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Outdated Fear: Criminalizing HIV+ Sex Workers

(Image via the Stigma Project)
(Image via the Stigma Project)

With thanks to members of SWOP-USA

Laws that criminalize HIV exposure are supposed to benefit public health, but in practice are extremely harmful to public health and to the targeted HIV-positive individuals. Sex workers are highly vulnerable to these laws, which sometimes target HIV-positive prostitution specifically. Many require forcible HIV testing, and sometimes they simply criminalize HIV but in reality are applied to sex workers more frequently than to other populations.

The criminalization of HIV-positive sex workers and mandatory post-arrest HIV testing arguably violates international human rights treaties signed by the United States. Treaties with applicable provisions include the International Covenant on Civil and Political Rights (ICCPR) and the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD), specifically their provisions on privacy, rights to equality before the law, and sanctions against inciting hatred and racial bias. Recent forced HIV testing in Greece provoked outrage among international human rights organizations such as Amnesty International and Human Rights Watch. WHO/UNAIDS (World Health Organization/the Joint United Nations Programme on HIV/AIDS) made a statement opposing forced testing. It is widely accepted that best practices for HIV testing, with the best public health outcomes, involve three key principles—consent to testing, the provision of counseling before and after testing, and confidentiality of results. The imposition of felony offenses on individuals who are said to be engaging in sex work while living with HIV punishes members of already vulnerable communities. They are prosecuted even when they use condoms and engage in less risky forms of sex with their partners, sometimes even if they have disclosed their status to their partner. Information about their HIV status, sometimes accompanied by photographs, is often distributed widely by the media in their communities, placing arrestees at risk of retaliation and other abuse. This incentivizes avoiding testing and does nothing to encourage treatment or safer sex practices.

PrEP: What It Is and How Sex Workers Can Use It

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.).

Ask a Pro: How To Quit Smoking

Image via http://www.fwweekly.com/2013/01/04/non-smoking-bars-in-fort-worth/
Image via http://www.fwweekly.com/2013/01/04/non-smoking-bars-in-fort-worth/

Dear Ask A Pro,

I’ve been a smoker for an embarrassingly long time. Let’s say, twenty years? I quit for a year about three years ago, when my city and club banned indoor smoking, but then started dancing in a town where it was allowed, and picked up the habit again. Smoking is really fun and awesome and I like it a lot, but I know it’s awful and that I should quit. Do you have any advice on how I can stop when I’m still working in a smoking club, and how I can convince myself that I really want to? I’d rather spend less money on cosmetic procedures to reverse the damage and lose less time to cigarette breaks at work.

Sincerely,
Pole Smoker

Sex Workers: YOU CAN AND SHOULD REQUEST PANDEMIC RELIEF

Eleanor Roosevelt at SheSheShe Camp for Unemployed Women in Bear Mountain, New York. (photo via wikicommons)

So we’re about a month into strip clubs being shut down. Before that, most in-person sex workers had already been worried about the potential of getting or spreading COVID-19 (the illness caused by the coronavirus) at work, and probably noticed a significant dip in business. Most times we’d be SOL when it comes to accessing unemployment benefits, since save for dancers at a handful of strip clubs, we’re not employees on payroll. But that changed when Congress passed the CARES Act in March, which expanded unemployment benefits to independent contractors.

There have been a lot of misleading screenshots and headlines implying that sex workers are excluded from pandemic relief. While it’s true that some adult entertainment businesses are theoretically excluded from the Small Business Administration’s disaster loans, sex workers as workers are just as eligible for stimulus payments and the expanded unemployment assistance that’s out there as any worker. Even if you’ve been operating as a business, you’re eligible as a sole proprietor to apply for unemployment now (Unfortunately, that only goes for citizens and permanent residents. If you are an undocumented worker in need of help, there are a lot of sex worker mutual aid funds that are prioritizing workers who can’t access government aid. Here are a few lists of those funds and resources for finding help. This COVID-19 resource post from Kate D’Adamo on Slixa also has information on other types of help available for all workers, as well as some myth busting on those Small Business Administration loans—you can still apply, and though there’s a chance you’ll be denied, you might just get it. “The definition of that term [“prurient sexual performance”] is based on the application of what’s called the Miller obscenity test,” D’adamo writes, “and a lot of things are actually fine – sex shops, sex educators, probably even strip clubs. Where it gets trying is anything involving the internet, because of competing court decisions that the Supreme Court hasn’t weighed in on.” D’adamo also notes that the whole process is a “clusterfuck” because banks don’t have enough information from the Fed to process applications, and “no one’s getting shit from anyone anytime soon, prurient sex-related or not.”)

There are two main types of assistance for individuals available: The one-time $1200 ($2400 for married couples and an additional $500 per child) Economic Impact Payments from the federal government, and the expanded unemployment benefits that cover the self-employed. Unemployment benefits are administered at the state level, so you’ll need to find your state’s unemployment website to start a claim. Maybe you’ve heard that the pandemic levels of unemployment have swamped unemployment claims? It’s not a great process to begin with, and having to revamp the whole deal hasn’t gone quickly or smoothly. But it’s a good idea to go ahead and start on the process. Supposedly workers will be able to get back payments, so try to get records of everything you can dating back to when you had to stop working due to the pandemic.

Here’s how to get started.

Dungeon or Psych Ward?: A Crazy Whore Explains It All

photo by Alex Colby
photo by Alex Colby

Being a crazy whore is kind of like being the meanest dog at the pound: out of all of the rejects, you’re the least wanted, and your very existence makes your peers look bad. I say this from experience. I used to work at a pound, and I’m definitely a bitch (HEY-O). I’m also a crazy whore—a pro-switch with disabling, medication-resistant Major Depression, to be precise.  Society has made clear to me that it would prefer if I were euthanized, and a lot of folks within the disability rights and sex workers rights communities don’t want me around either. I give credence to some of the most persistent, prejudiced assumptions people in each group encounter.  Namely, that women with mental illnesses are sexually promiscuous damaged goods, and sex workers are mentally unhealthy damaged goods. What better way to argue against those stereotypes than to deny the existence of those of us who fulfill them?

And there are a lot of us, more than most folks realize. We frequently stay closeted about one or both of these marginalizations, partly because we may lack the physical energy or emotional stamina to brazenly insert ourselves into the activist communities that dislike us. I rarely mention to other people with disabilities what I do for work, and I am equally reluctant to test the reactions of fellow sex workers by discussing my experiences as a crazy ho. Just the idea of walking into a sex worker empowerment meeting and telling everyone that I’m doing this job because I’m too nuts to work full time and I kind of hate it, makes me feel exhausted.

Exhaustion is also why a lot of disabled sex workers don’t work independently. Houses, agencies, clubs, and brothels take on more of the workload associated with sex work, such as finding clients and providing space and security. But houses, agencies, clubs, and brothels are also (usually) more concerned with profit than with their employees’ well being, so you’re likely to find that more agency girls hate their jobs. People who hate their jobs don’t often organize around that identity, which is another reason disabled sex workers lurk in the shadows.

It can get pretty dark hiding out in here. That’s why I like to liven the mood sometimes with some equally dark humor.