Watch: Sex Worker Activists Disrupt Special Session on the US Congress’ response to HIV

As we look back on the International AIDS Conference, there are plenty of lessons and conversations to carry with us. As a transgender woman and a sex worker, I want to make sure that the theme of exclusion, which people who use drugs, people who trade sex and transgender people repeatedly raised, is not lost. Let’s not fool ourselves into thinking that governments (like the United States) and huge organizations (like the International AIDS Society and the other organizers of the IAC) are the only ones making choices that marginalize key communities. While we critique the US for its flawed immigration laws or the IAS and conference partners for deciding to hold the conference in DC despite the barriers to sex workers and drug users, we are not off the hook. Everyday – from small grassroots groups to well-resourced foundations – we make decisions that determine whether those most affected by HIV/AIDS can enjoy their health and human rights.

At two disruptions of conference sessions and during the We Can End AIDS march, many of us chanted “nothing about us without us.” The concept was reinforced in workshops and panels and even by some plenary speakers – Debbie McMillan said on Thursday morning, “If you include people like me in your program design, your programs will be better and more useful”. As we leave the conference, we must not leave this idea behind. We can’t focus on the criminalization of HIV transmission without connecting it to the broader use of policing and imprisonment as a means of social control. We can’t demand law reform to decriminalize drug use or sexual exchange without recognizing that many of those most often arrested on those charges will instead be targeted under other laws and societal discrimination. We can’t let our moral qualms about whether young people “should” be engaging in transactional sex guide our policy decisions, but instead must focus on how to support and empower them to keep safe, healthy and free of rights abuses. We can’t pretend that racism doesn’t taint every aspect of our fight against the epidemic – from the lack of people of color in prominent leadership positions to lack of analysis about race, power and health.

What’s more, we must interrogate the common practice within the AIDS world of hiring or paying people from key communities (transgender, formerly incarcerated, youth, and so on) to give input only on “their issues.” Sex workers have insight into policy issues beyond criminalization of sexual exchange. Transgender people can write grants and run programs. People who use drugs can develop evaluation models and plan campaigns – including those not directly related to drug use, believe it or not.

An example from my own experience: in developing our statement on US policy regarding sex work and HIV ahead of the conference, US-based sex workers made a bunch of mistakes. At different moments we failed to fully consult widely with our communities, we left out critical policy issues, and we failed to clearly identify the groups and individuals involved in drafting the declaration. But we listened to critiques – and critiqued ourselves – and worked to address them in multiple ways. If we produced a document that did not reflect and have buy in from the most affected people in our communities, it would be worthless. Moving forward we have more work to do to ensure inclusion. But it is essential work.

Turning the tide on AIDS, turning the tide on human rights, must lift all boats. Anything less is like bailing water from a sinking cruise ship.

Darby Hickey is a writer, activist and DJ in Washington, D.C.

The OST programs in Ukraine have to satisfy the needs of its patients

OST patient from Ukraine: “We, the OST patients are the best experts in how this program should work, the state must listen to us and take to consideration our needs”

http://www.youtube.com/watch?v=Cs8670nlLak

Drug users in Russia: “Stop ingnoring us, stop violating our rights!”

The lies transmitted by the Russian government makes people die everyday and soon there will be nobody to provide treatment to in Russia….

Sex Workers’ Farewell to Kolkata from Matthias Lehmann | Matt Lemon on Vimeo.

(Posted with permission)

[July 26th, 2012] Sex workers and the unforgettable MC Tini say farewell to Kolkata after the Sex Workers’ Freedom Festival concludes. Travel restrictions by the US government had barred sex workers from attending the International AIDS Conference in Washington, but they made sure that their voices would be heard loud and clear!

Photo credit: Lauren Schneiderman

Optimism is the order of the day at AIDS 2012, with “treatment as prevention” now a reality, a blueprint for an AIDS-Free Generation just released by the US government, and non-US residents with HIV now allowed to enter the country. But there is another conversation going on — in the Global Village, the blogosphere, and the streets of Washington, DC — that is providing more of a reality check.

