Support for sex workers leaves Brazil without US cash

Abstract

Networks of Brazilian sex workers that first came together to fight police persecution are now turning their attention to preventing HIV. Government support has helped them succeed. But, reveals Bill Hinchberger, US funders of HIV-prevention schemes are not nearly so keen.As a child runaway, Carmen Lucia Paz worked as a housekeeper and nanny before drifting into prostitution in order to earn enough to survive. Despite dropping out of education early on, and managing to scrap together a decent living with her sex work, Paz, by age 21, decided she wanted to resume her studies. Eventually, she won a college scholarship and earned a bachelor's degree in sociology. This remarkable achievement afforded Paz the opportunity to help others from the life she had left behind, by taking a job at the Center for the Study of Prostitution (NEP).NEP is an association of sex workers in Paz's home city of Porto Alegre, capital of Brazil's southernmost state, Rio Grande do Sul. “I've found my calling in the movement”, says Paz, NEP's executive secretary.NEP is one of 27 organisations affiliated with Brazil's National Network of Sex Professionals. These groups defend the civil and human rights of sex workers. They advocate the full recognition of prostitution, which is not illegal in Brazil, as a profession under labour and social security laws. Public-health officials praise their contributions to Brazil's internationally acclaimed campaign for the prevention and treatment of HIV/AIDS.The Brazilian National Program on Sexually Transmitted Diseases and AIDS has reversed the tide of HIV/AIDS in South America's largest country. The effort combines free and universal antiretroviral treatment with a prevention campaign rooted in frank-and-open discussions of sexuality and intravenous drug use. In the early 1990s, the World Bank projected that the nation of 180 million would have 1·2 million people living with HIV/AIDS within a decade. Since 2000, the number of cases has remained steady at 600 000, according to the Health Ministry. The Brazilian programme has received awards from UNESCO, UNAIDS, and the Bill & Melinda Gates Foundation. “The Brazilian programme works better because we address people the way they are, not the way we would like them to be”, says Fernando Gabeira, a member of Congress from the Green Party and author of a bill to recognise the profession of prostitution.Groups of sex workers like NEP might have been allowed to continue their outreach in relative obscurity—literally in the shadows, at times—were it not for the US Agency for International Development (USAID).The Brazilian programme includes an ambitious network of partnerships with non-governmental organisations like NEP. Using money from many sources, including the World Bank, the federal budget, and USAID, the Brazilian government has funded hundreds of proposals. Earlier this year, it was revealed that the Bush administration planned to require that applicants for future funding via USAID sign an oath condemning prostitution. Sex professionals announced that they would refuse. In May, Pedro Chequer, director of the Brazilian programme, declared that everyone would refuse. Brazil would forgo US$40 million in financing if the USA stood its ground. “For no amount of money will we betray our ethical principles and principles of citizenship”, he says. “These groups have been our partners since the 1980s.”Sex workers and Brazilian federal officials first met to talk about HIV/AIDS in 1989. “That meeting marked the beginning of a partnership that has continued to this day”, says Gabriela Leite, executive director of Davida, a Rio de Janeiro group of sex professionals. The collaboration has stood the test of time.But AIDS was not always high on the list of priorities. At a nationwide gathering in 1987 in Rio de Janeiro, sex professionals revealed that HIV/AIDS concerned them far less than persecution by police. “Police violence was commonplace”, says Leite. “That's the only thing that got discussed.”Violence served as a catalyst for the launch of many organisations. Police in Porto Alegre were allegedly applying shocks to women's vaginas and breasts when NEP emerged in 1989. In Riberão Preto in São Paulo state, the death of a woman in 1998 galvanised sex workers. “First we had to address violence and citizenship”, says Tina Taborda Rovira, a social worker who founded NEP and serves as its executive director. “Then came health. Today we work with a tripod of issues: health, citizenship, and self-esteem.” One clear sign of progress: NEP has participated in police training seminars.HIV/AIDS prevention efforts start with the distribution of condoms and educational programmes for prostitutes. Condoms and instructional materials are customarily supplied by local public-health officials. One group in Rio de Janeiro, Fio da Alma, covers 15 areas and serves about 1500 women. NEP has 4000 women in its registry and estimates that about 400 drop by its downtown office every month. A project addressing male prostitution, run jointly by Nuances and the Support Group for AIDS Prevention (GAPA), distributes 300 000 condoms a month to gay bars, bath houses, and nightclubs in Porto Alegre.