Amsterdam Report

The VIII International Conference on AIDS/III STD World Congress, July 19-24, 1992, Amsterdam

From Andrew Sorfleet, Assistant Administrator
Maggie's, the Toronto Prostitutes' Community Service Project
298 Gerrard St. E. Toronto, ON.

Network of Sex Work-Related HIV/AIDS Projects

Outside of the official program, the conference provided the opportunity to bring together sex work-related HIV/AIDS projects in order to develop an international network. On July 18, these projects convened for an all-day inaugural meeting to determine the usefulness of an international network and to decide what its aims and objectives might be. During the morning the meeting caucused according to region — Africa, Europe, Latin America, North America, and Asia-Pacific — to determine regional concerns and work out the possible usefulness of regional and international networks. Some of the concerns were obvious: sex worker control, safe working conditions, info sharing regarding fund raising, and drug treatment issues. In the afternoon, we broke into working groups focused on the following topics: encouraging and developing sex worker-controlled initiatives for HIV/AIDS services, ethical issues and guideline development, working with diverse sexualities in varying cultural settings, male sex workers' projects, and information and resource sharing.

The following are some of the concerns that arose during these sessions:

• Ethical and human rights issues are a high priority in every region. The Network should be pro-active in identifying the issues and working to put forward our views and demands. The Network needs to strike a committee to develop guidelines and policy on human rights, research ethics and quality of service provision as each of these applies to people involved in commercial sexual transactions.
• The Network should review research to determine its usefulness and accuracy and should point out where research is needed. The Network should warn sex worker projects of unethical research afoot. The Network should not participate in any data collecting or encourage HIV testing. (The ethics of certain nonoxynol-9 sponge studies done on African women were questioned.)
• Sex-work related projects have difficulties lobbying and advocating because they are often seen as political activities and are therefore cannot get funding.
• Sex worker-controlled projects need to gain credibility in order to secure funding. Goals that need funding need to be determined by local sex worker groups and not by donors who have their own agendas.
• Sex work-related projects need to provide all the services needed by people involved in the sex trade and not just hand out condoms.
• Poverty rather than prostitution should be linked with HIV/AIDS. In developed countries, abolition of prostitution laws is the first step in addressing the relationship between prostitution and poverty.
• Non gender-specific work of the Network should always take equally into account the needs and perspectives of male, female and transgender workers.

It was determined during the meeting that an international network is necessary for information exchange, resource sharing, solidarity on global issues, providing support for people and new projects just starting out, and addressing the problems of underfunding, particularly in the developing world (and especially Africa) and the lack of representation of developing countries at international conferences. Facilitating information sharing about successful strategies, approaches and methods regarding situation assessment; project design, expansion and duplication; and monitoring and evaluation between projects in developing and developed countries would promote the development of sex work-related HIV/AIDS projects in the developing world.

These were some practical goals and tasks of the Network set forth at its first meeting:

1. Compiling and updating a region-by-region list of projects, including basic information about the work of each project.
2. Producing and distributing a newsletter or bulletin that disseminates relevant information based on the experiences of projects in different contexts, and provides a forum for the discussion of issues of interest to sex work-related projects.
3. Conducting training activities and other special events such as technical meetings, consultations, and other information-sharing forums.
4. Facilitating the development of policy alternatives and providing mechanisms for the input of sex work-related projects in forming policy at international and regional levels.
5. Forming links with research projects in order to develop improved methodologies and produce data in a form that is relevant and accessible to projects involved in providing services to sex workers and clients.
6. Providing technical assistance to sex work-related projects (e.g., in project design, implementation and evaluation), as well as assistance in locating potential sources of funding, sustainable condom supplies, and health promotion and training materials.
7. Assisting in the development of regional networks.

On July 24, 1992, seventeen representatives attended the second meeting of the Network of Sex work-Related HIV/AIDS Projects to determine the structure of the Network. The meeting was held at the office of The Red Thread.

The Global Programme on AIDS/World Health Organization gave $15,000 to the Network for development. This was used in part to hire Secretary Cheryl Overs, who developed the mailing list and arranged for the inaugural meeting at the VIII International Congress on AIDS. The Network currently functions under the auspices of ARHTAG (a registered UK charity) and it was decided at this meeting that we would maintain that relationship. Overs was directed to seek core funding for the network and for the activities of participating projects within their respective regions. It was decided that the network would be facilitated by a resource group that would have two representatives from each of the five regions: Latin America, North America, Africa, Europe, and Asia-Pacific. Quorum for decision making is to be one representative from each region. The resource group is open to ex-officio members and at the moment there are two: Priscilla Alexander (WHO), and Chris Castle. Resource people are responsible for locating and contacting, and collecting information from sex work-related HIV/AIDS projects in their regions and for passing information back and forth between the central resource centre (The Red Thread, Amsterdam) and regional members. The development of regional networks will require the organization of regional meetings and perhaps even national networks and meetings. The Scarlet Alliance of Australia, for instance, has ten member groups and projects.

