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Gender-based violence, sexual assault, and HIV

10 Mar

National Women and Girls HIV/AIDS Awareness Day Image from UNDP

National Women and Girls HIV/AIDS Awareness Day
Image from UNDP

Today (March 10) is National Women and Girls HIV/AIDS Awareness Day. This day is especially important to me, as a racial minority who works with HIV prevention and research. This day capitalizes on the growing need to focus attention toward newly emerging populations that are often overlooked in HIV discourse and rhetoric, particularly racial/ethnic minorities, and especially women of color.

Currently, the highest rise in HIV incidence rates are being observed among heterosexual Black women, comprising a three-way shift in race, gender, and sexual orientation from the group initially observed with having the highest HIV incidence rates in the early 1980’s: White homosexual men. Overall, Black and Latina women are disproportionately affected by HIV when compared to women of other races, highlighting a principal disparity in women’s health.

HIV is often viewed by the general public as its own isolated issue, directly linked to “promiscuity” or needle-use. In addition to contributing to unwarranted stigma surround HIV, these labels dismiss and discount other important factors that affect HIV transmission. Gender-based domestic violence and economic vulnerability (lack of financial means) are two factors that are often neglected in HIV discussions, yet they are integral players in the transmission of HIV, particularly among women of color.

Recently, in an effort to raise awareness around these issues, I published a composition of tweets linking gender-based domestic violence and economic vulnerability to rape/sexual assault and the predisposition to HIV.

Violence limits a woman’s ability to demand condom use & establishes and unfair power dynamic

On the flip side, even if a woman is not physically coerced into unprotected sex, she may forgo condom use with her partner or neglect to mention it out of fear that her partner will become violent with her.

Economic vulnerability also predisposes women, especially women of color, to HIV transmission. Financial dependence on a partner creates an imbalance in power dynamics that limits a woman’s ability to make decisions regarding condom use. A woman who is financially-dependent on her partner may feel pressured to meet the needs of her partner or “repay” her partner with sex, oftentimes unprotected, if it suits her partner’s needs.

 
There are many factors that predispose someone to HIV. Gender, violence, and one’s financial situation are three key players in this equation that we should not discount. Today, on National Women and Girls HIV/AIDS Awareness Day, I hope to raise awareness of these issues among the general public. As a healthcare worker and aspiring physician, I recognize that the application of medicine is not limited to diagnosis and treatment. I believe that it is important to have an understanding of the socio-economic factors that predispose populations to poor health. These factors, the “social determinants of health“, should be acknowledged and addressed first, as ultimately, prevention of the onset of disease is the most effective way to eradicate it.

–Rachel Safeek

Email me at rachel.safeek@duke.edu
Tweet at me: @RachSafeek

Human Rights Activism: End of the Year Reflection

25 Dec


Image

#FightStigma is a campaign that was started by students at Duke University involved with Know Your Status, an HIV testing and education group dedicated to providing free HIV testing to individuals on academic campuses in Durham, NC

@RachSafeekFollowing the incident with Justine Sacco, we should use #HasJustineLandedYet as an opportunity to educate about #HIV/ #AIDS & prevent future insensitivity https://bluedevilbanter.wordpress.com/2013/10/29/a-little-lesson-in-hiv-101/ …

This past week, former PR executive, Justine Sacco, was fired after posting a tweet connecting HIV transmission to race in South Africa. The tweet, which was posted by Sacco to her twitter while waiting to board a twelve hour flight from London to Cape Town, South Africa, was deemed insensitive and racist by twitter audiences, prompting an uproar among HIV/AIDS and human rights activists in the Twitter community. Airborne and without internet access, Sacco remained unaware of the frenzy that was occurring on social media sites in response to her tweet. The most notable response included the generation of the hashtag “#HasJustineLandedYet” to host discussion around the infamous post. Upon her arrival in Cape Town, a newly-unemployed Sacco was greeted by a crowd of journalists and angry activists demanding an explanation.