“They do the fieldwork that officials find difficult”, says Geralda Rigotti, director of the Agency for the Control of AIDS and Sexually Transmitted Diseases in the Rio Grande do Sul State Health Secretariat. “There are problems of access—not to mention issues of slang and cultural codes.”Federal czar Chequer says: “Peers are best for these interventions because they understand the problem and how to address it. They add credibility and ensure sustainability.”The effects of prevention campaigns by sex workers extend beyond the target groups of prostitutes and their clients, says Rigotti: “When a sex worker uses a condom with a client, not only are they protected but, if the man is married, his wife is also protected. The wife may not perceive the risk or may not want to bring up the topic with her husband.”One explicit effort to take the safe-sex message to a wider audience is NEP's Tent of Desire. Volunteers mount their booth in the public squares that often double as red-light districts in Porto Alegre and other towns. They participate in municipal and neighbourhood street fairs, setting up their tent alongside food and crafts stands. Visitors to the Tent of Desire receive complimentary condoms and educational materials. They are invited to answer questions pulled from the safe-sex quiz box. A correct answer gets you a t-shirt.As for the question of continued USAID funding for these and other Brazilian HIV/AIDS initiatives, it remains unanswered. As the Brazilians see it, says Chequer, they have tossed the ball back to the Bush administration and are waiting for a response. USAID has been silent. “We're waiting for more information”, says the official. “We would be open as long as the conditions of our government are addressed.”This isn't the first time Brazil has clashed with outsiders over HIV/AIDS policy: it resisted World Bank demands to stop free AZT distribution as a condition for a loan and has been embroiled in a debate with the USA over the generic manufacture of some antiretrovirals. During a previous round of USAID funding, the Americans tried to push their ABC scheme (emphasising abstinence and being faithful before condoms), but ultimately groups from the sex professionals network and libertarians like Nuances were allowed to apply for funds.The sex professionals network plans to invite USAID representatives to debate the issue in September at their national conference in Curitiba. Meanwhile, Chequer appears determined to find funds to further cement partnerships with NGOs of all stripes. “This episode with USAID has served to strengthen our resolve”, he says. “We'll find other sources of funding, from the national treasury or other bilateral agreements. And we will give priority to the sex workers.” Networks of Brazilian sex workers that first came together to fight police persecution are now turning their attention to preventing HIV. Government support has helped them succeed. But, reveals Bill Hinchberger, US funders of HIV-prevention schemes are not nearly so keen. As a child runaway, Carmen Lucia Paz worked as a housekeeper and nanny before drifting into prostitution in order to earn enough to survive. Despite dropping out of education early on, and managing to scrap together a decent living with her sex work, Paz, by age 21, decided she wanted to resume her studies. Eventually, she won a college scholarship and earned a bachelor's degree in sociology. This remarkable achievement afforded Paz the opportunity to help others from the life she had left behind, by taking a job at the Center for the Study of Prostitution (NEP). NEP is an association of sex workers in Paz's home city of Porto Alegre, capital of Brazil's southernmost state, Rio Grande do Sul. “I've found my calling in the movement”, says Paz, NEP's executive secretary. NEP is one of 27 organisations affiliated with Brazil's National Network of Sex Professionals. These groups defend the civil and human rights of sex workers. They advocate the full recognition of prostitution, which is not illegal in Brazil, as a profession under labour and social security laws. Public-health officials praise their contributions to Brazil's internationally acclaimed campaign for the prevention and treatment of HIV/AIDS. The Brazilian National Program on Sexually Transmitted Diseases and AIDS has reversed the tide of HIV/AIDS in South America's largest country. The effort combines free and universal antiretroviral treatment with a prevention campaign rooted in frank-and-open discussions of sexuality and intravenous drug use. In the early 1990s, the World Bank projected that the nation of 180 million would have 1·2 million people living with HIV/AIDS within a decade. Since 2000, the number of cases has remained steady at 600 000, according to the Health Ministry. The Brazilian programme has received awards from UNESCO, UNAIDS, and the Bill & Melinda Gates Foundation. “The Brazilian programme works better because we address people the way they are, not the way we would like them to be”, says Fernando Gabeira, a member of Congress from the Green Party and author of a bill to recognise the profession of prostitution. Groups of sex workers like NEP might have been allowed to continue their outreach in relative obscurity—literally in the shadows, at times—were it not for the US Agency for International Development (USAID). The Brazilian programme includes an