The Regional Network

It was decided at the meeting that Gloria Lockett from the California Prevention and Education Project (CalPEP) and myself from Maggie's would be the best people to represent North America since ours are the only sex worker-controlled, government-funded projects in the region. The position of regional contact requires funding for a full-time paid coordinator, a fax machine, postage, long-distance telephone charges, and possibly membership fees for a bulletin board system (BBS) in order to access electronic mail for the transfer of computer files. The regional contact person is responsible for seeking funding within his or her respective region, establishing and maintaining contacts with projects doing AIDS education for prostitutes, compiling and updating a directory, and providing for the exchange of information and resources within his or her region and with the International Network. It would be necessary to organize a regional meeting within one year, which would require additional funding. Nationally, there are two prostitute-specific projects doing AIDS education. Stepping Stone in Halifax (with which I established contact with during the May AGM of the Canadian AIDS Society) and Maggie's. There may be prostitute-related groups in Vancouver and Montreal but they are not AIDS education projects. Maggie's is the only government-funded, peer-controlled project in the country. Government funding is important in establishing community ownership and skills training is an integral part of any peer education project.

Meetings of the International Committee for Prostitutes Rights (ICPR)

There were two meetings to reconstitute the ICPR (July 17 and July 24). At the July 24 meeting, we sat down to determine how this international political body could be useful and how it would be structured. Its structure for the collection and dissemination of information would mirror that of the International Network of Sex Work-Related AIDS/HIV Projects. We decided that it would be be a watchdog for human rights violations against prostitutes and would be very vocal. Our first demonstration took place at the conference, immediately following the human rights plenary. We staged a die-in at the entrance to protest human rights abuses against prostitutes all over the world. In particular, we wanted to draw attention to the hushing up of the Burma incident. Twenty-two Burmese prostitutes who were found HIV positive in Thailand were handed over to Burmese army personnel, who injected the women with cyanide. It was a good demonstration — a positively affirming experience that got good press coverage and helped galvanize the group.

The VIII International Conference on AIDS/III STD World Congress

At the conference, most of the information of interest to a project like Maggie's was displayed in the poster area where groups were organized according to topic in order to discuss research. Relevant information included research on such topics as risk behaviours among drug users, female drug injectors, AIDS and street children in Brazil; the evolution of community-based organizations; the impact of high mortality on communities; and HIV testing for prevention, to name but a few. Much of the research that was prostitute-specific, such as that described in a session called, "Condom Use Among Commercial Sex Workers and Their Clients" which confirmed what outreach workers have known for a long time.

There were many poster abstracts reporting the extremely high frequency of the use of condoms (particularly in comparison to any other "sector" of the population) between prostitutes and their clients in such places as Rio, Bangkok and Africa. It's sad that this research fails to see prostitutes as normal people. As outreach workers and prostitutes, we know that prostitutes use rubbers extremely consistently with clients. Governments are concerned with clients not prostitutes. Like all people, prostitutes are most at risk in their personal relationships. There was absolutely no research presented at this conference that legitimately represented the concerns of prostitutes and the health of their community. The closest thing was the meagre attempt by Alexandra Highcrest, representing the Canadian Organization for the Rights of Prostitutes (CORP), entitled "When Love is Illegal" (See Appendix I). Its anecdotal style had sentimental appeal, but the paper lacked research value, and academic creditability. It included a mini-history of the prostitutes rights movement in Canada, which had little information and was full of factual inaccuracies.

There were also booths that represented agencies from all over the world, offering their educational materials. Both the research and educational materials are, for the most part, available to any agency that has access to the published abstracts and poster abstracts from the conference. Much of this information may be useful in its published form but it was the discussions of this research that were most useful in analyzing the information and bringing to light the repercussions likely to arise from it.

There were discussions about the information linking HIV and TB in weakening the immune system and this increasing people's susceptibility to either infection. There has been a high incidence of TB in cities along the east coast of the United States, particularly among street people and especially street people with HIV. Outreach workers have also been catching TB, which presents legal complications in terms of compensation. Public health legislation has been used to detain and charge prostitutes for failure to take medication for TB. There was also much talk about a new strain of tuberculosis that was vaccine resistant. (Gwendolyn recently went to the Department of Public Health and learned that this strain is in fact about 20 years old.)

There was a lot of discussion about the new information regarding crack addiction and HIV infection. One study showed that oral sex is the leading cause of infection in crack users in Harlem. Smoking cocaine and crack causes lacerations and sores in the mouth and unprotected oral sex for a habitual crack user is more risky then getting fucked without a condom.