There is no question we can end AIDS. That is reason for optimism and was the central message of the mobilization that took place on Tuesday afternoon. But ending AIDS won’t be easy, and the challenges lie in political, economic, social, and structural barriers that make it impossible in some places to translate the best science into more treatment and fewer infections.

These barriers are not trivial. They include the “war on drugs,” the prison industrial complex, the war on reproductive rights, the moral crusade against sex work, the negotiation of free trade agreements that place intellectual property above people’s lives, and other massive global phenomena. These phenomena haven’t stopped us from making great progress against AIDS in the last 30 years — but could they stop us from ending it?

We marched on Tuesday to call attention to these barriers. We marched to remind our political leaders that AIDS is a product not just of a virus, but of the kind of world we live in. We marched to unite science with social justice. We marched to show the diversity of voices and communities who need to be part of the solution.

Sadly, we marched without many of our peers. Sex workers and people who use drugs from around the world have been excluded from this conference by discriminatory laws barring them from eligibility for US visas. How can we speak so optimistically of ending AIDS when such a blatant example of te socia exclusion that drives the epidemic is staring us right in the face?

As the march wound down, I strolled over with two colleagues to the Washington Mall to view the AIDS Memorial Quilt, on display here this week. It had rained so the organizers were packing the quilt up. A solitary voice was reading a seemingly endless trail of names of the deceased into a microphone to an empty mall. Blocks away, activists were getting arrested for tying themselves to the White House fence.

Yes, we marched because we can end AIDS. But we also marched because AIDS is far from over.

Photo credit: Lauren Schneiderman

Photo credit: Robin Bell

Photo credit: Robin Bell

Photo credit: Robin Bell

Photo credit: Lauren Schneiderman

Photo credit: Robin Bell

We sat down and chatted with John at the Sex Workers’ Freedom Festival in Kolkata, India. Here’s what he had to say…

I was born in a poor poor poor family in the Central Province, a very remote place in Kenya. I am born gay – it is my identity. For 11 years now I have been living positive. I wanted people to know that gay men in Africa can also be positive. I came out openly, so I have three positives: gay man, sex worker, HIV-positive.

I’m the coordinator of the Kenya Sex Workers Alliance, which is a coalition of sex worker-led organizations in Kenya. We recognize diversity – male, female and transgender sex workers. I started activism long before I joined the Alliance in 2010 – I was an activist with the global Network of Sex Work Projects. I used to write articles, go to media, tell people I am a male sex worker. People always think in a country like Kenya there are only female sex workers.

Male sex workers face discrimination from the MSM community. They never realize we are gay people, but we identify as male sex workers. They ask us: “Why do you have to do sex work?” We are excluded from the MSM community. At the same time, we also face violence from clients for being gay – they have sex with you, then start shouting at you. “This man is gay! Beat him up!” Male sex workers have been raped and even had broken bottles shoved up their anus.

We tell people to report cases to our alliance for documentation and for legal support. But same-sex rape is not recognized as rape in Kenya. As a man, I cannot go to the general hospital or clinic and say I was raped. So we can only go to the sex workers clinic. If we go for treatment to the general clinic, doctors ask other health workers to come and see a gay man. This is the stigma that we face as gay male sex workers.

We also face abuse by the community. They always think this is so unAfrican, they think this is immoral.At the same time, they are the ones who want to come and have sex with you and pay you. They are the ones who identify you as a sex worker and call you names. Then when it is dark, they come and have sex with you. The police, they want a bribe, if you don’t have a bribe, they can rape you.

So many people here think that if you have anal sex, you cannot contract HIV – so many people want to have anal sex. These days competition between male and female workers is very high but we work so close; females and males get each other clients. The same client may go to a man or a woman.

In Kolkata, we are protesting against the US government and telling them to respect sex workers. Sex workers are mothers, fathers, sisters, brothers and children. HIV does not respect people. If we are fighting HIV, we need to join hands no matter whether we are straight, gay, sex workers, whatever…but with no discrimination. This is high time we tell the US government they should respect all human rights – whether you are a sex worker, straight, gay, disabled. We are all equal.

