively owned and run by sex workers, with best-practice occupational health and safety standards, a sex worker-designed security system, condom distribution, and workers who are trained as safe sex counselors.

Three thousand sex workers have studied at EMPOWER University, which offers primary and high school qualifications, computer skills, and safer sex counseling skills, as well as training in leadership, media, research and public speaking. English classes are designed by sex workers who want to learn the language in a way that meets their needs – and helps them protect themselves from HIV. For example, a sex worker who can say to a customer, “I like wine but I don’t like whiskey” and “do you have a condom?” will have a better chance to stay in control and away from unsafe situations.

Excerpt: Durbar Policy Document on HIV Positive Sex Workers

SEP. 2007 • Issue 6

In the Bengali language, Durbar means unstoppable. Based in West Bengal, the region of India with the major global city Kolkata (Calcutta), Durbar Mahila Samanwaya Committee, or Durbar for short, is an organization of 65,000 sex workers. Durbar grounds its work in the “3 Rs” – Respect toward sex workers, Reliance on the knowledge of the community of sex workers, and Recognition of sex work as an occupation. In 1999, Durbar took over a government HIV prevention program, the Sonagachi Project, which now has HIV prevention programs in 49 sex work sites and outreach efforts serving 20,000 street workers and their clients. The group also provides low-cost HIV medications at its own clinics, education and vocational programs for sex workers and their children, cultural activities, savings and credit, social marketing of condoms, and self-regulatory boards in sex work sites to prevent trafficking.

The following is an excerpt from Durbar’s policy document on the inclusion of HIV positive sex workers in its work and leadership. It also offers insight into how stigma, violence and criminalization fuel HIV risk. In this document, “+ve” means “HIV positive.” It can be found in its entirety at http://www.durbar.org/new/a011_policy_document_on_psw.html.

TAKE ACTION — WHAT YOU CAN DO

SEP. 2007 • Issue 6

If you’re part of a sex worker activist project and would like to learn from others doing this work, contact the following groups for insight and inspiration:

Different Avenues
Washington, DC
202-829-2103
www.differentavenues.org
Different Avenues is a peer-led organization working for the rights, health and safety of people at high risk for HIV, and fighting violence and discrimination. The organization works across labels and identities to envision a world where our communities live with justice and well-being. The majority of its constituents are youth and young adults, people who are homeless or just trying to get by, and people who formally or informally exchange sex for things they need. Most of its work is local, but Different Avenues also does its best to support national and global movements for social justice.

Project SAFE
Philadelphia
866-509-SAFE
http://www.safephila.org
SAFE serves women, including transwomen, and distributes a Bad Date Sheet to help street-based sex workers avoid clients who have attacked other women or stolen their money. Workers call SAFE’s hotline or invite SAFE volunteers to visit them at home (where they feel safer talking than in the street) and give a detailed physical description of the attacker and what happened. Reports are anonymous and shared only with women. This keeps the information from johns and the police (who may arrest or dismiss a sex worker trying to report a rape), builds trust and community, and helps women define what rape is and be heard without being stigmatized.

St. James Infirmary in San Francisco, run by sex workers for sex workers, provides free, non-judgmental healthcare.

Stella
Montreal
514-285-1599
http://www.chezstella.org
Stella, a broad-based sex worker activist group in Montreal, Canada, also has a

RESOURCES

SEP. 2007 • Issue 6

Bilingual Links:

Center for Health and Gender Equity (CHANGE) Policy Brief: Implications of U.S. Policy Restrictions for Programs Aimed at Commercial Sex Workers and Victims of Trafficking Worldwide (PDF).
English: www.genderhealth.org/pubs/ProstitutionOathImplications.pdf
Español: www.genderhealth.org/pubs/ProstitutionOathImplicationsE.pdf
This document is from November 2005, but remains an accurate overview of the anti-prostitution pledge and what it means. The document includes recommendations for lawmakers.