Gwendolyn did a CBC radio interview on grassroots concerns at the conference and brought Victor Ortiz, the information centre director of AIDS South Zone in Mexico City. Ortiz acted as translator for Claudia Colimoro (the Mexican prostitute who ran for parliament) and was involved in getting gay men — AIDS activists in Tiajuana — to support the prostitutes who were trying to defuse the police hostility and brutality. In order to fill a radio spot for the CBC, Gwendolyn asked various grassroots people about their needs. The concerns seemed to be unanimous: the lack of representation from developing nations, the white American bias, the lack of translation services, and social impact research that only proved what community workers have long known, (i.e., that prostitutes use condoms with their clients) and did not represent the concerns of large numbers of HIV-infected people.

There was discussion about elitism within the political movement. Demonstrations such as the "No Borders" protest by ACT UP were necessary and important but they didn't address the concerns of the millions of people infected with HIV in developing nations, for whom travel could never be a concern. For many people, clean water is a more important issue. Demonstrations to try to have the costs of extremely expensive drug treatments lowered don't help even the many Americans who can't afford medical care.

Granted, poster displays are a way of exchanging information. But they also seem like an attempt to pacify the community group contingent. The mini-courses all sounded interesting and useful but it was like prime time TV — everything was on at the same time. There was a real need for some sort of grassroots community room, a place and time to gather and have heated discussions and debates.

It was the opportunities to confer with people from different contexts and concerns, yet who were working on similar projects, which made attending this conference so useful. The chance to discover and strengthen contacts for the exchange of experience and information is very important from the perspective of a sex-work related HIV-education project — and especially one that is peer controlled — in terms of the development and iteration of global concerns for prostitutes and also in terms of self-evaluation. The VIII International Conference on AIDS provided several excellent opportunities to do just that.

One of these opportunities was the Sex work mini-course led by Cheryl Overs. The mini-course was divided into three sessions addressing the following three questions:

1. What are the effects of coercive or repressive laws, policies and practices aimed at the sex industry (including prohibiting seropositive individuals from working, registering sex workers and closing certain types of commercial sex venues) on AIDS prevention efforts with sex workers and their clients?
2. What are the approaches and results of legal reform policies and programs designed to help sex workers who choose to leave sex work? What are the implications of these strategies for sex workers who continue in the sex industry?
3. What are the approaches and results of programs to support behaviour change and/or to maintain safe behaviour amongst sex workers and their clients.

Panelists included people like Paulo Longo, Pegaçao, Brazil; Eka Esu Williams, Society for Women & AIDS in Africa, Nigeria; Ruth Morgan Thomas, ScotPEP, UK; Gloria Lockett, CalPEP, USA; Andrew Hunter, Scarlet Alliance, Australia; Chantipwa Apisuk, Empower, Thailand; and Priscilla Alexander from the World Health Organization. Because the mini-course was prostitute-specific, there were many prostitutes representing organizations from all over the world. Discussions arose from many different perspectives.

During the session on approaches to legal reform, Yolanda put forward an Australian perspective on dealing with the criminality of prostitution. Australia has much experience in this area: prostitution was legalized in the states of Victoria, and decriminalized in New South Wales. Their experience shows that the best approach is to remove the laws and wait. Let the situation balance itself and then, if necessary, implement laws to maintain a fair equilibrium.

The session on education programs for prostitutes and clients began with Priscilla Alexander of the World Health Organization, who presented WHO guidelines for sex work-related HIV/AIDS and STD prevention intervention projects. We learned at this mini-session that Maggie's is unique. It was one of five projects chosen as models from which to develop the WHO guidelines because it has secured funding and is a peer-controlled education project. The five projects were CalPEP, The Red Thread, Maggie's, Scot PEP and ?.

Later, discussion amongst sex worker projects arose regarding securing government funding for pairs of outreach workers as a work safety issue. There was consensus that funders are responsible for workers' safety and should not be allowed to fund only one outreach worker. But Maggie's represented a significantly different view on outreach strategies. At Maggie's, we feel we cannot afford to pair up outreach workers. We also feel that single outreach workers establish significant contacts more quickly and easily. Outreach workers pair up if they feel the need but it is not common practice. Finally, we believe that no outreach worker should ever work in an area where he or she does not feel safe. People should do outreach in communities where they feel comfortable. At the conference we quickly realized how vastly different the context is in different places.

Lack of representation from developing nations, compounded with translation difficulties at the conference, were discussed as significant problems. Claudia Colimoro, a prostitute from Mexico who ran for Representative Assembly of the Federal District of Mexico representing the Revolutionary Workers Party , spoke for fifteen minutes in Spanish about the difficulties of getting to an international conference and then not being able to understand most of the relevant information because of language barriers.

Diana, from the Prostitutes Collective of New Zealand, pointed out the need to have transsexuals employed in AIDS prevention projects and represented at the conference, since most transsexuals work as prostitutes to survive. In every session, it was prostitutes who determined the focus of the discussions. A bit of ownership.