Prostitutes and AIDS

How Brazil’s sex worker rights movement and its Ministry of Health partnered in creating one of the most well-structured and efficient HIV/AIDS prevention programs in the world.

This text is a composite of three academic papers on the subject of the dual rise of Brazil’s prostitutes rights movement and its national response to the AIDS epidemic from the 1980’s to present. The Brazilian Interdisciplinary Association (ABIA) and authors Gabriela Silva Leite, Laura Murray, Flavio Lenz and Soraya Simões are cited in full below.

INTRODUCTION

Sex workers have been the protagonists and focus of STD and HIV prevention campaigns and research since the late 1980s in Brazil.

The challenges posed by the AIDS epidemic brought prostitutes into the development of national public policies. This is how partnerships, mainly in the form of projects for the development of preventive actions with prostitutes, were established between the Ministry of Health and different organizations, most of which were members of the Brazilian Network of Prostitutes, which was formed by Gabriela Leite at the First National Gathering of Prostitutes in Rio de Janeiro in 1987. It was the first time prostitutes were included in the construction of a public response to a problem that affected them.

The mobilization of prostitutes these initiatives included a significant number of professionals, although by no means all of them, which represented prostitution across Brazil: it occurs in many spaces and in many distinct forms; it includes women of many socio-economic backgrounds; it is not always a mark of identity; it is not always an activity done for one’s entire life; and it does not only happen in public spaces.

Because of this mobilization of prostitutes, issues of human rights, stigma and discrimination, professionalization and regulation, and access to health services have become incorporated in the dialogue agenda between prostitutes and government agents.

This widening of the prostitute agenda beyond the subject of HIV/AIDS also questioned the underlying hygienist bias to an approach to prostitutes that  restricted itself only to disease transmission, and contributed to the establishment of the concept of vulnerability as a guiding framework of the national response to STDs and AIDS.

THE NUMBERS

 Indicator 23 in the Brazilian report of the monitoring of the 2010 UNGASS that analyzes the progress of the reduction of the prevalence of HIV among populations subject to the highest risk shows that the prevalence among female sex workers in 2009 was 4.9%, compared to 0.4% among the rest of women. This percentage, while demonstrating the progressive reduction of the prevalence of HIV among this population, which was estimated at 17.8% in 1996 (Szwarcwald and Souza Jr., 2006), and fell to 6.4% in 2001 (Brazilian Ministry of Justice, 2004), suggests that there is work still to be done.

The literature shows that sex workers’ greatest vulnerability is with their non-paying intimate partners, although research foci and designs often reinforce the idea that sex workers’ vulnerability is due to their sexual relationships with clients. At the same time, there is little research exploring their work contexts, and structural factors that influence safer sex practices with both types of partners.

Prostitution by its definition a context that involves not only affective and sexual exchange, but a material exchange as well, so that risk management is not only associated with decisions that assess disease risk, but also considers finance and labor issues (for example, when clients offer more money to have sex without a condom, or for the professional to accept or refuse prevention methods in order to keep her job).

PREVENTION METHODS

The male condom is the principal and most effective method of preventing HIV/AIDS recommended by the Brazilian and international literature on the subject. In Brazil, its use with clients has been extensively documented.In a study conducted in 2008-2009 by Szwarcwald, 90.1% of prostitutes interviewed said they used a condom in their last vaginal sexual relation with a client, in comparison with 36.6% of the same women with their fixed sexual partners. In a systematic review of the literature on the prevalence of HIV among vulnerable populations in Brazil, Malta et al verify that prostitutes were three times more likely to use a condom with clients than with their fixed partners (67.3% versus 19.2%).

Studies in Brazil indicate that sociocultural factors external to the work environment, particularly questions of autonomy and integration in social networks, also have significant associations with condom use. In their survey of 434 prostitutes in Rio de Janeiro, Kerrigan et al demonstrated that social cohesion and mutual assistance [defined by elements including the level of solidarity, affection and potential for emotional and material support from the group], possession of official documents and access to resources, and participation in community organizations were significantly associated with condom use with clients in the previous four months.

Beyond the literature published in academic journals, in 2012, three important documents on prostitution and AIDS were published by international institutions, including the World Health Organization, the World Bank and the Global Commission on HIV and the Law. All these documents recommended structural interventions, emphasizing the importance of partnerships with sex workers organizations; and the documents by the Global Commission and the WHO explicitly recommend the decriminalization of prostitution. In 2011, UNAIDS also published four addendums to their Guidance Note 2009 on HIV and Sex Work, which, after extensive discussion and review of the original document made in conjunction with sex workers, also strongly recommends prevention programs of a structural nature as well as decriminalization.

