In the wake of Charlie Sheen’s announcement that he was HIV-positive, there was talk of how it would affect the actor’s career and also news about the reactions of his exes. But after Sheen’s comments about how he was blackmailed by “unsavory and insipid types” (“I’m imagining prostitutes,” Matt Lauer clarified for viewers) over his diagnosis, advocates hope Sheen’s announcement can bring attention to increased risks of HIV for sex workers – and also destigmatize some of the myths surrounding HIV.

During the “Today” interview last week, Sheen framed the situation by saying he was forced to reveal his diagnosis because he was being extorted for $10 million. “What people forget is that’s money they are taking from my children,” Sheen said. “They think it’s just me, but I’ve got five kids and a granddaughter.”

[Charlie Sheen’s HIV diagnosis was discussed in a 2014 Sony hack e-mail]

“Is it true that on at least one occasion, you had a prostitute come over to your house, who after a sexual encounter went into your bathroom and with a cellphone took an image of your antiretroviral medications?” Lauer asked.

During an interview with Matt Lauer on the "Today" show, actor Charlie Sheen confirmed rumors that he is HIV-positive and was diagnosed four years ago. He says he has been blackmailed for "millions" of dollars over the disease. (The Washington Post)

“Yes. This is after I had told her, ‘Thank you for your time. We’re not going to see each other anymore,’” Sheen explained.

Sheen’s quotes have been much dissected over the past week. Missing in that conversation, sex worker rights advocates say, are the fraught power dynamics when an HIV-positive person solicits a sex worker. Even if a client with HIV discloses the disease (and it’s unclear how often that actually happens), many workers in the sex trade don’t have the latitude to negotiate or simply leave the situation. Reasons range from physical to legal coercion to financial necessity.

“That’s what’s really so hard to hear [from] someone like Charlie Sheen with so much power – especially financial leverage – to claim he was being victimized by people” blackmailing him, said Lindsay Roth, executive director of Philadelphia-based Project SAFE and a former board president of the Sex Workers Outreach Project. “The reality is, when it comes to a sex worker, they’re laboring in a job where they have no legal or human rights.”

Over the years, there have been many studies about the extreme risk of HIV for sex workers: The Center for Disease Control calls HIV prevention outreach to sex workers “a critical effort for public health.” But there are challenges for such prevention, from socioeconomic status (people who have little access to health care) to the “unequal relationship” between sex workers and their clients that lead to inconsistent condom use. Plus, sex work is often criminalized to the point where it can be difficult to get contraception and seek health or legal resources.

Experts warn that you can’t really generalize the sex worker experience because it’s such a vast industry, from the adult film world to strip clubs to people working on the street. And if someone was faced with an HIV-positive client who discloses a diagnosis, each worker can technically decide whether they want to proceed — though that doesn’t always prove easy.

“In a situation where a sex worker is in control of their work environment, their health and safety needs met and they’re working in a good situation where they’re in control, they can absolutely demand that a client uses protection,” said Crystal DeBoise, managing director of the Sex Workers Project at the Urban Justice Center. “One of the skills sex workers have is being able to negotiate boundaries and working conditions outside of any established rules and regulations.”

Even so, she added, the criminalization of sex workers means it’s still extremely difficult to seek safety if a client is “persistent or violent,” or they have a manager who insists that they have unprotected sex.

Penelope Saunders, coordinator for the Best Practices Policy Project, said there’s a misconception that sex workers don’t know enough to help prevent against diseases like HIV. “Sex workers…tend to be more educated about issues relating to sexuality and that makes them experts,” she said. “The stigmatizing view is they have no knowledge and are very unaware. Generally speaking, sex workers know a lot about these issues.”

Saunders also hopes that Sheen bringing this issue up will also raise awareness about the stigma surrounding HIV in general. As the “Today” show made sure to mention, HIV-positive people with “undetectable” viral loads who are treated and use protection have an extremely low risk of transmitting the virus. However, that’s still an unknown fact to many people.

“The United States has a very poor response to the issue of sex work and HIV, and I hope that this discussion would bring that to people’s attention,” Saunders said. “But it doesn’t matter whether it’s a sex worker or a married person not engaged in sex work….whatever the situation, there’s so little information out there about HIV that most people continue to see having HIV as a death sentence.”

Overall, advocates know that while the initial focus is on Sheen, viewers will recognize the “unsavory types” he referenced in his “Today” show interview still have rights. And even though Sheen insisted that he has told every sexual partner he has HIV, some workers in similar situations aren’t given a choice either way.

“For Charlie Sheen to think that simply disclosing his HIV status to someone allows that person to protect themselves in the best way possible – that’s not always the case,” said Celia Fisher, Fordham University’s director of the Center for Ethics Education and the HIV Prevention Research Ethics Institute. “They may not have either the economic or social power to say no.”

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