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Pledges and Punishment

The director of an HIV prevention program explains how the Christian Right's growing control over U.S. foreign aid policy may cost Indian prostitutes their lives.
 
 
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Since George W. Bush's first day in office, Republicans in Washington have come up with creative ways to attach puritanical restrictions to U.S. foreign aid, often at a tremendous cost to public health.

First came Bush's revival of Reagan's Mexico City Policy, which canceled funds for any family planning organization that advocates for abortion rights, a measure that pulled tens of millions of dollars from International Planned Parenthood and others on the far right's enemies list. Then came a State Department missive to USAID missions that all funded programs, publications, even websites had to fall in line with Bush's social conservative worldview on everything from abortion to drug use. Then Congress used the President's Emergency Plan for AIDS Relief, or PEPFAR, to set aside $1 billion for abstinence-only education, which bars discussion of condoms and safer sex. Most recently, Republican congressmen introduced a series of anti-prostitution loyalty oaths, requiring any organization receiving U.S. funds to combat AIDS or human trafficking to condemn prostitution in word and in deed.

This injection of conservative social mores into U.S. foreign aid policy has been fueled by what Rep. Barbara Lee of California has called a "coordinated campaign of false innuendo," led by such groups as Focus on the Family, which held a Capitol Hill briefing last year demanding that USAID be purged of its "liberal cancer," and by Republican ideologues like Representatives Chris Smith of New Jersey and Mark Souder of Indiana, each of whom seek to forge reputations as Capitol Hill's holiest. The strictures have produced a wholesale restructuring of who receives U.S. funds around the world -- from experienced family planning, AIDS, and relief organizations to public health neophytes such as Rev. Franklin Graham and the National Association of Evangelicals.

But harder to trace than who's joined the gravy train is what's happened on the ground to those who got kicked off. A consortium of international family planning organizations released a report, " Access Denied," in 2003 (updated in 2004) examining the impact of the Mexico City Policy. They documented a hobbling of HIV prevention efforts in Ethiopia and Zambia and, ironically, a potential uptick in abortions in Romania, where it is now harder to encourage women choosing abortions to access birth control in the future.

A recent Washington Post story noted that Brazil's decision to forgo $48 million in U.S. funds rather than sign the anti-prostitution pledge has put financial pressure on the nation's successful effort to combat AIDS. AlterNet had the chance to speak with Meena Seshu, director of Sangram, a small but widely respected HIV prevention program in western India, about how this crusade by social conservatives in Washington has reached all the way into her rural town.

With 5.1 million infected, India has the second-largest AIDS epidemic in the world -- smaller only than South Africa's in sheer numbers -- and infection rates among certain high-risk populations, including sex workers, has reached a stunning 40 percent. For 14 years, Sangram has been doing HIV prevention work among several thousand rural sex workers, helping them to form a prostitutes' collective, known as Vamp, which has lobbied the national government for improved condoms, enforced a 100 percent condom usage campaign within local brothels, and branched out to educate truckers, migrant workers and rural youth about HIV risk.

Sangram and Vamp together have survived on less than $150,000 a year -- even less now, since Sangram returned a $12,000-a-year grant to USAID last summer after refusing to adopt "a policy explicitly opposing prostitution," as the law requires.

Months later, Sangram remains in the crosshairs of the morality brigades. Evangelical missionaries targeted their town for a "rescue" last May, raiding the local brothels with military force to recover underage girls (they found only two). Last September, John R. Miller, head of anti-trafficking initiatives at the State Department, openly accused Sangram of thwarting efforts to rescue minors from brothels. And in early February, Rep. Souder circulated a dossier about the organization at a State Department briefing on Capitol Hill, accusing Sangram of "retraffick[ing] women back into a brothel" and calling for heads to roll at USAID. "It was a little over the top," said one Democratic congressional aide who received the document. "But USAID and the Global AIDS coordinator are feeling intimidated."

Just politics as usual in Washington these days, perhaps. But the consequences are serious for those, like Meena Seshu, who are on the frontlines of the global AIDS fight.

