For the past 10 years, Lindsay worked in Philadelphia as a sex worker and community organizer with Project SAFE. She now works with SWOP-USA and the Woodhull Freedom Foundation.


(Photo by Flickr user Javier Morales)

There is significant debate within our sex worker community about whether LEAD (Law Enforcement Assisted Diversion) programming, a pre-booking diversion program for low-level drug and sex work related offenses, is a good or bad thing. The first LEAD program launched in Seattle, Washington in 2011, with private funding from the Ford Foundation, Open Society Foundations, Vital Projects Fund, and several others. This pilot program has been championed by law enforcement and drug reform advocates alike and has since launched in several other cities, with slight regional variations—just this Monday, the Baltimore Sun ran a story about the launch of a three-year pilot LEAD program in that city which Police Commissioner Kevin Davis framed as a response to Baltimore’s proposed police reform agreement with the U.S. Department of Justice. A recent evaluation of LEAD programs, conducted by researchers at the University of Washington, yields seemingly impressive outcomes for the communities they allegedly serve. Indeed, LEAD programming even names “sex workers” and “drug users” as their “consumers”—a rather misleading label for those in state custody, implying agency where there is none. In truth, LEAD programming does not serve sex workers or drug users, or those profiled as such. Rather, LEAD can be understood as a diversionary program for law enforcement officers and should be analyzed under this lens.

Diversionary programs like LEAD represent the co-optation of harm reduction lingo in the service of criminalization masquerading as social services. While we may rejoice at terms like “sex worker” and “people who use drugs” being used by institutions who typically use other, nastier language to describe these populations, the population they are actually talking about is people living in poverty. Programs like LEAD, which claim to provide case management, public housing, and job training, don’t target drug users and sex workers, as most people who do drugs or trade sex have those needs met. Many, if not most, sex workers and drug users have the social and economic capital to get high or make money in private homes, apartments, or rented rooms in areas that are not under constant police surveillance.

So why do poor people, many of whom lack economic capital because of deliberate, targeted U.S. policies, need a diversionary program? They don’t. Cops do.

Many sex workers I have talked with about LEAD think it is a good way to get desperately needed housing or medication or other necessities, things which traditionally fall under the category of “fundamental human rights.” But we must consider what is gained and what is lost when private funders like Open Society Foundation and other progressive grant-makers support programs in which individuals achieve access to fundamental human rights as a consequence of crimes they may or may not have committed.

LEAD reinforces the logic that people who are trading sex or using drugs need intervention from law enforcement, even if that intervention is a “softer” redirect towards social services. Do we? Increasingly, the answer, as supported by research, is a resounding no.

As prohibitive policies against drug use and sex work are repealed and replaced, law enforcement workers are looking for ways to stay relevant in the lives of those they have hunted, abused, and marginalized for the past few decades. The LEAD National Support Bureau, made up largely of law enforcement, publicly acknowledges an “urgent crisis of mass criminalization and incarceration,” and yet advocates for, well, more police. The logic of LEAD is not much different from that of “community policing,” which made strategies like “stop and frisk” and “broken windows” household names, and redirected billions of tax payer dollars to the justice department and away from education, infrastructure, and health care. Advocates of these policies fail to realize that the issues they want to address, like drug use, are hardly a matter of police and community relationships. Rather, the root of these issues lies in the systematic disenfranchisement of targeted communities.

[READ MORE]

{ 6 comments }

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.).

[READ MORE]

{ 10 comments }