HIV/AIDS: Sex Trade Workers, American Blacks, And A New President For AIDS International
Well the 17th International Conference on AIDS wrapped up in Mexico City over the weekend and despite being attended by over 22,000 delegates from more then 170 countries, not much of anything happened or was said that hasn't been said or done before. In fact aside from the appointment of a slightly controversial figure as the new president of AIDS International, the only event of any real importance during the Conference was a plenary session featuring a representative of an Argentine Sex Workers association as it marked the first time that anybody from the industry was given standing at the conference. In fact it was so inconsequential an event that the biggest news of the week regarding the disease actually took place outside of the Conference with the release of "Left Behind" a report from Black AIDS Institute on the impact of the disease on their community.
Julio Montaner of British Columbia, and the director of the B.C. Centre for Excellence in HIV/AIDS was confirmed as the new president of the International AIDS Society at the end of last week's conference. He brings not only a wealth of experience to the job but an outspokenness that's seemed to be sorely lacking amongst AIDS bureaucrats for too long. Dr. Montaner came to Canada in 1981 after graduating from medical school in Argentina, and began working at St. Paul's Hospital in Vancouver, British Columbia. As well as his residency he also began a research project involving the then obscure disease known as pneumocystis carinii pneumonia, which we now know as AIDS.
It was Dr Montaner who started treating the disease with corticosteriods, worked on the first clinical trials for zidovudine (AZT) that was standard treatment for HIV/AIDS for over a decade, and helped pioneer the use of antiretrovirals, the drug cocktails that keep people with the disease alive far longer today then anything else has yet. He also has led the way in making the B.C. Centre an international leader in the field of HIV/AIDS, and making St. Paul's Hospital one of the best treatment sites in the world. He's also a very strong advocate in support of Vancouver's safe injection facility for intravenous drug users, Insite.
His support of Insite, and his general outspokenness, has drawn the ire of Canada's conservative federal government. Federal Minister of Health Tony Clement has even gone on record as criticizing Dr. Montaner by saying he and his colleagues have crossed the line from being scientists to being advocates and activists.
Dr. Montaner's response to his critics was best summed up by his speech at the closing ceremonies of last week's conference where he said that the world's failure to work more resolutely to combat the global epidemic is tantamount to a crime against humanity. He continued by saying we know what causes it, we know how to prevent it spreading, and we've even learned about ways to treat it, so what really matters now is taking action. In others words it's time to shit or get off the pot folks and take some direct action by doing what we know works in order to keep people alive and prevent the disease from spreading any further.
One of most common ways the disease is spread in many parts of the words is through the men, women, and transgendered folk who make their livings selling sex. Up until now nobody has thought to include a representative of the industry at these conferences, which hasn't stopped many organizations from deciding they know what's best for them and often causing more harm then good. This year Elana Reynaga, executive director of the Argentine Association of Female Sex Workers (AMMAR) didn't mince any words when addressing the conference about the current situation facing people around the world in the sex trade.
While her speech was peppered with statistics about the rate of infection among sex workers, its primary focus was to stress the following concerns: people working in the industry be recognized as being legitimately employed, workers be involved in the organization of any programming that impacts on their lives, and that there be an immediate ceasing of passing moral judgements on them as individuals and the nature of their work. In denying them their legitimacy and trying to forcibly "rehabilitate" sex workers, agencies like the International Justice Mission (IJM) who are funded to the tune of millions of dollars by the Gates Foundation to prevent the spread AIDS by fighting prostitution, cause more harm than good.
By coercing governments to crack down on prostitution, they get the American government to threaten to remove states from favoured nation status when it comes to receiving foreign aid, the sex trade is forced underground and the chances of infection increases exponentially. On the other hand, Ms. Reynaga sites the example of Brazil where the government collaborated with the Brazilian Network of Prostitutes on a public health and rights campaign called "No shame girl you're a professional" and the Ministry of Labour now includes prostitute among the list of recognized professions as part of their efforts to combat the spread of the disease.
