Truvada, the only HIV medication approved to be used in PrEP so far. (Photo by Jeffrey Beall, via Wikipedia Commons.)

Truvada, the only HIV medication approved to be used in PrEP so far. (Photo by Jeffrey Beall, via Wikipedia Commons.)

Lindsay Roth cowrote this post with sex worker ally and colleague Cassie Warren. Roth and Warren work together at PxROAR (Research, Outreach, Advocacy, and Representation), a program for community activists which offers training and support around biomedical HIV prevention research and advocacy. Readers can contact them with questions about PrEP at lindsay@swopusa.org and cassandra.r.warren@gmail.com.

So you’re telling me you can take a pill to prevent HIV?

Yup. We believe that if done right, PrEP has the potential to be one of the best tools brought to market for receptive partner protection and power since the pill in the 1960’s. PrEP doesn’t double as a contraceptive, but it does reduce your risk of HIV by 90% when taken correctly. It’s still a sweet tool to have in your make-up bag, hard femme box, tool kit, whatever you call it. We are still in the middle of an epidemic, with trans and cis women, men who have sex with men, and injection drug users still being hit hard and unjustly. We deserve to have access to all the options that protect us against HIV.

In what follows, we’d like to lay out the basics of PrEP (no really, what is it? does it cost the first month’s rent?), add context to some of the controversies, and offer our take on what this means for sex workers. We do not anticipate that we’ll be able to answer all the questions people have in this one post, and we hope that you will comment or reach out to us directly if you’d like to know more.

What the heck is it?

PrEP stands for Pre-Exposure Prophylaxis. The main part to note here is “pre,” implying treatment before exposure. In this context, we are talking about exposure to HIV (Human Immunodeficiency Virus). So, PrEP is a medication an HIV-negative person would take to prevent them from becoming positive. Currently, Truvada is the only form of PrEP approved by the Food and Drug Administration.

Truvada is an NRTI (nucleoside analog reverse transcriptase inhibitor) which is just a fancy name for an HIV medication. It has been used to treat HIV since 2004. We used to know HIV as the virus that caused AIDS, and knew AIDS as a death sentence. However, because of advancements in the treatment of HIV, positive folks can live long, healthy lives. Folks can even be positive, on treatment, and unable to transmit the virus to anyone else. Recently the medical establishment stopped giving AIDS diagnoses: Because of new treatment options people can be at various stages in their HIV diagnosis, and we now classify HIV as stage 0, 1, 2 or 3 HIV.

Many readers may be familiar with PrEP’s sibling, PEP, or post-exposure prophylaxis, the use of antiretroviral drugs—ARVs (again, a fancy name for HIV medications)—to mitigate the risk of HIV transmission after a potential exposure. Any doctor can write a prescription for PEP, most Medicaid programs pay for it, and Gilead, the large research based pharmaceutical company which makes Truvada, has a patient assistance program to cover the the costs for the uninsured or underinsured, regardless of immigration status.

To summarize, PrEP vs. PEP:

  • Truvada as PrEP is taken before an exposure to HIV, specifically one pill a day, every day.
  • PEP is taken after an exposure to HIV, specifically within 72 hours, and consists of 30 days of full-regimen HIV treatment medication.
  • Both prevent you from acquiring HIV.

How does PrEP work?

The rationale behind PrEP is based on the way most doctors are treating HIV-positive individuals with ARVs. Truvada is a combination of two medications, tenofovir and emtricitabine. If HIV is presenting itself in one’s body, this medication blocks the replication of HIV in the body. Doctors currently prescribe one pill a day, as the medication must be present in the body to do its work. However, there are trials underway to test the efficacy of other ways of taking PrEP. So far, the results of the iPrEX OLE (open label extension) say that if you take it 2-4 times a week you are protected 85% of the time against HIV, and if you take it 5-7 times a week, you are protected 99% of the time against HIV (not other STIs or pregnancy). If you take it less than 2 times a week you have zero protection. 1

Can I take it right before I meet a date?