Esther Kaplan: So explain why you need to organize sex workers in order to combat HIV. This idea is extremely foreign on Capitol Hill.

Meena Seshu: First of all, the data supports this approach. The HIV rates among sex workers that we have access to are from Bombay and Calcutta. The Calcutta data tells you that where the women were organized, the rate has dropped. And the data in Bombay, where the women are not organized, continuously shows increasing rates among sex workers -- in 2000 it was above 40 percent.

Look, I was educated by the same systems that educate all of us about prostitution. I was constantly looking for Bollywood in the brothels, expecting oppressed victims, wanting to rescue everybody. But I was reeducated. I remember when we first went in to work with the women there was this thing called the "client negotiation strategy" that the government had passed on to us, designed to help clients use condoms. And this woman turned to me and said, "You tell me why I should use a condom, how it needs to be used. I'm very interested. But you are going to teach me about men? You know nothing about men!" And it's true.

Don't forget that the government of Maharashtra sent us to the brothels. That's the truth. To combat HIV/AIDS by doing targeted interventions with high risk groups. The idea of the government was that women are the vectors of the spread of HIV, so you need to promote 100 percent condom use, such that men who go to them, who are known as the "bridge population," will be safe, so that good women in their houses will be saved. This is the model. Once we started working with women, we thought this was a terrible agenda. We didn't care about the women. They could die -- as long as they used the condom with the client, our part was over. Finally we realized there's something wrong here. And we stood everything on its head.

We began to ask, What are the fictions and what are the facts? One fiction is these women are oppressed, victimized, and the fact is that all of them are not. Many of the women I work with are what are known as Devadasis, called temple prostitutes in some parts of India. For them, prostitution is a way of life. The fact is some of the women are strong fighters, who negotiate with the police, who negotiate with health systems and doctors all the time, and come out with flying colors. And they're the best educators of their male clients I have seen. These women are able to talk to them straight. All of the truths we'd assumed were challenged by them. There are women here. They're saying something. Isn't it right that we listen?

They couldn't access health services. The police were very oppressive. They had a bribing system then. Police had to be told, "No, there'll be no more bribes." All that could only be done if you organized them. If everybody uses a condom, only then it'll work. Because if even one of them wouldn't use the condom, she'd have the most clients!

So the whole thing breaks up again. You must understand, it's business. There's cutthroat competition. So the first thing was to build that sense of a community. And it worked. For instance, we changed the civil hospital timings. You know how it works in India, 8:00 in the morning you have to stand in line at an STD clinic to get a case paper. And I said, do you think sex workers get up at eight in the morning? They don't. They only get up after 10. We said unless you open at 10 and keep it open till three, none of the women will come. Or the famous condom. We are a country that's been in the family planning business for a long time, right? Yet the ring would come off, the latex would come off in your hand, it would be only powder -- just crazy. Nobody had given any thought to this piece of rubber the government was handing out. We wrote letters and sent condoms right up to the minister of health in Delhi saying this is a good one and this is a bad one, and life depends on this. Small struggles have helped build that collective consciousness.

Kaplan: What was the USAID grant for?

Seshu: The grant was for a peer HIV prevention program among sex workers in the town of Sangli, and it was a three-year grant, which we finished in August, for 100,000 Rupees (less than $25,000) a year. What we'd done in Sangli was evaluated as this great project, so we decided to have it in another town, Karad, also. So in March 2005, we got another three-year grant for Karad for $12,500 a year. But when we went in for a re-grant for the Sangli project, this whole PEPFAR thing hit us. We decided at that point that we won't reapply for Sangli, and we'll return the money for Karad.

We called USAID and told them that we do not want to violate a law. We asked them, could you please come into our office and talk to us? They sent a representative from the Delhi office of USAID to our office in Sangli, and we told him we will not sign this pledge, and we'd like to terminate this funding, that it should be mutual, and let's do it without any fanfare. And that's exactly what happened. We thought that was the end of it.

Kaplan: Why not just sign a statement condemning prostitution?