Whether a poorly executed joke or a genuinely crude display of carelessness, the callous nature of Sacco’s tweet comes as a disappointment to many. Such frivolity from a PR exec, REALLY? At least one thing of which we can all remain assured is society’s willingness to address overt instances of social injustice. Hence, the thousands of Twitter viewers who were quick to denounce Sacco’s behavior, albeit via 140 characters or less.

Another recent human rights victory related to health and HIV prevention comes in a different form: The Ruling of Canada’s Supreme Court to Strike Down Anti-Prostitution Laws. Having worked with female sex worker populations in the past, the issue of decriminalization and regulation of sex work is one that I am particularly invested in. This past week, Canada’s highest court passed a ruling that condemned the nation’s anti-prostitution laws, arguing that such laws endanger individuals within the profession, ignoring the health-related risks of the trade.

Finally, another recent personal victory comes from my own work with HIV and human rights-related causes on World AIDS Day 2013. December 1 (World AIDS Day) always marks an important day for anyone committed to work with HIV.

Last year, while working with Know Your Status, an HIV testing organization run by Duke University students, I spearheaded an HIV testing and launched a photo campaign entitled #FightStigma”, along with the amazing photographer and my former classmate, Shayan Asadi. (More pictures here.)  Every year, I take some time to reflect on the events from World AIDS Day. Last year’s reflection was actually a Facebook post turned very short blog posting:

“Today is World AIDS Day! Exactly one year ago, I spent this day testing for HIV and educating about the disease with female sex workers in Salvador, Brasil. It was the most meaningful experience I had until that time, and I never thought I could make a difference in the same way. One year later with Know Your Status, we (a group of 20+ Duke students) have managed to test hundreds of students and Durham residents over the course of one semester…It makes me so incredibly proud and inspired to see so many college students invested in a cause, whether political advocacy or human rights activism, I am so honored to be a part of a college campus with such progressive enthusiasm.”

Fight Stigma is a campaign that was started by students at Duke University involved with Know Your Status, a volunteer group dedicated to providing free HIV testing to students in Durham, NC

Fight Stigma is a campaign that was started by students at Duke University involved with Know Your Status, a volunteer group dedicated to providing free HIV testing to students in Durham, NC

One year later, I’m still continuing my work with HIV prevention as an HIV Education Specialist, researcher, and, of course, blogger. I spent the majority of the first week of December (unofficially deemed “HIV /AIDS Awareness Week”) engaging in various outreach events throughout my community, including helping to launch an HIV testing marathon event, entitled “#LoveSafely” and a panel discussion about “Caring for HIV/AIDS Patients in the United States”.  Check out the details below:

HIV/AIDS Awareness Week

HIV/AIDS Awareness Week

HIV Testing Marathon

HIV Testing Marathon

We tested over 65 people in just a few short hours, and I did a few of those tests in Spanish. Over the course of the week, over 100 tests were administered. The successes of these events, coupled with the very fulfilling research/outreach I do leading up to December truly make this season the most wonderful time of the year.

Email me at rachel.safeek@duke.edu

-Rachel Safeek

HIV Transmission & Voluntary Sex Work in Exchange for Housing & Food

8 Dec


In line with World AIDS Day, which was December 1, the New York Times published an excellent piece on the front page of its December 4 issue, “Poor Black and Hispanic Men are the New Face of HIV”. Link to article.

Poor Black & Hispanic Men are the New Face of HIV

Front Page of December 4, 2013 New York Times

While I do not necessarily agree that there is a “face of HIV”–HIV can affect anyone and assigning a face to the disease may actually stigmatize individuals who fall under the category of the assigned group–, I commend this piece for highlighting the numerous social factors that contribute to the spread of HIV, specifically among gay Black and Hispanic men.

Among these social determinants include the social stigma attached to homosexuality among minority men. The stigma among Black or Hispanic men who identify as homosexual often leads to isolation and abandonment from their families and friends. Removed from the financial and emotional support of family and friends, individuals are left in a disempowered and desperate state. Sex (oftentimes unprotected) is often used in exchange for a place to sleep.