No. PrEP acts like a full metal jacket around your T-cells, so if HIV is introduced to your body it can’t get into the cells it wants to infect and replicate itself.2 It takes about seven days to make this metaphorical metal jacket around the cells in the rectum (drugs taken orally are absorbed quicker in the digestive track), and about 20 days to make a metal jacket around the cells in the vagina (our apologies if you call your junk something else) and in the bloodstream. So, for full protection, you’d need to be taking it every day for a week before you’re protected during anal sex, and every day for three weeks before you are protected during vaginal sex or during any activity in which you would share blood (e.g., sharing needles for tattoos, hormones, drugs, piercings, etc.).

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 aswopchicagostylebook2Help Tits and Sass contributor Peechington Marie’s fundraiser to offset funeral costs for murdered young Black strippers Tjisha Ball and Angelia Mangum meet its goal in its final week.

The Daily Dot covers an online campaign to have the AP style book replace “prostitute” with “sex worker.” Want more on this? You’re in luck, as Tits and Sass will be running a series on sex worker nomenclature, including posts debating the merits of “prostitute” vs. “sex worker.”

Monica Jones is still fighting her case in court over a year after being arrested and funneled into her own school’s diversion program, but the flaws in Project ROSE are becoming more apparent and more public.

Government officials and social workers need to come to terms with the fact that the victim/criminal binary simply doesn’t fit the majority of underage sex workers, points out Elizabeth Nolan Brown.

There are more male sex workers in England than the government thinks!  Which is not surprising as government stats have a male sex worker population of 0.

Another Christian anti-trafficking organization is using sex workers as labor for their tacky little products, and the products as a metaphor for the reformed sex workers’ transformation from something no one wants into something beautiful.  Such empathy!  Wow.

The Daily Mail appears to be having a slow news week, as Amanda Goff hugging a football player she ran into at brunch was judged newsworthy. (Amanda Goff made headlines earlier this year after outing herself and writing a book about her work as an escort, to much handwringing over the psychic damage this revelation will do to her children).

Trans sex workers in Pattaya, Thailand are being targeted by the police as part of an across-the-board morality drive:

Officials in Pattaya say they need to be seen to be doing something to scrub up the city’s reputation before the army is tempted to intervene in ways which local officials say might be bad for business.

More on the five year study that resulted in its researchers having the revelation, “Sex workers! they’re a lot like us!” Still, as fatuous as that comment was, the study is a nice respite in a week dominated by anti-trafficking organizations: its findings show that most sex workers are not coerced.

Backing this up is yet another report from Operation North Star: police officers in Regina also found that sex workers were working because they wanted to (despite the police interviewers’ apparent inability to accept that fact.) Guess it’s just that hard to accept an escort’s word at face value.
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The RedUP gang at yet another conference. (Photo courtesy of Red Umbrella Project.)

The RedUP gang at yet another conference. (Photo courtesy of Red Umbrella Project.)

When I accepted the chance to go the International Human Trafficking, Prostitution, and Sex Work Conference in Toledo, Ohio, I wasn’t sure what to expect. The organization I work for, Red Umbrella Project, attended the conference to present our report on New York’s new Human Trafficking Intervention Courts. Just the fact that they accepted us—a sex worker-run organization—to speak threw me for a loop. When I saw that members of SWOP (Sex Worker Outreach Project) and Miriam Weeks (AKA Belle Knox) were also speaking, I wondered if this conference might prove an exception to the usual anti-sex work stance of the rescue industry. After all, “sex work” was right there in the title. Someone in charge must have understood the complex reasons people get into sex work better than to assume that everyone everywhere within the sex industry is being exploited and trafficked, right? But as a sex worker, I also knew what the rescue industry—and what seems like most of the world—thinks of me and my job.

Our organization has just completed an eight-month study on New York’s Prostitution Courts, now known as Human Trafficking Intervention Courts (HTICs). Now, in 11 jurisdictions within New York state, anyone charged with prostitution is assumed to be a victim of human trafficking and instead of being charged as a criminal can choose to do five to six sessions in a diversion program.