We are telling the US government to repeal the anti-prostitution pledge which was signed by the former president George Bush. Obama, when he became the president, he said “I am the president of everyone” — that should include gay people and sex workers. He said ‘Yes We Can’ for change! But there’s no change yet, so he has failed the whole world of discriminating against sex workers and not removing that prostitution pledge.”

Photo courtesy of: Drugreporter | drogriporter.hu/en

Boarding the plane, I met Alexey Kurmanaevsky, one of the few Russian activists who went public about his life as a person who uses drugs. Alexey appealed to the Russian Ministry of Health asking for opioid substitution treatment (OST). His request was rejected. Then he sued the Ministry for refusing to provide effective, evidence-based treatment to its citizens. If the European Court of Human Rights agrees to review the case, there is a chance that it will find the actions of our government to be in violation of international norms. But for now Alexey Kurmanaevsky and I were travelling to Irpen, a small town just outside of Kiev, to attend a forum on HIV/AIDS for those who couldn’t be at the international conference in Washington, DC.

Upon arrival we met with Misha Golichenko from the Canadian HIV/AIDS Legal Network and Irina Teplinskaya, another drug user activist from Russia, who also went public about her drug use. She was the first person in Russia to file a lawsuit demanding access to substitution treatment. About a year ago when Irina was crossing the border into Russia from Ukraine, the customs officers found a methadone pill in her luggage. The local Federal Drug Control Agency got involved, Irina faced charges. But the whole world came to her rescue, Irina’s name became known in the UN corridors and the Russian Parliament. The poorly fabricated case was dismissed; the story with the methadone pill seemed forgotten. However, Irina no longer felt safe in her hometown—she now lives in Poltava, Ukraine, where she is a methadone patient.

The person who helped her and Alexey navigate through these cases is Misha Golichenko—a former police captain, a legal expert and simply an incredible person. So there we were, sitting and talking about the future of drug policy. And though all of us were in a fine mood, no one was overly optimistic. The thing is, for many years now the Russian government has been waging the so-called “war on drugs,” pursuing increasingly repressive drug policies and being staunchly opposed to harm reduction. Irina Teplinskaya and Alexey Kurmanaevsky came to Irpen to discuss this with their colleagues from other countries.

The next day, at the opening of the conference, Dasha Ocheret of the Eurasian Harm Reduction Network said: “I’m very happy to see you all; this is truly a star-studded cast!” She was right: the conference hall was packed with people from various Eastern European and Central Asian countries, as well as from several Western countries. Some of them spent time in prison solely because they’d used drugs. Many had been stigmatized because of their drug use or their HIV status. There were people from the Hungarian “Drugreporter” project, who came up with a completely novel way of reporting on drug policy. There was Michel Kazatchkine, formerly of the Global Fund, now part of the Global Commission on Drug Policy and just appointed the UN Secretary General’s Special Envoy for AIDS in Eastern Europe and Central Asia. There were activists from “Patients in Control”, a movement fighting for HIV and hepatitis C treatment in Russia. For many of these people, this was their first opportunity to meet offline, in person. All of us felt that this was the time to come together and mobilize. The hour is upon us.

I tried to spend less time in the sessions and more time talking and interviewing people. One of the most heart-breaking stories I heard came from Larisa Solovieva, a social worker from Kaliningrad. One of her clients, a patient suffering from excruciating pain had encountered a problem with access to opioid pain relief. At one point the doctor refused to prescribe tramadol to this young man, saying that the patient had developed a drug addiction, while the pain, he reckoned, was quite tolerable. When Larisa Solovieva demanded the necessary medication, the doctor said the following: “If every AIDS carrier is going to boss me around and tell me what to do, I’m going to run out of prescriptions!” The young man ran out of pain medication and died a week later.

When I hear these stories, I want to climb the walls with anger and frustration. Here we are, organizing forums, meanwhile the people are dying! And it doesn’t matter what you do—nothing seems to change!

