Current law requires all organizations that receive PEPFAR funding to have a policy that explicitly opposes prostitution and sex trafficking. This policy, known as the anti-prostitution pledge, or the Anti-Prostitution Loyalty Oath (APLO), has been shown to have a negative impact on prevention efforts because it undermines the most effective approaches to working with sex workers.

Sex workers are among the most marginalized people in any society and often lack access to social and health support systems – while being at increased risk of HIV infection. Their rights to access health care and to be free from violence are frequently violated, making it essential that organizations work with them non-judgmentally.

Organizations that build trust with and peer relationships among sex workers have yielded dramatic reductions in HIV infections among these populations. But CHANGE has found that these organizations are unlikely to sign the pledge, making them ineligible for funding.  Other groups have been cut off from funds because of over-interpretation of the policy by U.S. officials in the field, made possible because the government has not clearly defined what constitutes a violation of the policy. Moreover, the pledge has led organizations to eliminate, scale back, or censor their prevention efforts with sex workers, undermining best practices in public health.

As a result, the pledge has led to further alienation of already-stigmatized groups, given free rein to police who abuse or extort money from sex workers, and has resulted in further violence, discrimination and human rights violations against women, men and transgender people in prostitution.  The policy is driving sex workers underground and away from the non-governmental organizations and health workers best poised to provide them with HIV prevention, health and alternate-livelihood services.

Fortunately PEPFAR’s five-year strategy states that services must be responsive to the public health needs of marginalized communities including persons in prostitution. PEPFAR says it supports countries in the following activities: engaging in targeted prevention, care, and treatment outreach for prostitutes; helping governments to support alternatives to prostitution; and working to reduce demand for prostitution. 

However, until the pledge is clarified or removed, it will continue to create confusion in the field, keeping sex workers from the life-saving programs that they need and that are their right.

For more information on the impact of the anti-prostitution pledge and resources on sex workers, HIV/AIDS, and human rights, please see the following:

• CHANGE’s press release on the 2011 court ruling, Women’s Health Rights Advocates Applaud Court Ruling Against Bush-era HIV/AIDS Policy Against Sex Workers, July 6, 2011.
• CHANGE’s policy brief, Implications of U.S. Policy Restrictions for HIV Programs Aimed at Commercial Sex Workers, August 2008.
• Report by CHANGE and American University Washington College of Law, Human Trafficking, HIV/AIDS, and the Sex Sector: Human Rights for All, October 2010.