Kwame said he had sex that night — with a man he met at a gay services center, where he had gone in search of emergency housing. “I wore a condom,” he said. “I did it sort of out of guilt, or pity. It’s how I was raised. I didn’t want him to think I thought less of him. Also, I needed someplace to stay.”

– “Poor Black and Hispanic Men Are the New Face of HIV”. New York Times. 4 December 2013

Earlier this year, I published a piece about the differences between “Voluntary Female Sex Work vs. Sex Trafficking of Women“. In my post, I comment on the manner and degree to which women, particularly minority women who lack financial support, often resort to the voluntary exchange of sex for food or housing.

“Sex work is the exchange of sexual services, performances, or products for material compensation”

Considering this definition, an individual who has offered sex in exchange for food, money, or a place to stay has engaged in a transaction that is deemed sex work, even if he or she does not formally identify as a sex worker…

–“Voluntary Female Sex Work Vs Sex Trafficking of Women“. Rachel Safeek. 13 October 2013.

As described in the New York Times article, economic vulnerability among men who have sex with men (MSM), coupled with abandonment from friends and loved ones, can also lead to the use of risky sexual encounters, including unprotected sex with strangers, in exchange for food or a place to stay. These exchanges contribute to the spread of HIV among financially disempowered groups, which are oftentimes minorities. Many times, we do not think about these type of sexual exchanges as actual sex workbut whether we acknowledge these encounters as instances of sex work or not, we must acknowledge that these casual exchanges of sex in return for food or housing DO exist and the resulting health risks ARE REAL.

Email me at rachel.safeek@duke.edu

-Rachel Safeek 

#FightStigma

Know Your Status "Fight Stigma" Campaign photo

Know Your Status “Fight Stigma” Campaign photo

HIV as a Human Rights Issue: Intersection of Gender, Race, and Violence

10 Nov


 

I Care about HIV/AIDS because...

I Care about HIV/AIDS because…

Why should people care about HIV if they are not personally affected by the disease, or if they do not know of anyone who is personally affected? I’ll tell you why: HIV is a human rights issue. 
One of the things that I love about my job is that when I’m discussing HIV prevention, I’m never just restricting my conversations to talking about HIV. I talk about STD concerns, general sexual and reproductive health, issues of consent for sexual activity, and finally issues related to power dynamics within relationships.
Here is one thing many people don’t realize, at least not consciously: condom use is all about negotiation. Okay, logically, to prevent the sexual transmission of HIV (and other STD’s), one should engage in all sexual or intimate encounters using condoms. That makes sense.
What if no condom is available at the moment? Or how about if your partner doesn’t want to use condoms? Okay, let’s focus for a second on the latter: Your partner is pressuring you into not using condoms.

There’s that classic line:

“You’re on birth control, and I don’t have anything (read: Sexually Transmitted Disease)….and neither do you. Why do we need to use condoms?”

If your partner doesn’t want to use condoms when you do, then logic tells us to just kick him/her to the curb. But unfortunately, logic cannot always be applied to instances of sex or intimacy. Beyond the emotional attachment which may cause someone to abandon his or her preferences “out of love” for their significant other, there are a few other matters to consider: What if you are in a long-term relationship and your partner is upset or offended by your request to continue using condoms? What if he/she threatens to leave you if you go against his/her wishes. Or…..

What if your partner threatens to (or does) hit you for resisting his/her demands? Ultimately: HIV transmission is not as simple as someone forgetting to wear a condom or not having any condoms available. It’s not even JUST an issue of a lack of education around HIV or sexual health. It comes down to negotiation. It’s and issues of power dynamics: who has the power (or IS empowered) to demand that condoms are (or are NOT) used.

The Three-Way Shift

In the early 1980s, when HIV was first observed in the United States, it was considered a “gay disease” because it was primarily observed among young, Caucasian, homosexual men in the Los Angeles area. Almost thirty years later in 2013, there has been a three-way shift in the race, gender, and sexual orientation of the demographic group with the highest incidence rate of HIV: from Caucasian, homosexual, men in the 1980’s to African American, heterosexual women in present day.

