Activism

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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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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(Photo by Quinn Dombrowski, via Flickr and the Creative Commons.)

(Photo by Quinn Dombrowski, via Flickr and the Creative Commons.)

I work as a writer and a pro-domme. For me, the first stems from the second; the financial independence I earned from my pro-domming gave me the confidence and clarity to think and write. In my writing, I am out as a sex worker. My byline is a name, Margaret Corvid, that I consciously link to the name I use for sex work. As a dominatrix, I am Mistress Magpie; the real magpie, a whimsical, intelligent, and slightly evil bird, is in the corvid genus, along with jays, crows and ravens. This little play on words honors my sex work and my kink, the foundations for my work as a writer. I also link the two because my politics dictate my being out. As a white, able-bodied cis woman from a middle class background, my privilege affords me a modicum of protection, so I write as a sex worker even when I am writing on an issue entirely unrelated to sex work. Hopefully, this choice helps in its own small way to move us forward towards a time when sex workers can participate fully in the public sphere.

The privilege of my origin shows through in my writing, which is the product of my education. I inherited my skill at writing through the educational opportunities my middle class background afforded me; I learned it, but I did not earn it. Because of that skill I have been able to write for top-level publications in the UK, writing some explicitly pro-sex work and pro-kink pieces for them. Unfortunately, I have made some mistakes in my writing. The first piece I wrote for the Guardian referred to some sex workers as “miserable slaves”, because in my advocacy for the understanding that sex work is work, I was trying to inoculate my argument against people’s likely criticisms. In doing so, I bought right into the trafficking myth. Months later, I came across some criticism of the piece. I engaged with it, apologizing and putting myself through a crash course on the rescue industry; this study resulted in the first piece I wrote about sex work which I feel is truly worthy. Through my embarrassment, I realized that I needed to completely reeducate myself. The reputation of the “social justice warriors” on the internet is fearsome, but I have tried to approach feedback with a sense of humility, and a few of the most vocal activists have graciously offered me their support.

With my unearned platform, I have an opportunity to carry the message of sex worker rights to policymakers. I am duty-bound to do my best to get up to speed with the voices of the most marginalized among us, while not using my privilege to insist that others educate me. As I prepare to write a big article about the sex worker rights movement, aimed at those who have heard little of it, I’m frightened of making a mistake, of making things worse for us. When I’m speaking to an audience of non-sex workers, my choice of message and the way I deliver it must avoid reinforcing the assumptions and stereotypes that marginalize us, and my politics must not pander to the social forces that criminalize us. If I can’t do that reliably, I might as well say nothing.

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Mother's Day protest at an Arizona prison (Photo by PJ Starr)

Mother’s Day protest at an Arizona prison. (Photo by PJ Starr)

I spoke to sex worker rights film maker and photographer PJ Starr about her upcoming documentary film, NO HUMAN INVOLVED, on the death of Arizona street worker Marcia Powell through prison brutality. The interview that follows is a composite of a week of e-mails between the two of us.

Who was Marcia Powell? 

Marcia Powell was arrested in 2008 for solicitation of prostitution and was sentenced to 27 months in Perryville Prison, a women’s prison located in Goodyear just outside of Phoenix, Arizona. In 2009, while she was serving that sentence, she was left in a cage in the sun during the heat of the day for hours. She collapsed and some hours later died in a hospital in Goodyear when the Director of the Arizona Department of Corrections had her removed from life support.

Marcia should not be and cannot be defined solely by her death. Marcia Powell was a parent; she named one of her children—her daughter—Eureka. A former partner described her as “so beautiful she would stop traffic.” Marcia loved coffee, everyone who knew her in prison mentions that. She had experienced mental health issues, that was clear, but as one of her friends from Perryville said to me during an interview, “she had good sense.” On one hand, there is the public figure that Marcia came to be after her death, but, as is always the case, her story is much more nuanced than what we can contain in one news story. At points in her life she did not even choose to be “Marcia Powell.” She sometimes used another name, but in prison, her ID name Marcia Powell came to be how she was known and is now remembered.

How did you get the idea to make a film about her death?