ambitious network of partnerships with non-governmental organisations like NEP. Using money from many sources, including the World Bank, the federal budget, and USAID, the Brazilian government has funded hundreds of proposals. Earlier this year, it was revealed that the Bush administration planned to require that applicants for future funding via USAID sign an oath condemning prostitution. Sex professionals announced that they would refuse. In May, Pedro Chequer, director of the Brazilian programme, declared that everyone would refuse. Brazil would forgo US$40 million in financing if the USA stood its ground. “For no amount of money will we betray our ethical principles and principles of citizenship”, he says. “These groups have been our partners since the 1980s.” Sex workers and Brazilian federal officials first met to talk about HIV/AIDS in 1989. “That meeting marked the beginning of a partnership that has continued to this day”, says Gabriela Leite, executive director of Davida, a Rio de Janeiro group of sex professionals. The collaboration has stood the test of time. But AIDS was not always high on the list of priorities. At a nationwide gathering in 1987 in Rio de Janeiro, sex professionals revealed that HIV/AIDS concerned them far less than persecution by police. “Police violence was commonplace”, says Leite. “That's the only thing that got discussed.” Violence served as a catalyst for the launch of many organisations. Police in Porto Alegre were allegedly applying shocks to women's vaginas and breasts when NEP emerged in 1989. In Riberão Preto in São Paulo state, the death of a woman in 1998 galvanised sex workers. “First we had to address violence and citizenship”, says Tina Taborda Rovira, a social worker who founded NEP and serves as its executive director. “Then came health. Today we work with a tripod of issues: health, citizenship, and self-esteem.” One clear sign of progress: NEP has participated in police training seminars. HIV/AIDS prevention efforts start with the distribution of condoms and educational programmes for prostitutes. Condoms and instructional materials are customarily supplied by local public-health officials. One group in Rio de Janeiro, Fio da Alma, covers 15 areas and serves about 1500 women. NEP has 4000 women in its registry and estimates that about 400 drop by its downtown office every month. A project addressing male prostitution, run jointly by Nuances and the Support Group for AIDS Prevention (GAPA), distributes 300 000 condoms a month to gay bars, bath houses, and nightclubs in Porto Alegre. “They do the fieldwork that officials find difficult”, says Geralda Rigotti, director of the Agency for the Control of AIDS and Sexually Transmitted Diseases in the Rio Grande do Sul State Health Secretariat. “There are problems of access—not to mention issues of slang and cultural codes.” Federal czar Chequer says: “Peers are best for these interventions because they understand the problem and how to address it. They add credibility and ensure sustainability.” The effects of prevention campaigns by sex workers extend beyond the target groups of prostitutes and their clients, says Rigotti: “When a sex worker uses a condom with a client, not only are they protected but, if the man is married, his wife is also protected. The wife may not perceive the risk or may not want to bring up the topic with her husband.” One explicit effort to take the safe-sex message to a wider audience is NEP's Tent of Desire. Volunteers mount their booth in the public squares that often double as red-light districts in Porto Alegre and other towns. They participate in municipal and neighbourhood street fairs, setting up their tent alongside food and crafts stands. Visitors to the Tent of Desire receive complimentary condoms and educational materials. They are invited to answer questions pulled from the safe-sex quiz box. A correct answer gets you a t-shirt. As for the question of continued USAID funding for these and other Brazilian HIV/AIDS initiatives, it remains unanswered. As the Brazilians see it, says Chequer, they have tossed the ball back to the Bush administration and are waiting for a response. USAID has been silent. “We're waiting for more information”, says the official. “We would be open as long as the conditions of our government are addressed.” This isn't the first time Brazil has clashed with outsiders over HIV/AIDS policy: it resisted World Bank demands to stop free AZT distribution as a condition for a loan and has been embroiled in a debate with the USA over the generic manufacture of some antiretrovirals. During a previous round of USAID funding, the Americans tried to push their ABC scheme (emphasising abstinence and being faithful before condoms), but ultimately groups from the sex professionals network and libertarians like Nuances were allowed to apply for funds. The sex professionals network plans to invite USAID representatives to debate the issue in September at their national conference in Curitiba. Meanwhile, Chequer appears determined to find funds to further cement partnerships with NGOs of all stripes. “This episode with USAID has served to strengthen our resolve”, he says. “We'll find other sources of funding, from the national treasury or other bilateral agreements. And we will give priority to the sex workers.”