That’s a pretty remarkable shift to consider. In just thirty years, a virus has completely changed its course to disproportionately affect an entirely different demographic. This was what initially drew me toward researching HIV and its relationship to women.

Reasons cited by scholars for this shift in HIV to targeting women, particularly African Americans, include the power dynamic between men and women engaging in heterosexual intimate/sexual relationships, particularly in relationships in which:

  1. Gender-based violence (GBV)/Intimate Partner Violence (IPV), including domestic violence, rape, and sexual assault, are involved
  2. Women are financially unstable/”economically vulnerable”
  3. Men in heterosexual relationships bear attitudes of dominance or patriarchy

Because condom use is a direct product of negotiation, the individual with more power has the greater efficacy to control whether or not condoms are used in a relationship. Below I discuss the three situations listed above and describe their relationship to power dynamics within heterosexual relationships, condom use negotiation, human rights issues, and HIV transmission.

Gender-Based Violence (GBV)/Intimate Partner Violence (IPV) in Heterosexual Relationships

Julia Kim (2008) describes the most visible “manifestation of the unequal power balance between men and women is violence against women”, specifically, violence against an intimate partner. If violence or sexual assault is an impending threat for a woman while she is in a relationship, she may not feel empowered to demand condom use from her partner out of fear of physical or sexual abuse. GBV and IPV constrain of individual agency and consequently lead to issues with women’s health. Women are physically at risk of being hurt from being hit or sexually abused by their partner. Additionally, they are left scared and in a disempowered state, in which they are unable to defend their human rights and protect themselves from STI’s and HIV.

Currently, the intersection of gender-based violence, intimate partner violence and HIV prevention among women is an initiative that is being undertaken by the White House (see link below).

Financial Disempowerment/Economic Vulnerability of Women Engaging in Heterosexual Relationships

Demonstrated lack of financial security among  women characterizes another social factor that contributes to female disempowerment, and subsequent transmission of HIV. Oftentimes, women who are struggling financially may turn to men for financial support.  In many of these situations, financial dependence upon men, the “sole bread-winners” of the household, places women in vulnerable positions. Women who are poor, many of whom are minorities, may rely on their partners for housing, food, or other forms of financial support. As a result they may be pressured to submit to the sexual needs of their partner. Women are more likely to engage in risky sexual behaviors, such as unprotected sex, because they believe they owe their partners in exchange for money, food, and resources. These type of sexual transactions in exchange for money or other material goods, including housing, clothing, food, or even drugs predispose women to HIV and other STD’s.

Patriarchy/Structural Violence

A woman who engages in sexual relationships with a man who bears attitudes of superiority toward women may be pressured to submit to the needs of her partner, including forgoing condom use if her partner demands it . If a man asserts his dominance, as the male “head of the household”, a woman may have limited control over protecting her body during intimacy, leaving her in a position of little control. Women may unwillingly submit to the pressures of her partner out of fear that her partner will leave her or engage in affairs outside of their relationship. The “subordinate status of women”, particularly of minority women, directly influences the health-threatening decisions made by women in relationships and characterizes a violation of women’s rights (Farmer 2003).

Dr. Paul Farmer (2003) cites structural violence,  the historically adopted behaviors or attitudes, e.g. sexism, racism, or classism, “that conspire to constrain individual agency”, as a key contributor to health disparities. Sexism, racism, and classism deprive certain groups of their basic human rights, creating “inegalitarian social structures”. Sexist or patriarchal styles of thought establish a hierarchy and division of power between the sexes, in which men are afforded the power to make final decisions. As a result, women are denied their right to assert control over their bodies and their health.

References

Farmer, Paul. (2003). Pathologies of power: health, human rights, and the new war on the poor. Berkeley: University of California Press.

Farmer, Paul. (1996) Women, poverty, and AIDS : Sex, drugs, and structural violence In Simmons J. (Ed.), Monroe, Me. : Common Courage Press

Kim, Julia, Pronyk, Paul, Barnett, Tony, & Watts, Charles. (2008). Exploring the Role of Economic Empowerment in HIV prevention. AIDS Journal (2008) Volume 22. Lippincott Williams & Willkins.

