An Analysis of the Implementation of PEPFAR’s Anti-Prostitution Pledge and its Implications for Successful HIV Prevention among Organizations Working with Sex Workers

April 2013 - Structural Prevention

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Ditmore, M.H., & Allman, D. Journal of the International AIDS Society (2013), 16:17354.

The authors discuss the U.S. President's Emergency Plan for AIDS Relief's (PEFPAR) anti-prostitution pledge and illustrate its implications for HIV prevention through a case-study approach that uses cases from over 25 organizations and projects in 14 countries. Guidance on the implementation of the anti-prostitution pledge has been unclear and unpredictable, and many organizations interpret the restrictions subjectively, with varying outcomes. Analysis shows that some organizations have refused to work with sex workers out of fear of losing contracts with the U.S. Agency for International Development; others recognize that this refusal would discriminate against sex workers and deny them HIV prevention and health care. No clear guidance exists for HIV programs with sex workers, although there are guidelines for other high-risk populations. This guidance should be established so that no one, including sex workers, is denied services. The current U.S. Global AIDS Coordinator has said that "turning away anyone who should receive services would not be tolerated." Some programs and access to services for these populations have been eliminated as a result of the funding restrictions, and reporting and information about successful HIV prevention programs for sex workers is lacking, which impedes future development and implementation. The authors suggest re-evaluating funding restrictions and implementing evidence-based HIV programs for these populations.

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