Seshu: The truth is, we're working with these sex workers, we're telling them that if they use condoms men will be saved from HIV. That is the agenda of the state. You're asking them to help you fight HIV. And in the same breath you are telling them that they are terrible people and that you're against them. It just doesn't make sense. That was what upset me so much. We have actively used these women to stop the transmission of HIV into the general population. And it's very, very -- I don't even want to use the word unfair -- it's unethical to then go and say that they're terrible people and that you're anti-them. That doesn't ring correct. This is a fight against people who are against women, and I don't know why everybody else cannot see it.

Kaplan: What was the take of the women in Vamp?

Seshu: We had lots of conversations. Because it was their salary that was going to be affected. We had discussions with all the women in all the sites, and we got them to go into the communities and talk about it. And almost unanimously everybody said, "No, don't do this, because if you say let's sign it for money, then how come the money has become so much more important than we ourselves?"

The reason we were able to do this was from day one we've been very suspicious of money from outside, saying we don't know how long it will last. I've been preparing the women, saying, They're giving me money now, don't know if they'll continue, because the dominant norm is so against you people. We need to have a sustainable program. If we get used to big salaries then these things become quite difficult to say no to.

Kaplan: Not long before this back-and-forth about the USAID funds, a group of Christian missionaries violently raided the brothels in Sangli. Describe those events.

Seshu: In May of last year, an organization called Restore International, which had come into Sangli, got the police to do a raid of sex workers there, saying they wanted to rescue children trafficked into prostitution. (While Rep. Souder claims that Restore International receives State Department funding, a USAID spokesperson said the agency has never made a grant to the organization. Restore International's CEO, Robert Goff, declined to comment.) They made a huge drama of conducting this raid, with guns and some 60 police persons. People were beaten up. They were kicking in doors. Vehicles were charging down the street, there were policemen standing on the bridge with guns, there was tremendous verbal abuse. They beat women on their calves, such that they can't run. The entire community was terrorized.

Anyway, they picked up 35 girls and sent them for a medical exam to the civil hospital. The exam came back saying there were only four minors, at which point Sangram jumped in and said, if they are adults, then their rights are being violated. In India prostitution, per se, is neither legal nor illegal. That's the law. But Greg Malstead, of Restore International, was angry. He advised the police to send them back for a re-exam, and the re-exam came back saying 17 girls are between ages 16 and 20. Because the medical exam cannot pinpoint the age -- it only gives you a range. Two girls out of these were school-going children of sex workers who had come home for their summer holidays. It took us 15 days to get those two school-going girls out. Though their teachers came and deposed in front of the Child Welfare Committee, the kind of suspicion this man was able to create, that everyone are traffickers, nobody would believe us. Of the remainder, two were really minors. The rest went to court with their birth certificates and were released as adults. Some months later, when we returned the money to USAID, Malstead reappeared to accuse us of sex trafficking.

After this whole thing hit us, we called USAID and on Oct. 6, the American Embassy in Delhi issued a letter saying the termination of funds was "by mutual consent" and that the grant was not terminated because the U.S. government thinks we are traffickers. The truth is UNAIDS has accepted this work as a best practice. That this work is critical for HIV prevention has been established. Now it's being undermined by the prostitution pledge.

Kaplan: Do the sort of raids conducted by Restore International serve to halt sex trafficking?

Seshu: We are totally against this type of raiding, because we believe that if you rescue 10 children, 10 more will come back within two days. The point is how do you educate within these communities. When we established that out of the 35 caught in the raid, only four are minors, I was overjoyed, because this is the work Sangram has been doing for 14 years, talking to the community about child sexual abuse. We do not even accept the concept "children in prostitution." We are very clear that it's sexual abuse. We only don't think raiding is the answer. We believe that we need to work within these communities to have this conversation. If I go back into my own history, my grandmother got married when she was 10. She had my uncle when she was 13. I'd be horrified if my six-year-old had sex at 10. But the sex workers are not there. These communities still believe that after the menstrual period, it's OK to have sex. That's where they are. One needs to talk with them.