As always, please feel free to email me. I limited much of my discussion for ease of reading, but I’m always open to questions/further discussion and reading.

–Rachel Safeek

A Little Lesson in HIV 101

29 Oct

Fight Stigma is a campaign that was started by students at Duke University involved with Know Your Status, a volunteer group dedicated to providing free HIV testing to students in Durham, NC

Fight Stigma is a campaign that was started by students at Duke University involved with Know Your Status, a volunteer group dedicated to providing free HIV testing to students in Durham, NC

Occasionally, I receive questions from friends/twitter followers asking about my work with “AIDs” prevention.

First of all, it’s AIDS (Acquired Immune Deficiency Syndrome). Secondly, I work with HIV prevention. HIV can be transmitted from one person to another. AIDS cannot. The two are not synonymous.

Below is a list of 5 recurring incorrect themes related to HIV, along with a detailed response as to why each statement is incorrect.

5 Myths about HIV/AIDS

1) HIV and AIDS can be used interchangeably. False.

HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS.  HIV and AIDS are not synonymous.

Acquired Immune Deficiency Syndrome, or AIDS, is a syndrome. To be diagnosed with AIDS, an individual must be HIV-positive AND have a CD4+ T Helper Cell count of 200 or less in his or her body OR be diagnosed with an opportunistic infection.

An HIV-positive diagnosis only means that HIV has entered an individual’s bloodstream and may be living/replicating within an individual’s body.

2) HIV infection is hard to prevent. You can get HIV from toilet seats or kissing/touching someone who is HIV-positive. False.

There are four bodily fluids known to transmit HIV:

  1. Blood
  2. Semen (including pre-ejaculatory fluids)
  3. Vaginal Secretions
  4. Breast Milk

HIV is NOT transmitted through saliva (kissing), sneezing, coughing, or touching. While HIV is contained within saliva, the amount is so minuscule that one would have to drink gallons of saliva infected with HIV in order to contract the virus (which is disgusting!)…same idea goes for urine.

HIV can only be transmitted once the virus enters the bloodstream of a non-infected person through:

  1. Cuts or rips that may be pre-existing or may develop due to friction during unprotected sex
  2. Sharing needles containing contaminated blood
  3. Direct contact with one of the four infected bodily fluids on an open cut or wound of a non-infected person

In order to contract HIV through kissing, an individual who carries the virus must have a cut in his or her mouth and be bleeding. The person who is not infected with HIV must also have an open cut or wound in his/her mouth through which the blood from the infected partner can enter into the bloodstream….otherwise, it’s just not possible!

While HIV may be transmitted through all three types of sex, transmission of HIV via penetrative intercourse is 100% preventable through correct use of condoms. 

3. HIV can be transmitted through mosquitoes, since mosquitoes feed on blood.  False. 

To date, there have been no confirmed cases of HIV infection through mosquito vectors.

While mosquitoes, indeed, feed on blood, they do not inject blood from their previous meal into the next individual they feed on. They inject their saliva (which cannot transmit HIV) into their prey. If a mosquito does feed on the blood of someone is who HIV-positive, the virus will be transferred to the mosquito’s gut where the virus particles will be killed by stomach acid.

Furthermore, the mosquito genome is not comparable to that of the human genome. Mosquitoes do not have CD4+ T helper cells, which are necessary for replication and survival of the virus.

For specific details about the life cycle of HIV: 

Upon entering the bloodstream of a non-infected person, HIV targets CD4+ T helper cells. A CD4+ T helper cell is a white blood cell in the immune system of the human body, responsible for fighting off foreign pathogens in the body, e.g. viruses, bacteria, etc. Specifically, a CD4+ cell 1) secretes cytokines, chemical messengers that alert the body to the presence of foreign pathogens and 2) activates B cells, which are responsible for producing antibodies that fight the presence of infection. When HIV enters a CD4+ T Helper Cell, it copies its genetic material using the machinery of the CD4+ cell, by way of reverse transcription (process by which RNA is converted to DNA for replication). After replication, the new virus leaves the cell via budding, rupturing (“lysing”) the existing CD4+ T Helper Cell in the process, effectively killing the cell. The newly replicated viruses float about the bloodstream in search of new CD4+ T helper cells to repeat the process of replication and cell lysis.