There were a few people with us in Irpen receiving substitution treatment. Every morning they and those who wanted to learn about OST were taken to an OST site in Kiev. At first glance, Ukraine seems to be not that different from Russia, and yet they have substitution treatment with methadone and buprenorphine. I talked to people, I filmed them talking about how they walked away from street drugs and criminal activity, how they completed their hepatitis C treatment and began treating their HIV, how the quality of their lives had gone up. This is harm reduction in action! But, as it turns out, substitution treatment is still a contested subject in Ukraine. It is not uncommon for opponents to try and sabotage OST programs by attempting to sell drugs outside the clinics, or have journalists with dubious ethics publish slanderous articles on OST. During the forum we learned that Uzbekistan had shut down its OST programs, though at least the clients were warned ahead of time and could prepare for the transition. There are only three countries in the former USSR that don’t have OST: Turkmenistan, Uzbekistan and Russia.

One of the most interesting sessions was dedicated to strategic planning of the newly established Eurasian Network of People Who Use Drugs. We talked about the mission of the network, about how to structure our work, how to present it back in our countries. There were heated debates and even arguments, but for some reason I was thinking about something different. I was thinking that the western model of civic action and mobilization doesn’t work that well in the former Soviet Union. In Germany and Holland it all got started as a grassroots movement, a lateral process of mobilization that gradually expanded into effective advocacy at the national level. But how many times have we tried to do the same! Ten years ago Russia had quite a few well-funded, well-staffed harm reduction projects. Almost all of them are gone now. Obviously, the Russian government isn’t going to provide any funding. International donors are all but gone or have significantly reduced their contributions. But what happened to the people?? Where are the “harm reduction activists”? With a few rare exceptions we hadn’t seen community mobilization in Russia, though there were opportunities. Yes, working in Russia is perilous. But people get long sentences for miniscule amounts of drugs, and that doesn’t deter them from using drugs. So why does advocating for drug policy reform, a less risky business from the legal standpoint, seem to be such a lonely battle?

When I was leaving Irpen, I thought to myself that no Global Fund, no international forums will be able to save us from our own trouble until we, ourselves, get to work, until we start to mobilize, until we take our destiny into our hands. It’s not that simple, no. But the hope shines on, like a star through the fog and darkness.

Alexander Delphinov is a poet, a drug policy journalist and an art activist. He splits his time between Moscow and Berlin.

© IAS/Steve Shapiro – Commercialimage.net

A high point of the International AIDS Conference (IAC) for sex workers and allies occurred at the July 26 plenary featuring presentations by Cheryl Overs, a sex workers rights advocate and founder of the global Network of Sex Work Projects, and Debbie McMillan, an African-American former sex worker.

Cheryl opened with the image of waves washing up in the beach, noting that no wave could be disconnected from the others, just as the structural factors that contribute to HIV risk cannot just be addressed individually as bio-medical, behavioral and structural components. All are interconnected and no wave can be turned back singly.

Citing the Robert Carr Doctrine on the Principles of Meaningful Response to HIV Among the World’s Key Affected Populations, she asked “is there really a medicine that can change the dynamic between sex workers and their clients?”

She explored the real consequences that must be expected if new prevention technologies are introduced in the absence of adequate (and adequately funded) work to address the structural and power inequalities that shape sex workers’ HIV risk.

Applying a labor rights analysis, Cheryl noted that, in the sex work industry, larger market forces will determine how Pre-exposure Prophylaxis, microbicides and other new prevention technologies (NPTs) impact on sex workers‘ work-related HIV risk. Unless sex workers’ negotiating power is increased through realization of their labor rights, they will likely face additional risk as a result of the advent of NPTs and the consequent pressure on them to abandon condom use.

She noted that “the more rights sex workers have,the greater the chance that new prevention technologies will be productive for them”. She added that the greatest repression experienced by sex workers is driven by the political distortions created by anti-trafficking raids and rescues. The “rescue industry” shapes policy in a way that makes it virtually impossible for women to reduce their risk because it is disempowering. The focus, she emphasized, should not be on “rescuing” women or getting services to women in dangerous places but, instead, on getting commercial sex out of dangerous spaces and into safe settings where women have rights, options, and negotiating power.