Kaplan: What has it meant for your organization to end up in the crosshairs of this U.S. policy?

Seshu: It's been very traumatic. They're vicious in their language. It hurts a lot to be labeled as people who are trafficking young children, especially when we have worked so hard against child sexual abuse. We're a well-known organization, an organization that has tremendous credibility. We were one of the few organizations chosen to advise the National Planning Commission on AIDS. When the Maharashtra government put together an advisory group on sex workers and HIV prevention, I was part of that. But all this credibility we've built up could be removed with a stroke. There are some people who are sitting on the fence, who we were slowly gaining ground with, and they are just toppling over to the other side. Elected officials, bureaucrats, organizations. That's where we're going to lose. They will not ask for our advice any longer, they will not engage with us.

The other place we're going to lose is among the community itself. We had gained so much by having these conversations with them, that children should not be in prostitution. Now the community has become very closed on issues of children.

Kaplan: And how has the loss of funding affected your AIDS programs?

Seshu: The collective is made up of women who work in a huge geographic area, covering almost 60 sites throughout westeran Maharashtra and northern Karnataka. The collective travels huge distances to meet every Monday, to formulate what they're going to do. Those meetings have got affected because there's no money to get them together. The second thing that gets affected is condom access. The requirement is 350,000 condoms a month, and these big bulky boxes have to be transported from the District Health Office to wherever the women are. And this means that somebody has to have a vehicle, which it is now difficult to pay for. The third place they are getting affected is when people fall ill, we once set aside a certain amount of money to take them to the civil hospital, but now we're largely dependent upon our own personal funds to do that. Some of these sites are 100 kilometers from the district hospital, so if they have to be brought all that distance.

The other problem is that because of the anti-prostitution environment, the government is now deciding that they will not give free condoms any longer. That's going to affect us a lot. We are totally dependent on free condoms for the poor women. And then there's the pay for our 60 peer educators. I'm surprised the women have held together already for six months without any money. They're being heroic about it, but how long can they last? Another six months?

Kaplan: How has the United States' hard line against prostitution affected policy in India?

Seshu: For politicians it's such a soft option. They think, let's say yes to this, and something else can be negotiated. Trade. Our nuclear program. Frankly speaking, what's a few prostitutes here or there? There's no cost to it. And it's very holier than thou to say you're anti-prostitution. In fact, they just changed the law. Soliciting and running a brothel used to be the main prohibitions. But the anti-trafficking groups advocated for a change, saying it's OK to solicit, but they'll penalize demand. It's so ridiculous -- all along, calling a client and servicing him was illegal. Now it's perfectly all right to call him, but if he comes, he's going to be put behind bars. They passed this really fast on Dec. 28. We were shocked. Things in India don't move so fast! Then we realized that Bush was planning to come to India, and maybe the Women and Child Department wanted to hand this on a platter, saying, "See, we've changed the law."

Kaplan: So this was the kind of reform that would please the Bush administration?

Seshu: It's considered a strengthening of the law by the anti-trafficking lot. For instance, before you had to have a police officer of a certain rank to conduct a raid. Now they've brought it down to any police officer. And the new law follows along with this "women are victims" story. Soliciting is out because, you know, those poor women, and men are evil, so therefore you arrest them. We are advocating for them to re-look at this, because the new law says that if any man is found in a brothel, he can be picked up. So it will be impossible to do HIV/AIDS work. If outreach workers are found in brothels, they can be penalized.

I've also brought up the issue of Indian sovereignty, because our National AIDS Control Program has a mandate to do targeted interventions for the empowerment of sex workers. It says that very clearly, they're open about it, it's on their website. And then PEPFAR comes and says you have to be anti-prostitution. It's crazy. The U.S. is pressuring all these governments to change their laws, to say they've done something about trafficking. And now we have a government in India that wants to engage with the U.S., so this has changed everything.

Esther Kaplan is a contributing editor at POZ, the national AIDS magazine, and author of " With God on Their Side: George W. Bush and the Christian Right " (New Press, 2005).