HIV life cyrlce

If HIV is not treated, the virus can continue to kill CD4+ T helper cells in the body, weakening the the body’s immune system and increasing an individual’s susceptibility to other illnesses. Once there are only 200 or less CD4+ T helper cells or an individual has been diagnosed with an opportunistic infection, (s)he is then diagnosed with AIDS.

4. If you have HIV, you’re going to get AIDS and die. Definitely false. 

There is no cure for HIV, however, HIV is not a death sentence! There are plenty of options of HIV medications on the market. These medications, known as anti-retrovirals (ARVs), slow or prevent the replication of HIV in the body through blocking various pathways of HIV replication, including the binding process of HIV to a CD4+ T helper cell or blocking the reverse transcription (replication of HIV’s genetic material).

The potency of anti-retrovirals on the market has become so strong that someone may live for many years being HIV-positive and never be diagnosed with AIDS (ARVs will help to keep viral loads low and CD4+ cell counts high). Sero-discordant couples, in which one partner is HIV-positive while the other partner is HIV-negative, can have a baby together by engaging in unprotected intercourse, and both the non-infected partner and the baby can remain HIV-negative, if medications are taken correctly, as prescribed by a doctor.

5. It’s possible to list AIDS as a cause of death. Not quite. 

To respond to this, let’s briefly review the effect HIV has on the body: HIV enters the bloodstream of an infected person, killing the body’s CD4+ T helper cells, which are responsible for fighting off foreign pathogens in the body. The higher one’s viral load is, the lower his or her CD4+ cell count will become, leading to a weakened, or compromised, immune system.  Someone who has been diagnosed with AIDS has a high viral load and a low CD4+ cell count (200 or below).

A compromised immune system makes the body more susceptible to illnesses. For this reason, someone who is diagnosed with AIDS is not able to fight off common illnesses, such as the cold or pneumonia, when compared to someone whose immune system is not compromised. In this manner, someone with AIDS may die of pneumonia because of his/her body’s inability to fight off the infection due to a weakened immune system, caused by AIDS. So, yes, AIDS indirectly will have played a role in this person’s death, but it would be more correct to state that the person died of “AIDS-related causes” or “AIDS-related pneumonia”, not necessarily AIDS.

Educate yourself! #Fight Stigma

–Rachel Safeek

Email me: rachel.safeek@duke.edu
Twitter: @RachSafeek

HIV Outreach Event for National Coming Out Day

HIV Outreach Event for National Coming Out Day

Voluntary Female Sex Work vs. Sex Trafficking of Women

13 Oct



sex-workers-rights

@RachSafeek: Not all #sexworkers are products of sex #trafficking. There are women who enter sex work of their own volition.

The difference between human sex trafficking versus consensual and/or voluntary sex work among women is a topic that I’ve been meaning to address for a long time. Oftentimes, when I mention that I work with HIV prevention among Female Sex Workers (FSWs), many incorrectly assume that the women with whom I work are all victims of female sex trafficking.  Just this morning, I received an email from a fellow Duke graduate with a link to Nicholas Kristoff’s column about sex trafficking in the United States. The sender noted that I would likely appreciate the column  “because of the work [I] do with sex trafficking victims”.

Indeed, I value the article for the education that it reinforces to readers regarding sexual exploitation in the United States. However, I believe that an important piece of the story is missing, the part of the sex trade that includes the group that I DO work with: women/girls who choose to enter the profession “willingly”. (Note: I refer to “willingly” as such because I do acknowledge that it is debatable whether women who do enter the sex trade without being forced by a third party pimp or madam choose to do so 100% agreeably. Many who do choose to engage in sex work do so out of desperation or a lack of better options, including a lack of skills, resources, and education. These women, however, do not fall under the category of trafficked women, which is problematic, as I will discuss later in this post.)

