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The plan was quick to draw criticism from foreign-based organizations, which claimed this oath would hinder their ability to communicate with, treat, and provide prevention materials to sex workers in the developing world.
Then the U.S. government went a step further. In June 2005, USAID also began requiring U.S.-based organizations to sign the oath. The requirement is constitutionally questionable, and two lawsuits, filed by the Open Society Institute (OSI) and DKT International -- organizations that work with sex workers as part of a larger goal to reduce HIV transmissions in the Third World -- are challenging the restriction.
OSI and DKT International are suing on the grounds that this restriction violates free speech. The restriction forces U.S. organizations to take a mandatory policy position and also controls even an organization's private funds. According to the government guidelines, an organization's anti-prostitution loyalty oath must be applied "organization wide," which means that any privately funded programs must also comply with the government's anti-prostitution agenda.
The PEPFAR office in Washington declined to comment on the rationale behind the policy because the matter is pending before two courts.
For years, UNAIDS has identified programs run by sex workers and for sex workers as model programs that yield good results on issues of safe sex and HIV health care, but these are just the sort of programs that are no longer being funded by the U.S. government.
In countries like Nepal, where sex workers are among the most at-risk for contracting and spreading AIDS, curtailing outreach and prevention efforts could prove disastrous.
"Until conservatives acknowledge [the] needs and rights of sex workers to health and human rights protection, anything groups can do to help sex workers stay alive needs to be done," says Holly Burkhalter, the U.S. policy director for Physicians for Human Rights. "Forcing groups who work with sex workers to oppose it [prostitution] could threaten the survival of a lot of women in the world."
Though the PEPFAR office contends it has not kept track of organizations now refusing U.S. money or programs that have been defunded for noncompliance, anecdotal evidence reveals that many foreign- and U.S.-based organizations and the country of Brazil have rejected U.S. funds based on the new restriction.
Last May, the government of Brazil rejected $40 million in U.S. aid because accepting that funding would have forced the nation to halt some of its most effective strategies in addressing HIV. The country has recently seen a 50 percent decline in new HIV infections, in part because it has prioritized prevention and education efforts among prostitutes.
Because the terms of the anti-prostitution loyalty oath as set by Congress are vague, different programs are implementing the oath in varying degrees.
"In many Asian countries, organizations are refusing to provide services to prostitutes, even though policy technically allows for that," says Phil Harvey, president of DKT International. Harvey points out that because the policy is so vague, many organizations are self-censoring their efforts for fear of losing funding.
Both the PEPFAR and USAID offices have declined to further define the restriction at the request of the Open Society Institute and DKT International.
"What we are seeing is that different USAID offices are coming up with different definitions. In one country, an organization was told the restriction would require that commercial sex workers say a prayer before receiving services," Harvey says. "That is the kind of macabre you can get with this kind of policy."
Many are incensed over the restriction, but others believe it will work to save the lives of prostitutes and trafficked women. For Dr. Janice Raymond, the co-executive director of the Coalition Against Trafficking in Women, by taking a direct stand against prostitution, groups and organizations are making an important statement. "The issue is, do groups supporting the legalization of sexual exploitation receive money to promote a policy that keeps women in sexual servitude and encourages them to be harmed and treated as sexual commodities?" she asks.
Unfortunately the vagueness of the policy has not just kept groups from promoting the legalization of prostitution, it has in many cases kept groups from being able to provide options and care.
Hundreds of nongovernmental organizations all over the world, including six in Nepal, have written letters to President Bush arguing that the restriction threatens their ability to target, treat, and educate sex workers.
"It is bullshit," says Rajiv Kafle, one of Nepal's most celebrated HIV-positive men. As the founder of Nav Kiran Plus, an HIV counseling and rehabilitation NGO in Nepal, Kafle was asked to sign the anti-prostitution loyalty oath last year because he gets some funding from Family Health International, an organization that is primarily funded by USAID. Kafle reluctantly signed the oath in order to keep his program afloat.
Equal Access both receives funding from the U.S. government and provides programs and content that deals with sex workers. But it has not been asked to sign the oath.
Its determination to remain apolitical has allowed it to partner with an array of organizations, foreign NGOs, and Third World governments -- including the feuding USAID and Open Society Institute.