She underscored the irony of the conference theme –Turning the Tide Together — when sex workers and drug users were not able to attend IAC 2012. “This contravenes everything that is being said here about human rights,” she said.

Debbie McMillan picked up on key themes mentioned by Cheryl — including challenging organizations and funders to engage authentically and fully with sex workers by hiring them in meaningful (not token) capacities and channeling significant resources directly to sex worker organizations. “If you include people like me in your program design, your programs will be better and more useful,” said Debbie.

Describing her own life story – being kicked out of the house as a teen for gender non-conformity, engaging in survival sex work, developing drug addition, spending time in prison, being diagnosed with HIV – Debbie personalized the experiences of those most affect by the epidemic. She, like Cheryl, noted that without addressing societal issues like stigma and biased justice system, AIDS will continue to devastate marginalized communities.

Debbie emphasized not only the need for legal reform but also changes in social attitudes towards stigmatized communities. “I have a dream that one day society will recognize the transgender population as human and deserving of all rights granted to most citizens,” she said to applause. Both Debbie and Cheryl received standing ovations from the sizeable plenary audience.

These themes were reiterated in subsequent conference sessions. One, called “Is Sex Work Work?” gave about 250 audience members an opportunity to experience the inadequacy of the conference tele-communication facilities between the Kolkata and Washington DC.. The transmission, however shoddy, did Washington participants see and hear the fierce determination of the activists meeting in India. One of them told us, “Washington can’t stop us from coming together. You may have stopped us from going to Disney but you can’t stop us from coming together!”

Naomi Akers, a sex worker leader from San Francisco, noted that one major challenge to the movement is the lack of funding to support the emergence of stable advocacy organization. What little there is comes now from minimal HIV-related grants. Even without the travel ban problem, she said, most sex worker advocates could not afford to come to the conference. More money is urgently needed to fund advocacy for sex workers’ basic human rights. Otherwise, it will be impossible to create an efficient, well-informed movement that can move forward.

At the conclusion of this session, the co-moderator, Marijke Wijnroks, noted that “We also need to say to IAS: No more AIDS conferences be organized in countries that ban entry to people who should be a part of our dialog!”

These sentiments were reiterated in several other sessions during the remainder of the day. In a discussion in the Sex Workers Networking Zone on the impact of the medical model on sex workers, another San Francisco activist — Cyd Nova — discussed the need for cohesive, multi-faceted HIV prevention strategies for people engaged in commercial sex. Far more important than new prevention technologies, he said, are structural strategies such as decriminalization, health care reform, housing rights and resources to support sex workers’ self-organizing. “It has a lot more to do with policy and rights than with technologies”, he concluded.

And in a later session on the Empowerment of Young People in the Sex Trade, Kelli Dorsey, a sex worker advocacy leader in Washington DC, noted that, when she started five years ago, some public funding was going into sex worker organizations. Now those resources have dried up. She linked this to the total absence of any mention of sex workers in the National HIV/AIDS Plan. Since this work is not recognized in the plan, it is not a funding priority for HIV/AIDS funders (public or private).

Kelli added that her agency’s funding had been coming through organizations advocating for sexual and reproductive health and rights but that source was also vanishing. As abortion rights and contraception access come under increasing political challenge, these organizations can no longer afford to invest in sex workers’ rights. She noted the need for drug policy organizations to increase their support for sex workers’ advocacy work, since it is also a vital part of the harm reduction agenda.

Post by: Anna Forbes

Interview with Eka: “Women IDUs in Georgia exist! And they have equal rights, just like any other women”

Georgian leader of women who use drugs is convinced women have to stand up and fight for their rights

The following speech was delivered by Debbie McMillan of Transgender Health Empowerment as a plenary address at AIDS 2012 on Thursday, July 26. Posted with permission. 

Good morning and thank you all for being here. Before I give my presentation, I’d like to invite you to watch messages from my peers around the world.

Welcome to the United States. We’ve missed you for the last 22 years.

I want to especially thank the IAS for giving me this opportunity to speak to all of you. It’s a privilege.

Who am I? Like most people, the sum of who I am is much more than my individual traits. However, there are facts that categorize me as “high risk” in the HIV world.