In any case, global health students, researchers, and health care workers alike have responded to my work in a manner similar to my classmate’s, assuming I work solely with trafficked women. While directing attention to an important cause, they are simultaneously dismissing the value of work with women who voluntarily engage in the trade, an unintended effect.

Personal Experiences with Trafficking

Before delving into further discussion of consensual and voluntary sex work, I would like to first like to acknowledge that I do not wish, in any way, to alleviate the seriousness of human sex trafficking. We can all agree that the effects of unlawful human sex trafficking are damaging to the individual and society as a whole. Even Hollywood has made a supreme effort to portray the traumatizing and dehumanizing side effects of trafficking in films such as Taken (2008).

I myself have been the personal target of trafficking because of the work I do. On World AIDS Day 2011 (December 1), while leaving my workplace in Salvador, Brasil, I was grabbed by two individuals who attempted to force me into their vehicle. The two men were later identified as pimps. As an HIV researcher and activist, I am committed to decreasing stigma around HIV through prevention education and research. Eager to assist in the World AIDS Day festivities at my workplace, I stayed at work late into the evening, a dangerous decision which put my own life in jeopardy. Due to extreme luck and some willful attempts to fight back, I was able to escape the situation and run to the police, who were not much help and mostly likely involved…but police corruption in Brazil is another topic which I’ll reserve for future blog postings. In any case, having almost been forced into the trafficking system, I am without a doubt privy to the manner and degree to which sex trafficking is an issue of paramount concern and represents one of the highest and most inhumane human rights abuses.

From World AIDS Day 2011. Holding a red candle for HIV awareness and wearing a red ribbon HIV activism shirt

From World AIDS Day 2011. Holding a red candle for HIV awareness during a candle light vigil and wearing a red ribbon HIV activism shirt.

Sex trafficking is not the same as consensual Sex Work, but discourse should develop around each topic equally

Nevertheless, even with my own personal experiences with trafficking, I believe it is important to consider cases of women who are not forced or kidnapped and sold into the sex trade. There are a several reasons why I am against the singular portrayal of female sex workers as products of human sex trafficking:

First, I believe that assigning the title of “trafficked” to all women engaging in transactions of sex relegates women who voluntarily enter the profession, labeling them as “victims”. This is both an unfair and disempowering assumption. Many women, some of whom are highly educated and accomplished, willingly choose to enter the sex work trade. One rather famous case involves the Ivy League graduate who documented her experiences with prostitution.  Additionally, I have worked with many female sex workers in the past who noted that they were comfortable working in the sex trade. Sex work was their profession–their source of income. It was what they were comfortable with, and while perhaps they would not want their daughters to continue with the trade, they personally did not identify with feeling “used” or “victimized”. If anything, they were happy they could provide for themselves and their children. While the notion of “empowered” sex workers may not represent the overwhelming majority of sex workers in the United States or internationally, and while they certainly may not be the headlines for discussion around sex work, these women cannot be overlooked when engaging in discourse about sex work.

Secondly, and related to the first reason, dismissing all women who engage in sex work as “trafficking victims” ignores the job-related risks of women who voluntarily engage in the profession. Women who engage in consensual transactions involving sex cannot be discounted when considering the needs and, more importantly, the RIGHTS of those involved in the trade. If all sex workers are readily labeled trafficking victims–or victims, in general–, those who have chosen to enter and remain in the trade willingly (or for lack of better options), will have their rights overlooked. The focus will be shifted mainly to helping women leave the profession. As I noted earlier, not every woman wants out. Many are comfortable with the work they do, and so, it is essential that women who do choose to remain in the trade are not denied their rights e.g. safer working conditions, protection from rape/sexual assault and gender-based violence, and addressing key health concerns, including prevention of STDs and HIV. Focusing on cases of female sex trafficking ONLY subtracts from the much needed attention that should be paid to public health and gender-related risks associated with women who are not being forced and sold into sex work by a third party pimp/madam.