Sex workers of Apizaco, Tlaxcala, Mexico meet with the Zapatistas’ Other Campaign (2006)
English: www.allwomencount.net/EWC Sex Workers/MexicoSexWorkersEnglish.htm
Español: www.allwomencount.net/EWC Sex Workers/MexicoSexWorkersSpanish.htm
Addressed to sex workers and supporters of the Zapatistas’ Other Campaign (a movement of marginalized people against capitalism and allied with the massive teachers’ strike in Oaxaca), the CNUC (Women’s Rights Network Collective) of Apizaco, in the state of Tlaxcala, Mexico, calls for sex workers across Mexico to fight for their rights together.

English Links:

Desiree Alliance
A coalition of sex workers, health professionals, social scientists, professional sex educators, and supporters working to reinvigorate the U.S. sex workers’ rights movement.

$pread Magazine
A magazine for sex workers, sex worker outreach and labor rights.

Bound, Not Gagged
A blog for sex workers to respond to the way they are portrayed in the media in the wake of the Deborah Jeane Palfrey scandal.

The Manual (PDF, 2002)
Tips for providers planning services for male sex workers. Compiled by the European Network Male Prostitution, which lost funding in 2003 and dissolved into Correlation, the European Network Social Inclusion and Health.

Top Ten Positive Changes for Agency Staff

By the Young Women’s Empowerment Project (YWEP)

SEP. 2007 • Issue 6

This document was created by YWEP, a group of girls and young women in Chicago, aged 12 to 23, with  experience in the sex trade and street economies. Based on their firsthand knowledge of what has worked – or not worked – for them both as young girls looking for help and youth organizers offering help, these guidelines can help adult activists and social service providers make their efforts more respectful and effective. In the Chicago area, YWEP offers trainings and popular education for girls, as well as trainings for adults (through the Harm Reduction Training Collaborative). They can be reached at 773-728-0127. On its website, www.youarepriceless.org, YWEP offers this document and other resources to download.

YOUTH WORKERS – WANT TO HELP GIRLS IN YOUR YOUTH PROGRAM WHO TRADE SEX FOR MONEY OR SURVIVAL NEEDS?

1) Ask young people currently involved in your program about what they know on this issue. Ask on a one-to-one basis or call for a group to ask what they know.

2) Create a welcoming environment to tell you about it – keep disclosures private (don’t let other youth know, and staff should only talk in private when necessary) and make it known that you are open to listening without judging.

3) Do not have negative consequences for disclosing to staff, like losing level, suspension, or making youth leave your program. Work together to find what the young person wants or needs in their life.

Harm Reduction and Crystal Meth

by Suzy Subways

JUNE 2007 • Issue 5

Many of us recall moments of drunken sexual risk-taking—whether disastrous or delicious—and can attest to the fact that crystal meth (methamphetamine) isn’t the only drug that can lead us to make decisions that put us at risk for HIV. The link between crystal meth use and risky sexual behaviors certainly isn’t limited to men who have sex with men. It’s a complicated link that isn’t well understood, varying from person to person and situation to situation. The community websites described below were created and maintained with the participation of current and former crystal users. Both sites are geared toward gay and bisexual men, but the content is relevant for anyone using or interested in understanding crystal meth. They offer a harm reduction approach, providing individuals with various tools to help them make informed personal decisions.

• Tweaker.org is an innovative San Francisco-based website with an array of resources for men who use crystal meth. Committed to harm reduction, the site provides background information about crystal meth and how it affects your physical, mental and sexual health. Tweaker.org includes a public forum in which men share their experiences and ideas about crystal meth. Men may submit their “True Stories” for publication and read the refreshingly honest writings of others, including some searingly funny anecdotes. Click on “Campaigns” to see current and past social marketing campaigns that Tweaker.org has kicked off. The site also includes a helpful list of harm reduction resources. This summer, sections of the site will be launched in Spanish, allowing it to serve even more men.