I’m African American.

I’m a transgender woman.

I used to be a drug user.

I used to be a sex worker.

I used to be incarcerated.

For 20 years I lived a life that virtually guaranteed I would contract HIV.

But that shouldn’t mean that I was then, or am now, irrelevant.

That would gravely underestimate me and miss an important opportunity to address HIV.

I’m here today because I represent people at the heart of the AIDS crisis – a small group with a big HIV problem.

If this is true, then it should be equally true that the solution lies with people like me. When people like me are included in the design of policy and programming, these programs are much more successful. They are much less so when we are not consulted.

While everyone in the high risk populations that I represent are individuals with their own unique set of circumstances, the broad outlines of my story are not uncommon.

I went to the street alone at 14. It seemed the only place for someone like me.

I became a commercial sex worker because I believed it was the only occupation available to me.

I got high to dull the reality of what I had to do to survive that life.

My addiction to drugs took me to places that I never want to go back to.

Crack smokers – my drug of choice when I was using – are three times more likely to be infected with HIV than non-smokers.

For many years injection drug use directly and indirectly accounted for more than one-third of AIDS cases in the United States.

Clean syringes are an essential component in the prevention of HIV among people who inject drugs. Research consistently demonstrates the effectiveness of syringe exchange in preventing transmission.

But syringe exchange programs are prohibited from receiving federal funds in the United States. In fact, Congress just last year re-established that funding ban.

Chris Collins, of the Foundation for AIDS Research, calls the decision anti-science and anti-public health.

But I don’t need research to know this is true. I’ve seen it myself – both on the street and later when I worked with HIPS, an organization that provides clean syringes and other services to sex workers.

Drug use and sex work go together like power and money. You can have one without the other but it doesn’t happen often and it didn’t with me.

It’s hard to get good data on the rate of HIV among sex workers in this country. But I can tell you that out there infection is considered inevitable.

Having HIV drives sex workers further into the shadows, further into depression and despair, and leads to more drugs.

And in this country, the drug use and sex work are themselves crimes.

No matter how risky your life on the outside, being in prison is worse. After one of many arrests for solicitation, I was sent to a men’s prison – and housed in the wing with the murders and rapists. I’m sure you can guess what happened. Nothing is gained by describing the details.

I could have gotten HIV anywhere, but I’m convinced I got it in prison.

Americans are sent to prison in this country every day just for using drugs. In fact, the United States incarcerates more of its citizens for drug use than any other country on the planet. This ensures that we get multiple public health problems instead of just one.

Instead of helping users identify and decrease risky behaviors, the American legal system punishes them in a way that significantly increases the chances of HIV infection.

If you really look hard at drug addiction, you’ll see that it’s just a symptom. For me, it was a product of the stigma I experienced for most of my life as a transgender woman, a chick with a dick.

And that’s for those of you who don’t understand what a transgender woman is.

Data isn’t uniformly collected for the transgender population so we don’t know how many of us in the US are infected with HIV. What data there is indicates high rates.

My mother was an IV drug user and a sex worker. She left me with my grandmother.

For some my mother represents everything that’s wrong with America; someone who could have risen above her circumstances if she’d stayed in school, but who chose a life of drugs and prostitution instead.

For others she represents the failure of society to take care of the most vulnerable among us.

To me, my mother was the only person who ever completely accepted me just as I am.

Unlike my mother, my father disowned me when it became clear that my sexual identity was not what he thought it should be. On the street I looked for acceptance, family, a man who would give me what my father never did.

At some point, my mother was infected with HIV. While she was still alive and living with my grandmother, she had one cup…one fork…one spoon…one plate. When she used the bathroom, my grandmother followed behind her, bleaching everything she touched.

During one of my incarcerations for solicitation, my mother died of complications of AIDS. I had to view my mother’s body alone…in shackles and handcuffs.

Two months later, I was diagnosed with HIV. I was 20 years old and convinced I was going to die.

So there I was; a stigma on top of a stigma. As a rule, medical personnel don’t excel in bed side manner when it comes to transgender people.

