Gina Stevens is a 41-year-old mother in Chicago who was diagnosed with HIV in 2000. She has been homeless numerous times over the past 15 years. Unable to get or keep a job because of her lack of address, she turned to prostitution.
The Supreme Court overturned a 2003 federal law last week stating that any organization accepting U.S. funds to combat HIV/AIDS and related diseases overseas must explicitly denounce prostitution as a condition of receiving funding. Writing for the 6-2 majority (Justice Kagan recused herself), Chief Justice John Roberts stated that while government can restrict the ways that funds are spent, it cannot require organizations to "pledge allegiance to the government's policy of eradicating prostitution." Compelling grant recipients to adopt a particular belief as a condition of funding is an affront to their free speech rights.
While one has every right to object to prostitution, this is not only a smart legal decision but a smart public health one as well. The United States is spending $60 billion to combat infectious diseases around the world. According to a 2012 UNAIDS Report on the global AIDS epidemic, female sex workers are 13.5 times more likely to be living with HIV than other women.
Service providers grapple with how to keep all populations safe, not just those engaging in legal and socially desirable behavior.
"Although encouraging progress has been made in stabilizing HIV prevalence and promoting condom use among workers in sex work," the report states, "substantially greater gains will be needed to halve the sexual transmission of HIV among sex workers by 2015."
There are women like Ms. Stevens all over the world.
Forcing non-profit organizations that are doing AIDS prevention and treatment work to explicitly condemn prostitution may lead sex workers to stay away from services for fear of stigma or worse, prosecution. Further, service providers at these organizations know that part of their job entails having frank conversations about the realities of prostitution and their potential implications for the AIDS pandemic.
Having to explicitly state opposition to prostitution as a condition of funding may prevent those discussions from happening. These providers grapple with how to keep all populations safe, not just those engaging in legal and socially desirable behavior. As a result, the very people who need the most access to HIV preventive and treatment measures may not receive them, driving them even deeper underground.
As principal investigator of the Health, Hardship, and Renewal Study, my team and I have interviewed more than 100 women living with HIV/AIDS in the Chicago area. Not all women living with HIV have a history of sex work, nor do all sex workers have HIV/AIDS. But more than 20 percent of the women we interviewed found themselves turning to sex work at some point in their lives to make ends meet or while in the throes of drug addiction.