• CRYSTAL NEON, based in Seattle, provides accurate, honest information about how crystal affects the body and mind, options for reducing sexual and drug-using risks associated with crystal, and suggestions for managing or stopping crystal use. NEON’s philosophies are rooted in the concept of harm reduction and the belief that all individuals are capable of making life-enhancing decisions, regardless of their drug use. The website has useful materials, like a downloadable budget worksheet (click on “Managing” and then “Paying Your Dealer… and Your Rent!”) It’s also clever and lots of fun!

For information about the possible effects of crystal meth use on HIV disease progression and interactions between meth and anti-HIV drugs, read Much Ado About Meth by Tim Horn, published in the Spring 2005 issue of ACRIA Update.

Katrina’s Aftermath: Stranded Without Medication and Medical Care

by Suzy Subways

APRIL 2007 • Issue 4

A disaster that uproots large numbers of people causes an immediate public health emergency, and the effects continue to be felt if the damage isn’t quickly repaired. Soon after the hurricane, P. Gregg Greenough, MD, MPH and Thomas D. Kirsch, MD, MPH went a step further in an October 2005 New England Journal of Medicine commentary, observing that, “Given the ineffective response mechanisms that were in place, Katrina could become a public health catastrophe.” They cited potentially devastating sanitation and immunization problems, among other concerns. “The biggest health issue, however, was and will continue to be the inability of the displaced population to manage their chronic diseases,” they argued. “Katrina disproportionately affected the poorest residents of New Orleans, who did not have the health reserve or the access to care needed to absorb the blow of a breakdown of the local public health system. In the long run, the destruction of the public health and medical care infrastructure has the potential to be more devastating to the health of the population than the event itself.”

Before the hurricane, Charity Hospital’s respected HIV Outpatient (HOP) Clinic served about half of New Orleans’ 7,000 HIV-positive patients. Severely damaged by Katrina, the clinic closed for two months, then operated out of several temporary facilities. Rebecca Clark, MD, says, “Seventy percent of our patients experienced disruptions in their medications for a month or two.” This is far more than a temporary inconvenience, since it can lead to HIV drug resistance and dangerously weakened immune systems, increasing the risk of serious illness and death.

In its 2006 report Voices of the Storm: Health Experiences of Low-Income Katrina Survivors, the Kaiser Family Foundation, documented cases of lower CD4 cell counts due to medication disruptions. One resident of a group home said that her facility gave her only a three-day supply of her HIV medications when she was evacuated. An incarcerated man with HIV missed his medications when he was moved to another prison. An HIV-positive man with severe mental health needs lived on the streets for weeks after evacuation from his group home. These incidents illustrate what many people with HIV experienced when a major natural disaster was combined with a callous and inept government response.

Charity Hospital is now permanently closed. The HOP Clinic is back in its original location but shares the space with other clinics—and only half of its former patients have returned. Many no longer have homes to come back to.

In June 2006, members of the Survivors’ Village tent city marched on the affluent Garden District of New Orleans to protest plans to replace low-income public housing with “mixed income” developments. Photo by Nick Fuller Googins, NOLA Indymedia.

Housing Crisis Increases HIV Risk

Following the hurricane, serious barriers made it difficult or impossible for people to return to their homes or obtain new housing. The lack of affordable housing in New Orleans has created new gaps in HIV prevention services, as many providers themselves haven’t come back. Five of the city’s ten community-based HIV prevention contractors went under in the wake of the storm due to the hurricane’s destruction and to staff not returning. Residents who have made it back are dealing with housing instability and stress, heightening their HIV risk, says Noel Twilbeck, co-chair of the Louisiana AIDS Advocacy Network and executive director of NO/AIDS Task Force. “When people are living in stressful situations, they have a tendency to engage in risky activities,” he says. “There are people living in houses that still don’t have walls up, waiting for repairs.”