From its enactment in 2003, the Bush administration's global AIDS initiative included a requirement that groups getting U.S. money "have a policy explicitly opposing prostitution and sex trafficking." But over time, the designation of who was covered has changed.
Initially, the policy was applied only to foreign organizations operating overseas. U.S.-based charities were exempt because the Justice Department believed that forcing them to make the declaration might infringe their First Amendment right of free speech.
Also exempt were multilateral organizations such as the Global Fund, the World Health Organization, and U.N. agencies, whose policies or charters prohibit them from enforcing the national laws of member countries.
Last September, the Justice Department revised its advice and said it could "defend [the] constitutionality" of extending the anti-prostitution pledge to U.S. charities working overseas. They are now being asked to comply.
In February, however, a group that included CARE, the International Rescue Committee, Save the Children and the International Center for Research on Women, among others, protested the policy in a letter to Tobias.
Nobody involved supports prostitution. The argument is whether making AIDS groups officially declare their opposition is helpful.
The framers of PEPFAR in the administration and Congress believe that prostitution should never be condoned or legalized because it creates a market for trafficking in women and girls and encourages the resulting cruelty, coercion and disease.
In addition, the PEPFAR law states specifically that nothing in the anti-prostitution clause "shall be construed to preclude" services to prostitutes, including testing, care and prevention services, including condoms.
But Maurice I. Middleburg, acting president of EngenderHealth, a 62-year-old public health charity working in 16 countries, said the declaration "risks further stigmatizing a population [prostitutes] that is already very difficult to reach."
"We know that stigmatizing people with HIV, or who are presumed to have HIV, is one of the root causes of the pandemic. So why would we issue statements that might exacerbate that?" he said.