Firstly, in 2009, when Marcia Powell died, my friend Cris Sardina (who is now the co-coordinator of Desiree Alliance, but then was involved with the Women’s Re-Entry Network in Arizona) sent me an e-mail telling me about what had happened. Cris’ message put the story in my mind and I continued to think about it for a long time. Secondly, I was given a space to be part of the Filmmakers’ Collaborative at the Maysles Institute in 2010 and the collaborative focused on writing a treatment for documentary film. I proposed three ideas to the other filmmakers and every person in the collaborative advocated for me to make a film about Marcia Powell. That was a wake up moment for me to think that other people outside of the movement for sex worker rights would be so affected by the story, so I prioritized the film. I thank the other filmmakers at Maysles for helping me see what was important for me to pursue.

What is the intended audience of your film? What would you like viewers to learn about the prison system and survival sex work by watching No Human Involved?

I am very proud that we have the genre of representation that has been carefully encouraged by people like the incomparable Carol Leigh, and I am always keen to make films that speak to the sex worker community, but I have been working on this film with the aim of having a broader audience as well. I am aiming for the film to also resonate with people who may care about human rights or women’s issues already, but who really have not yet had information about what I am starting to think of as a conveyor belt that moves people along via arrests for prostitution, or related issues like “trespassing” of “camping” in urban areas, to the court where they have no choice but to plead guilty, to the prisons where they are at the mercy of a brutal system of incarceration.

In the promo video for your film, Peggy Plews laments, “How can sixteen people pass by a human being in a cage—defecating over herself and pleading to be let out—and do nothing?” Where does this systemic brutality come from? How can we combat it?

Yes, how can so many people ignore someone who is begging for water? Incarceration relies on categorization, dehumanization and a hierarchy of command that distances each person from responsibility. Part of the problem that day was that Marcia was not seen as a person in a cage by the officers walking by. She was viewed as an irritant, a thing to be ignored until the sounds (i.e., her pleas) stopped. But no matter how responsible those individuals are for what happened, there is equal responsibility held by the people who have designed the current approach within the Arizona Department of Corrections. People who institute and maintain systems of brutality have a vested interest in erasing its history so that it seems that the the system is “normal” and permanent, and that there is no way to create change.

The first step to being involved in change is then to learn how the system was set up so we can dismantle it. One excellent resource is the book Sunbelt Justice by Mona Lynch, which explains how Arizona’s carceral policies developed and the role that their approach plays in America’s current system of mass incarceration. Another step in combating brutality is to be in solidarity with prisoners, because wherever there is injustice there is always resistance. And perhaps one more element to remember is to keep an open mind about who can be part of standing up against the abuses as allies. There are people who have worked in Corrections who challenge the dehumanization and who have questioned what happened to Marcia Powell. The system is not as invulnerable to criticism from within as the leadership might want the public to think.

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Do not use our passive bodies as props for your agenda (Photo by Anton Marcos Kammerer, via Flickr and the Creative Commons)

Stop using our passive bodies as props for your agenda. (Photo by Anton Marcos Kammerer, via Flickr and the Creative Commons)

I am a sex worker who was coerced into doing work I felt violated by, and I am horrified by SWERFs (Sex Worker Exclusionary Reactionary Feminists) who insist that all sex work is by nature coerced and non-consensual.

Recently, I’ve noticed a disturbing rise in anti-sex work rhetoric that rests on the premise that all sex work is coerced. The proponents of this claim argue that because the workers may need the money and thus feel unable to turn down a proposition they are uncomfortable with, sex work encounters are always non-consensual. As far as they are concerned, if money is involved, sex can never be consensual. They claim that by promoting the criminalization of all forms of sex work, they are “protecting” sex workers and engaging in “feminist solidarity” with us.

I’ve already seen a number of brilliant sex workers debunking this argument: by discussing their own consensual sex work experiences, by pointing out that all professions involve money and thus a potential for coercion or abuse of workers, and so on. Tits and Sass contributor Red wrote a particularly interesting piece on her tumblr in which she notes that she finds the term “constrained consent” a far more accurate term than “coerced consent.” All of those points are valid and important, if often ignored by the audience they’re intended for.

But I’ve noticed one perspective missing from the discussion: that of someone who was sometimes unable to consent to sex work, and is harmed by those who would tokenize that experience and devalue the experiences of other sex workers. After seeing my experiences casually commandeered by SWERFs as a talking point, I’ve decided to speak up.

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