It’s hard enough to face HIV. You want a doctor who understands that your entire life changes the instant you get that diagnosis. Not someone who doesn’t bother to look in your eyes and see the very basics of who you are.

On the street I lived my life as Debbie. I had a different name once but that name has nothing to do with who I am today. To have a doctor consistently call me by my birth name feels like a punch in the stomach. It feels like one cup…one fork…one spoon…one plate.

When you’re using drugs there are high moments and low moments. In the high moments, you just want to keep getting high. In the low moments you think about the things that drove you to use drugs and your self-esteem plummets.

I broke free in a low moment when I thought I could actually envision living my life as a woman. That single wish to actually BE Debbie is what made me persevere.

I got into the Bridge Back recovery program, which was specifically for HIV positive LGBT people. The key to its success was that they accepted me one hundred percent.

Any inkling of a barrier, any whiff of attitude would have given me the excuse I needed – actually the excuse I was looking for – to leave and go back to the street.

For me to kick drugs, I needed to focus on that single goal – without the distraction of being HIV positive, without being a sex worker or a transgender woman. When I had that space, I stopped using. Then I got off the street.

I came to the organization Transgender Health Empowerment, the only agency in Washington DC that provides services specifically for transgender people. Through them I found supportive housing.

I got a cosmetology license but my heart was with the family I found on the street. So I got a job with HIPS. And then three years later I started working at Transgender Health Empowerment as a specialist in Comprehensive Risk Counseling. Our primary goal is to help drug users, sex workers, and transgender people get connected to the social services they need to prevent or live with HIV.

Now I’m Debbie in every sense. But the Bridge Back program is gone. It died for lack of funding.

The lesson I want to impart today is that if you include people like me in your program design, you get solutions like Bridge Back, solutions that work. No matter how well meaning, a program that didn’t truly understand where my head was when I walked in the door was never going to be successful. We need MORE programs like Bridge Back. Not less.

If you include people like me in your advocacy efforts you get powerful proponents for syringe exchange funding and changes to drug laws.

This conference is the perfect venue to discuss what does and doesn’t work and why. I don’t want to be on the outside looking in

I want to collaborate with all of you, AND my peers who are in Kolkata and those who were in Kiev because they can’t be here.

As you know, the United States, while generous with HIV funding around the world, has policies that make it extraordinarily difficult for current or former sex workers or drug users to enter the country.

If you honestly respond to the questions on the application for a U.S. visa, someone who has engaged in either of these activities during the last 10 years will be denied entry. You can apply for a waiver – at a cost of more than $500 – but when you arrive our system says that you have confessed to crimes of moral turpitude.

You can be denied entry anyway. You passport is then branded with this confession.

I, like the IAS, applaud President Obama for lifting the ban that prevented people living with HIV from entering the U.S. – and I’ll tell him that if I get to meet him. However, it would be far more productive for our government to eliminate policies that are moral judgments and have nothing to do with good public health.

The U.S. entry ban sends the message that people who have a history of drug use or sex work are not actually included in this dialogue. This is a serious setback in the fight against AIDS.

It would be better for this conference to be located where the most affected groups could participate.

In fact, peer driven programs often prove the most successful in combating the epidemic in both the sex work and drug user groups. Over and over, my peers and I have proven our value. Don’t underestimate our knowledge and our potential for contribution.

Include us!

Let us help!

If we are truly Turning the Tide Together, then transgender people, sex workers, and drug users – people like me – should be part of the solution.

©IAS/Steve Forrest/Workers’ Photos.

I am thrilled to have been appointed, last Friday, as the United Nations Secretary-General’s Special Envoy for HIV/AIDS in Eastern Europe and Central Asia.

Eastern Europe is the region of the world that has witnessed the largest increase in HIV prevalence in the last ten years and where the epidemic continues to expand. While the overall HIV incidence has decreased globally, seven countries of the world have seen the number of new infections increase by more than 25 percent in the last ten years. Five of these countries are in the region.