Emblematic of this approach was the national campaign launched by the Ministry of Health in 2002 entitled “No Shame, Girl. You have a profession.”, and formulated in partnership with the Brazilian Network of Prostitutes with stickers, primers, a handbook for health professionals and radio spots. Incorporating the idea of “profession”, all the slogans on the stickers and banners started with “Without shame”, followed by “To fight for my rights”, “to value my work”, and “to be a prostitute”. It reflected the force of the movement to recognize prostitution as an official occupation by the Brazil’s Ministry of Labor that same year in 2002.

They refused to sign a cooperation agreement with the US government, through USAID, for the prevention and control of AIDS, which included a clause (anti-prostitution pledge) that condemned prostitution and prevented the transfer of funds to institutions that defend the legalization of the profession or that are not explicitly opposed to it.

The prostitute’s movement and federal government ran the “Without Shame” project from 2006-2008 with national resources. Training and identification of leadership, political advocacy, human rights, sustainability and advocacy were the main axes of this project, which was coordinated among regional and national partners by the Davida, the prostitutes rights NGO founded by the late Gabriela Leite.

PROSTITUTES HAVE RIGHTS

Gabriela Leite’s vision was constant over the next quarter century of activism: Prostitution is a profession, people can choose to do it, and shouldn’t be ashamed of their choices…. For this reason, recognizing prostitution as an “occupation” became one of the principal objectives of prostitute associations across the world, and in Brazil, found support with the Ministry of Health, and then, the Ministry of Work and Employment.

Using “peer methodology” and benefitting from the idea of a “multiplier” agent, in other words, the action of a member of a category informing other members about a certain problem and courses of action, the Ministry of Health didn’t just embrace the formation of prostitute associations in Brazil, but transformed them into the department’s “right arm” in combatting STDs and AIDS.

The institutional and financial support to the collective identity-building campaigns represented the consolidation of a new social and political capital and, likewise, fulfilled the role of a seed money that has contributed to the process of defining the category of prostitution as an occupation recognized by the Ministry of Labor.

Starting in the 1990’s, the NGO Davida, founded by Gabriela Leite, the president of the Brazilian Prostitutes Network, and based in Rio de Janeiro, produced plays and organized serestas at various points of prostitution in the city. In the following decade, the same association would gain international visibility with the creation of Daspu, a design brand for which not only prostitutes walk the catwalk in Tiradentes Square in the center of Rio de Janeiro. In Vila Mimosa, known “zone” of prostitution located in the region adjacent to the city’s business center [and the city’s historic red light district], fashion shows were also organized.

It is necessary for society to look at the oldest profession in the world with new eyes and hear our demands.

— Gabriela Leite

LEGALIZE IT

“Sex professionals” entered into the Department of Labor’s list of recognized professions in 2002.

The initiative to seek inclusion on the Classificação Brasileira de Ocupações, or CBO, organized by representatives of the Brazilian Network of Prostitutes, allowed a woman who prostitutes herself to perceive herself as doing a job, same as any other member of society; to declare her income; and to register for Social Security as a self-employed “sex worker”; the last two items contributing to the creation of public policy. The identification of prostitution as work makes it possible to reach a level in the discussion of the rights of professionals who perform this work [beyond the simple question of “whether it should be legal”].

The dialogue between Brazil’s Ministry of Health and the prostitute’s movement was strengthened in 2005, when the federal government took into consideration the Brazilian Network of Prostitutes’ decision to refuse to participate with and condemn USAID/PACT’s requirement that participating NGOs sign a formal “prostitution pledge” condemning prostitution [in order to receive aid] to combat HIV/AIDS in Brazil. This was later declared an unconstitutional act by the Supreme Court in 2013 as a violation of free speech.]

The clause, introduced by PEFAR, did not exist in 2004 when prostitute organizations applied for USAID/PACT funding. The associations refused to accept it as a violation of its own policy line, and the government was firmly encamped in the National Program of STDs and AIDS and with the diverse players of Brazil’s fight against AIDS. The result was the federal government’s executive refusal to accept USAID/PACT funding associated with the anti-prostitution clause, an amount in excess of $40 million.

TODAY

The associations formed by prostitutes or other parties in the business of prostitution, compete today for resources from programs funded by the Ministry of Health, through bilateral agreements with the World Bank, IDB, international NGOs and until 2004, USAID.