Finally, and this is a more subtle yet very important point, focusing solely on sex trafficking ignores the reality of women who engage in casual transactions using sex. For this point, I refer back to the definition of sex work:

“Sex work is the exchange of sexual services, performances, or products for material compensation”

Considering this definition, an individual who has offered sex in exchange for food, money, or a place to stay has engaged in a transaction that is deemed sex work, even if he or she does not formally identify as a sex worker. Take, for example,–a situation that I have heard time and time again from the women I work with–the case of a young woman/girl who is homeless, lacks formal skills and education, and the support and resources that a family can provide. She may see sex work as her only option for money and choose to enter the trade, albeit out of desperation. Oftentimes, she is not being forced by a pimp or madam, which does not qualify her as a trafficking victim. And while she may have entered the trade out of desperation and circumstance, she is still voluntarily engaging in sex work for money, shelter, or food. An unfortunate situation, but for many women who do voluntarily engage in sex work, it can be a reliable source of income which some (NOT ALL) women may be comfortable with.

This is a more common occurrence than society is willing to accept. However, even if we do not always include these transactions as instances of “formal prostituting”, we must acknowledge the role that they play in leading women to officially entering the trade and the number of health risks that develop as a result of engaging in these types of desperate transactions. Women who engage in sexual encounters for goods for money out of their own volition (even if out of desperation), and in the absence of a third party pimp/madam or John who forcefully demands that a woman submit to prostitution, represent an under acknowledged group.

This sheds light on a need to uncover the greater issues at hand: Ultimately, female sex trafficking and female sex work (excluding cases of women who entered the trade voluntarily and not out of lack of other options) are two micro issues in a macro problem: gender disempowerment. Whether actively forced by a third party, e.g. a pimp/madam or a John, or voluntarily engaging in sex work out of desperation or lack of skills, education, and resources (forced out of circumstance), the macro issue at hand is the vulnerability of women in each situation.

We all recognize the dangers that are present for women who are kidnapped, trafficked, and sold into the trade. However, if we choose to focus solely on female sex workers who are the products of female sex trafficking, we are ignoring the macro issue of disempowerment among women who are compelled to enter the trade due to circumstance ( lack of skills, education, and a strong support system/resources). This disempowerment should be a topic that is capitalized upon and addressed via public policy, and it is often overlooked by the assumption that all women in the profession are forced in by pimps or madams, rather than also by circumstance or choice.

Finally, there are various other issues to consider with regards to sex worker rights and public health/human rights issues. For the purpose of this post, I have restricted my discussion to women. I did this on purpose to demonstrate the role that gender plays in increasing vulnerability among sex workers. Gender is continually cited as a factor which predisposes women to violence and disease transmission, two key topics that I choose to focus on with my research. I focused on female sex workers, given my extensive background working with this group and in an effort to highlight the particularly devastating effect that financial disempowerment, gender-based violence, and rape/sexual assault can have on women in the trade. However, it is also important to consider the situation of male or transgender sex workers.

Additionally, one must consider what is truly consensual sex work.  I mentioned that I have met some women who are truly content with their earning income through the sex trade, but what percentage of all sex workers do these cases account for? Furthermore, do young girls/women who express content with engaging in sex work really have the ability to engage in consensual transactions using sex? All very important questions to consider. In any case, these questions represent even more of a reason to consider all instances of sex work, despite only the “sexiest” and most shocking stories of sex work/trafficking which are often highlighted in the media.
Email me at rachel.safeek@duke.edu
–Rachel Safeek

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HIV Decriminalization & “Justice for All” event

5 Oct


Left to Right: Honorable Judge Ernesto Scorscone, board president of JustFundKY, Robert Suttle, Assistant Director of the Sero Project, Rachel Safeek (myself), Sean Strub, Founder of POZ magazine and Executive Director of the SERO Project, and Blake Flaugher of AVOL, inc.

I had the opportunity to meet these notable individuals at the inspiring JustFundKY “Justice for All” event at the Kentucky Theather on Thursday, October 3, 2013. The event included an open panel discussion about bringing progressive policies to the state of Kentucky. Sean and Robert of the SERO Project also spoke earlier that day about HIV decriminalization and their campaign, the SERO project. http://seroproject.com/

–Rachel Safeek