HIV and Prostitution: What’s the Answer?
by Jeffrey J. Barrows, D.O., FACOOG
You may not be reading about it in the news, but there is an ethical and political battle being fought right now over how best to approach the problem of the connection between prostitution and the global spread of HIV/AIDS. I want to first sketch out the political setting before delving into a discussion of the ethics involved.
The Bush administration believes that the best approach is to work for the abolition of prostitution because it harms both the individuals working as prostitutes and society as a whole. The Christian Medical Association and over 100 other groups agree. This support was expressed recently when a letter was sent to President Bush, signed by these 100+ women’s, health, and policy organizations, encouraging him to stand firm in his policy to enforce the U.S. government’s current abolitionist approach to prostitution. This position was also previously adopted by Congress when it passed the “United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003.” This Act stipulated that any organization applying for federal funds to fight HIV/AIDS must have “a policy explicitly opposing prostitution and sex trafficking.” This congressional policy was strengthened further when President Bush issued a National Security Presidential Directive (NSPD-22) fully supporting the abolitionist approach to prostitution and related activities.
The letter of support for the President’s opposition to prostitution was in direct response to a letter sent to the President in May 2005, by over 175 groups—International Planned Parenthood, ACT UP, Feminist Majority, etc.—asking the President not to enforce the anti-prostitution pledge. These groups advocate a “harm reduction” approach to prostitution and HIV/AIDS. In other words, their answer to the clear association between prostitution and the ongoing spread of HIV/AIDS is to provide prostitutes with condoms and screen them regularly for sexually transmitted infections.
The harm reduction approach is shortsighted, doomed to failure, and ethically lacking. It fails to recognize that many prostitutes are unable to negotiate condom use with their clients but often are forced to provide whatever services the client may want. In addition, it is common knowledge that prostitutes are often paid more if they agree to have sex without a condom. In fact, a study in Calcutta India found that prostitutes who regularly use condoms suffer a 79% reduction in their earnings over prostitutes who do not use condoms.1 A 79% loss of income is a huge motivator to forego the use of condoms!
Furthermore, advocating regular testing for sexually transmitted infections ignores the biological characteristic of latency. Latency refers to the fact that every type of infection—including sexually transmitted infections—has a period of time before it begins to manifest itself. In addition, for every test performed to identify a sexually transmitted infection there is a period of time between when the infection occurs and when the test will be able to detect it. This is called the “window period.” According to the CDC, for HIV testing, the usual window period is 4-6 weeks, but may be as long as 3 months.2
Even if a prostitute is being tested every week for HIV, she will test negative for at least the first 4-6 weeks and possibly the first 12 weeks after being infected. If we assume that he or she takes only 4 weeks to become positive, because there is an additional lag time of 1-2 weeks to get the results back, there will be at best a window period of 6 weeks for a prostitute. The average prostitute services between 10-15 clients per day. This means that while the test is becoming positive and the results are becoming known, that prostitute may expose up to 630 clients to HIV. This is under the best of circumstances with testing every week and a four-week window period. It also assumes that the prostitute will quit working as soon as he or she finds out the test is HIV positive, which is highly unlikely. This is not the best approach for actually reducing harm. Instead, in order to slow the global spread of HIV/AIDS we should focus our efforts on abolishing prostitution.
Jonathan Imbody of the Christian Medical Association at email@example.com is serving as the contact person for other groups willing to sign this statement. CBHD
1 Rao, Vijayendra, Gupta, Indrani, Lokshin, Michael and Jana, Smarajit, “Sex Workers and the Cost of Safe Sex: The Compensating Differential for Condom Use Among Calcutta Prostitutes,” (May 2000), World Bank Policy Research Working Paper No. 2334 http://ssrn.com/abstract=350200 (accessed August 17, 2005).
2 CDC, “Pocket Guide for Prevention of Mother to Child Transmission of HIV”, available at: http:/ / www.cdc.gov/ nchstp/ od/ gap/ pmtct/ Pocket%20Guide/ PocketGuide.doc; accessed 8/16/05.
Source: The Center for Bioethics and Human Dignity. Post Date: September 9, 2005
The contents of this article do not necessarily reflect the opinions of CBHD, its staff, board or supporters. Permission to reprint granted as long as The Center for Bioethics and Human Dignity and the web address for this article is referenced