It felt to me like we were pretty well received. We didn’t deliver an impassioned speech about the plight of American sex workers, we instead explained the trafficking courts of our city, pointing out how they aren’t meeting the needs of the people they’d taken a seemingly more compassionate legal stance for. Our study found that the racially motivated arrest tactics of the NYPD were very visible within the courts, and that due to a shortage of capable interpreters, defendants who spoke English as a second language were progressing through the system at a third of the speed of native English speakers. We also suggested that the six weeks of therapy the diversion programs provided did little to address the needs of people doing sex work for survival. After a defendant charged with prostitution completes their mandated diversion program, they have an open record for six months, which can be a barrier when trying to find other work. They also cannot be re-arrested during this period or they have to start the process from the beginning again.There are more and more new court systems in the US that are similar to New York’s, and the idea of using “human trafficking” as a term that refers to all people in the sex trades is becoming more popular. And most of the time, the fight to end human trafficking is led by people who make no distinction between someone who is forced or coerced into the sex industry, someone who enters it by choice or curiosity, and the myriad scenarios in between the two. We saw a lot of this in the Toledo conference.

The best example might be the woman who, after finding out what Red Umbrella Project does, asked us, “But if your organization is made up of current and former sex workers, how do you keep the current ones from recruiting the former ones?” The member who she asked was floored as he tried to explain that that has never been a problem. How could you explain to someone with that view of sex work that no, our organization is not partially made up of unscrupulous hookers lurking around trying to sucker recovering trafficking victims back into a life of drug-addled degradation? We all tried to explain, taking varying tacks with forced cordiality. We explained that RedUP is made up of sex workers from all walks of life and varying circumstances, that our main goal is to give our members the tools to tell their own stories and advocate for themselves, and would you like to take a look at our literary journal of sex worker memoirs? It was exhausting, but it felt important for us to be there, no matter how much teeth-gritting it took.

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The ladies I performed with in the new Mastodon video, “The Motherload,” were not all strippers, but I don’t think that matters much to the 800,000-plus viewers that watched the video in the first week. Though those of us who were strippers initially sat in cliques—the girls who knew each other from the same club or girls who had danced with each other in the past—we still exchanged pleasant glances. When the director came in and told us we’d be having a twerk dance battle with dancers we didn’t know, there was a momentary gasp.

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(Screenshot of Association of Club Executives newsletter.)

Mayang Prasetyo, a trans woman sex worker, was killed by her boyfriend in Australia (trigger warning: article describes a brutal, perverse murder).  The Courier Mail used some unconscionably unfeeling headlines in relating the murder, and is being called on it.

Oregon lobbyists are working with strippers and social workers to come up with legislation that will offer protections to strippers, reinforcing their labor rights given that, in Oregon as in so many other places, strippers are illegally classified as independent contractors. Mary Emily O’Hara notes:

Though the panel won’t finalize the bill until later in the year, everyone seemed to agree on one thing: if you’re going to work as a stripper, some sort of basic education that clarifies rules around touching, employee status, and other workplace protections is desperately needed.

The Association of Club Executives was way less than thrilled by O’Hara’s article, as you can see from the screen shot above, taken from their newsletter. “Empowerment Enterprises”! That’s some beautiful cheek.

The Cambodian government is also proposing to enforce the labor rights of workers in entertainment venues, including sex workers.

A recent study of sex workers over 40 in India found their circumstances to be very distressed, often exacerbated by the Devadesi system.

Another sex worker is on reality tv: Former stripper Courtney Lapresi is on Master Chef, and the response to this from contestants and critics has been even more negative than Irish response to sex worker Kate McGrew on Connected. Naysayers theorize that Lapresi might exchange sexual favors in exchange for winning. As Esmerelda Murray reports, Lapresi herself is framing stripping as an embarrassing and regrettable decision she made while she was broke.  What’s embarrassing and regrettable is that, after making it on to a cooking show, she felt she had anything in her past to apologize for. Badly done, Master Chef.

Several cases of male violence after rejection made the news this week, only one involving a sex worker (progress?): An English sex worker was attacked on the outskirts of Manchester after attempting to keep walking and ignore a man who wanted her attention.

A days-long trafficking investigation/sting across Canada, which interviewed over 300 sex workers, resulted in 9 arrests, although police in Edmonton, for example insist that they got a very guarded feel from many of the women.  You don’t say.

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