The number of people in the region living with HIV now reaches 1.5 million. In 2011 alone, 170 000 people were newly infected with HIV, and there is no sign that the epidemic is slowing down. HIV prevalence is estimated to be one percent or higher in the Russian Federation and in Ukraine which, together, account for almost 90 percent of the newly reported cases in the region. The epidemic is concentrated mainly among people who inject drugs and their sexual partners, as well as among sex workers and, to a lesser extent, men having sex with men.

It has been estimated that one quarter of the 3.7 million people who inject drugs in the region are living with HIV. High HIV prevalence has also been found in prison populations, particularly among prisoners who inject drugs. Aggressive drug law enforcement and lack of adequate access to harm reduction programs in most countries of the region drive people who use drugs away from public health services and into environments where there is a much higher risk of contracting HIV, as well as tuberculosis and viral hepatitis.

Access to HIV treatment in the region remains very low, with only 23 percent of those estimated to be in urgent need of antiretroviral treatment accessing it, compared to 55 percent in the African region. This is even more troubling now that it has been shown that HIV treatment is also a powerful public health tool to suppress transmission of HIV.

The above factors, plus a number of specific political, societal, cultural and policy-related challenges, pose formidable obstacles to the fight against the epidemic in the region. I sincerely hope I will be able to make a difference and am committed to encouraging countries in the region to turn the tide of the epidemic and save millions of lives. An urgent mobilization is needed to respond to the epidemic in Eastern Europe and Central Asia, including much greater attention to, and involvement of marginalized and criminalized populations, particularly people who use drugs, sex workers, and gay men and other men who have sex with men.

I vividly remember the fantastic march and rally for human rights at the last International AIDS Conference in Vienna two years ago. At the press conference that preceded the event, I said that we all needed to use the conference, and the march and rally, to re-invigorate the AIDS movement as a human rights movement. This is as true today as it was two years ago.

Why are human rights so central to the AIDS response, in Eastern Europe and Central Asia, as everywhere else? For all the 10 reasons that are so well articulated in the “Human Rights and HIV/AIDS: Now More Than Ever” declaration, that remains as important today as it was when it was first released six years ago. But also because new approaches, such as treatment as prevention, simply will not work without much greater attention to human rights. We will only be able to get people into treatment early, and retain them in treatment, if we finally move from rhetoric to real action on HIV and human rights.

Many good news stories are emerging at AIDS 2012 in Washington this week, about the scale up of access to antiretroviral treatment, the decreasing AIDS-related mortality and the decrease in the overall incidence of new HIV infections. I am happy about the progress that has been achieved, demonstrating the feasibility and effectiveness of large scale prevention and treatment programs in poor settings, something that, even five years ago, many experts did not believe could happen. But I remain troubled about the lack of attention to human rights issues and the large inequities we are seeing in access to prevention and treatment. Discrimination against, and marginalization of, people vulnerable to HIV remain formidable obstacles to the control of the epidemic. Inappropriate laws and policies continue to fuel the epidemic. People who use drugs, sex workers, gay men and other men who have sex with men, and other stigmatized populations have a right to the same support, including social and medical support, as everybody else, but too often suffer exclusion, police harassment, arrest, violence and prison. I strongly believe that efforts to fight the epidemic among vulnerable populations will continue to fail unless human rights are truly brought to the forefront of everything we do. We must pursue efforts to reduce HIV incidence among these populations with the same energy and determination that efforts directed at reducing mother-to-child transmission of HIV are currently benefiting from. Everyone has a right to prevention, and to support and treatment, if needed. In this context, I deplore the fact that so many sex workers and people who use drugs are not able to attend the conference. We all can and must listen and learn from them – not prevent them from participating in our debates!

As Special Envoy, I will continue to speak out loudly and clearly about the need to devote much greater attention to human rights. And I pledge to listen to the voices of those who too often are excluded.

Michel Kazatchkine is an internationally recognized physician who has devoted thirty years of his professional life to the AIDS response. From 2007 to 2012 he served as the Executive Director of the Global Fund to fight AIDS, Tuberculosis and Malaria and from 1998 to 2005 he was Director of the French National Agency for AIDS Research. Between 2005 and 2007 he served as France’s Global Ambassador for HIV and Communicable Diseases.