The continued stigmatization of sex workers and the denial of their rights as individuals places them more at risk then anything else. In some countries sex workers aren't even able to carry condoms as police will use them as evidence of prostitution and threaten to arrest them. As Ms. Reynaga so bluntly puts it, sex workers are dying because of a lack of health care, a lack of condoms, a lack of treatment, and a lack of rights - not because of a lack of sewing machines. (IJM suggests that sex trade workers be taught how to sew so they can get "decent" employment - of course well paying sewing jobs are just lying around waiting to be snapped up aren't they)
Sex trade workers have always been one of the groups at highest risk when it comes to HIV/AIDS, yet instead of helping them organize in their own defence, money is actually being spent on programs that puts them at more risk than if we were to do nothing. Isn't it time people grew up about sex and accepted the fact that people are always going to be willing to buy and sell sex? Instead of trying to pretend it doesn't exist, or pretend we can make it go away, why not ensure that the people involved are as safe as possible by helping them help themselves?
While sex trade workers finally getting a public voice and International Aids selecting a president who will hopefully push for more direct action on fronts that are actually effective is a good sign, the biggest news of the week concerning AIDS didn't come out of the conference in Mexico City, but from north of the border. The Black AIDS Institute's report "Left Behind" revealed statistics that make it obvious that the disease has reached epidemic proportions in Black America. While African Americans only make up thirteen percent of the total American population, 50% of Americans with HIV are African American.
In every single risk group black people are more far more likely to be infected than whites: gay men who are black are twice as likely to be infected as white, more then half of infected drug injectors are black, black people are more likely to be diagnosed late then white which contributes to a much higher death rate - in New York City a black man with HIV is twice as likely to die as a white man with HIV. With black men seven times more likely to be imprisoned than white men, and the percentage of prisoners in the US with access to condoms hovering at 1% of the inmate population, jail represents another real risk to black men for infection.
Unlike other "countries" Black America not only sees a high infection rate among it's at risk population - men who have sex with men and intravenous drug users - it also is showing signs of having symptoms of a generalized epidemic - where the whole population is at risk. While only a quarter of black men have been infected by unprotected sex with women, three quarters of black women have been infected by unprotected sex with men. With black women reporting having multiple partners in a limited time, the chances of the disease spreading among the general population increase dramatically. The report warns of this danger and admonishes black men to be more responsible when it comes to sex.
What must be the bitterest pill for the authors of this report to swallow is the fact that prevention accounts for only four cents out of every dollar spent on domestic programs for HIV/AIDS. Even more ironic is the fact that although the US government insists that countries it funds help combat AIDS have a strategy in place before they receive a penny of aid, America has no strategic plan to combat its own epidemic. It seems like the government of the United States would like its citizens to believe that HIV/AIDS is only something that happens to other people, but not to Americans.
When you combine the statistics reported in "Left Behind" with the disturbing revelation that the U.S. Centre For Disease Control and Prevention has been low balling it's estimated number of new cases of HIV by around 16,300 annually for the last ten years, it starts to look like government has been ignoring the problem in the hopes it will go away. Even worse it looks like they have been cynically hoping as long as they can keep it contained to minority populations, not enough people will care for them to have to do anything about it.
Although if you take these figures in the context of the current American government's policy of allowing their moral agenda to trump actually achieving results with regards to HIV/AIDS funding in foreign countries, their attitude on the home front isn't very surprising. Would you expect them to fund money to hand out condoms or clean needles to prostitutes or intravenous drug users in the United States when they won't over seas? "Left Behind" concludes by saying that as long as we continue to allow political or moral issues to dictate the way we deal with HIV/AIDS people will continue to die.
The numbers don't lie no matter what country or continent you live on. Every year more people are still being infected with HIV/AIDS then are receiving treatment which means not enough is being done to actually prevent the spread of infection. While there was some sign of movement towards a more accepting attitude with regards to sex and the disease at the most recent International Aids conference, and a renewed call for action over talk, we have delayed taking action for so long that it could take decades before we are able to climb out of the hole we've dug for ourselves.