Holly Burkhalter

p. A25.

Better health, better lives for sex workers

Women and girls in the commercial sex industry — including millions who were trafficked, forced or sold into the trade — are overwhelmingly at risk of contracting HIV-AIDS. In Asia, Africa and the Caribbean, an estimated 60 percent to 80 percent of those in the sex industry are infected with HIV.

Women in sex work almost always are compelled into it by sexual violence, poverty and discrimination. They often are debt-bonded to pimps and brothel owners, and they are marginalized within society. They are vulnerable to violent abuse, including rape and robbery, by local police. Many are young girls, who are much sought after. They often are unable to speak the local language and incapable of negotiating safe sex — much less their freedom. Their situations are desperate and their lives short.

There have been a handful of successful rescues in India, Cambodia and Thailand in which police have raided brothels and taken the younger girls to rehabilitation facilities. But most police raids on brothels have also resulted in the arrest and deportation of adult sex workers and the closing of brothels. Many liberal advocates for sex workers' rights have vigorously denounced past rescue operations and discouraged new ones. Thus is the right of child prostitutes to their freedom from the brothels sacrificed for the adult prostitutes' right to earn a livelihood there.

On the other side of the issue are conservatives who oppose not only trafficking but all prostitution. In April HIV-AIDS legislation was amended to require U.S.-funded groups to adopt a position opposing prostitution and trafficking. It could end up defunding some of the most successful HIV-AIDS prevention services and empowerment strategies for women in the sex industry. One such group's representative, describing her effort to help Bangladeshi brothel workers acquire the right to wear shoes or sandals outside of brothels — a simple dignity denied them by local custom — stated: "How can we help these beaten down, marginalized women organize themselves to achieve such victories if we are publicly opposing what they do to earn money?"

Sound health policy requires an approach that helps liberate children and adults from the sex slave trade while securing condoms, health care and protection from police violence for those who remain. A comprehensive approach should include the following:

• Energetic enforcement of the Trafficking Victims Protection Act, which requires that governments make good-faith efforts to eliminate sexual slavery. Two of the worst abusers in the world, India and Thailand, get a free pass in the annual State Department trafficking report. Honest reporting and vigorous diplomatic intervention to demand the rescue of trafficking victims and prosecution of those who abuse them would inestimably aid these women and children.
• U.S. support for creation of independent ombudsmen's offices where service providers, journalists, religious groups, family members and human rights organizations could anonymously report evidence of coerced, forced or under-age prostitutes. The United States and other nations should help finance and train independent anti-trafficking police and courts to arrest pimps, pedophiles, brothel owners and corrupt police.
• U.S. promotion to foreign governments of a "rescue protocol" that targets sexually exploited children and enslaved women and affords them shelter, physical and mental health care and education. No criminal or deportation proceedings should be brought against sex workers collaterally swept up in rescue operations, nor should any woman or girl ever be returned to a repressive country, such as Burma, against her will.
• U.S. funding of local nongovernmental groups that have records of excellence in promoting empowerment and organization. One model can be found in the Sonagachi neighborhood of Calcutta where a community-based sex worker union has secured services that sex workers themselves demand: education for their children, health care, and condom use by customers. The unabashedly "pro-prostitution" group has considerable bargaining authority and forbids the exploitation of underage girls.
• Finally, the United States should fund local income-generating alternatives for marginalized women and girls. Impoverished women and girls who have been raped, abused, divorced or widowed are at particular risk of sexual exploitation, as are street children and orphans, whose numbers are skyrocketing because of the HIV-AIDS pandemic. A generous U.S. foreign aid initiative to rapidly scale up programs for safe housing, schooling, micro-credit, health services and child care could provide alternatives for at-risk women both inside and outside the commercial sex industry.

The new resources available for HIV-AIDS prevention, care and treatment offer the prospect of strategies to aid trafficking victims and child prostitutes; they also can help women attempting to better their conditions within the sex industry. Policymakers and nongovernmental organizations across the ideological spectrum need to join hands to get the job done.

The writer is U.S. policy director of Physicians for Human Rights and its Health Action AIDS Campaign.

© 2003 The Washington Post Company