Not all of these associations are even part of the Brazilian Network of Prostitutes, a national organization that defends the professional recognition of the category of prostitution, and serves as the principal partner of the Ministry of Health in STD and AIDS prevention campaigns. As a result, projects of this nature can vary greatly in terms of methodology and in their outcomes, although they are all designed to support prevention campaigns targeted for the same “population.”

But it is stimulating the formation of new associations of ‘sex workers’, and their institutional strengthening is a common objective to be achieved through funding provided mainly by the Ministry of Health. This, at least, was the agenda stipulated by the Brazilian Network prostitutes and supported by the National AIDS Commission (CNAIDS).

The participation of so-called ‘sex workers’ – a category that includes prostitutes, transvestites and michês – in STD and AIDS prevention work is considered by both the Ministry of Health agents as by other members of the CNAIDS one of the factors responsible for the recognition of the National Program of Brazilian AIDS as one of the most well-structured and efficient in the world.

CENSORSHIP

At the start of 2013, the federal government invited prostitutes to develop a campaign of STD prevention and civil rights for International Day of Prostitutes on June 2. Gathering in João Pessoa, in a communication workshop, they constructed a campaign of slogans and videos that were published on the website of the National Department of STDs, AIDS and Hepatitis. [View the uncensored images here.]

However, upon learning of the campaign, the then-Health Minister, Alexandre Padilha, ordered that the parts that dealt with happiness (“I’m happy being a prostitute”), citizenship (“My greatest dream is that society sees us as citizens”) and the fight against violence (“not accepting people as they are is a form of violence”), leaving only the linking part that dealt with STD prevention with condoms.

The Brazilian Network of Prostitutes responded by publishing a note in which they accused the government of abandoning “the fight against stigma and prejudice as a strategy for prevention of STDs and AIDS” to focus only on encouraging the use of condoms, making the campaign “sanitized and decontextualized”. Then prostitutes who had participating in the campaign revoked the right of the use of their image in protest. The Ministry of Health then convened a meeting at which they made a formal apology, but without reintroducing the censored parts or suspending those using images of women who had revoked their consent, leaving the censured campaign live on the website. The imbroglio led to the resignation of top-tier members of Department of STDs, AIDS and Hepatitis.

CITATIONS

The introduction, “Numbers”, “Legalize it” and “Censorship” are excerpted and translated from the Brazilian Interdisciplinary Association (ABIA) 2013 report, “Analysis of the Context of Prostitution in relation to Human Rights, Work, Culture and Health in Brazil”, and specifically from the report’s paper, “The Trajectory of the Movement of Prostitutes and their Relationship with the Brazilian Government,” authored by Gabriela Leite and Flavio Lenz.

“Prevention Methods” is excerpted and translated from “The Peer and Non-peer: The Potential of Risk Management for STD and HIV Prevention in Contexts of Prostitution”, a critical analysis of the response to AIDS and epidemiological studies on prostitution and HIV by Gabriela Silva Leite, Laura Murray and Flavio Lenz that will be published in the Brazilian Journal of Epidemiology.

“Prostitutes Have Rights” and “Today” are excerpted and translated from “Identity and Politics: Prostitution and the Recognition of a Métier in Brazil”, written by Soraya Simões and published in 2010 in the Brazilian Journal of Social Anthropology of the Students of PPGAS-UFSCar, v.2, n.1, January-June, p. 24-46.

Gabriela Leite is Brazil’s #1 Puta. She organized the First Meeting of Brazilian Prostitutes in 1987 in Rio de Janeiro, where the Brazilian Network of Prostitution was founded. She founded the Brazilian Network of Prostitution; the NGO DAVIDA: Prostitution, Civil Rights and Health; and the fashion label Daspu.

Soraya Simões is a professor of anthropology at the Federal University of Rio de Janeiro (UFRJ); organizer of the Observatory of Prostitution, an extension project of the  Metropolitan Ethnography Lab-LeMetro/IFCS-UFRJ; and current president of DAVIDA, Rio de Janeiro’s non-profit advocating for sex worker rights and inclusion as full citizens of society.

Laura Murray is a doctoral candidate in Socio-Medical Sciences at Columbia University, and produced the documentary A Kiss for Gabriela about the late Gabriela Leite’s political career.

Flavio Lenz is a doctoral candidate in Communication at the State University of Rio de Janeiro; advisor at the NGO DAVIDA; and editor of Beijo da rua, a street publication for Rio sex workers.