By  M. Dante – Sex Workers Outreach Project-Philadelphia | Derek Demeri & Janet Duran – New Jersey Red Umbrella Alliance | Cris Sardinia – Desiree Alliance | Katherine Koster – Sex Workers Outreach Project | Penelope Saunders – Best Practices Policy Project


Printable Version (.pdf)


Through November 19, 2015

[5PM EST], PEPFAR is soliciting civil society feedback on its Draft 2016 Country/Regional Operational Plan Guidance. 

Feedback can be submitted through a simple, easy-to-use form linked below. 

WHAT IS PEPFAR? PEPFAR is the United States President’s Emergency Plan for AIDS Relief. PEPFAR is the vehicle for U.S. funding for global HIV prevention, treatment and care, and disburses ~5-6 Billion USD in funding globally annually.

iac20122In 2003, PEPFAR added an “Anti-prostitution Loyalty Oath” to grantee contracts.  The devastating effects of the anti-prostitution oath annihilated agencies that depended on the funding to sustain their operations, and more importantly, excluded and harmed vulnerable populations that were considered at highest risk for HIV.

In 2013, Open Society Foundation succeeded in challenging the oath under free speech grounds. Although the argument was successful for agencies headquartered in the U.S., the restrictions still apply for global NGOs.  

As the oath continues to harm the global fight against HIV and AIDS, US sex worker rights organizations collectively and vehemently oppose the current restrictions that PEPFAR continues to:

1.) Make acceptance of PEPFAR funding contingent on opposition to prostitution for all non-US organizations, excluding the Global Fund to Fight AIDS, Tuberculosis and Malaria; the World Health Organization; the International AIDS Vaccine Initiative; and any United Nations agency. ( “by accepting this award or any subaward, a nongovernmental organization or public international organization awardee/subawardee agrees that it is opposed to the practices of prostitution and sex trafficking.”) See Pg. 243-244 of the 2016 Draft.

2.) Require exempt organizations to insert anti-prostitution language into sub-awards or subcontracts with local/national CBOs.

3.) Require that no funding be “used to promote or advocate the legalization or practice of prostitution or sex trafficking.”


 We encourage allied organizations, researchers, funders and advocates to submit feedback regarding the anti-Prostitution language (and any other key concerns for their organizations).

 Providing feedback should take no more than 10 minutes. Guidance for providing feedback and talking points are included below.


 M. Dante – Sex Workers Outreach Project-Philadelphia Derek Demeri & Janet Duran – New Jersey Red Umbrella Alliance | Cris Sardinia – Desiree Alliance | Katherine Koster – Sex Workers Outreach Project | Penelope Saunders – Best Practices Policy Project



PEPFAR Feedback Guidance


Providing feedback should take no more than ten minutes.

Go to this link:  

Click “Submit Feedback.”

Select the “Appendices” option for the “Section to which Comments Pertain” field.


If you are not in (or your organization does not operate in) a PEPFAR-funded country:

  • Name and describe your organization (or identity as a stakeholder/expert)
  • Use talking points included below for support or use your own.


If you are in/your organization operates in a PEPFAR-funded region or receives PEPFAR funding:

  • Name and describe your organization (or identity as a stakeholder/expert)
  • Ask for the removal of the” PROHIBITION ON THE PROMOTION OR ADVOCACY OF THE LEGALIZATION OR PRACTICE OF PROSTITUTION” section as well as any other concerns.*
  • Explain how the requirement to oppose prostitution affects your organization and the communities you serve or use the talking points below.


*As an example, here is Sex Workers Outreach Project’s feedback on other sections of the PEPFAR 2016 COP/ROP Guidance draft: 


Continue to engage with PEPFAR in the future by:

    • Writing to the US PEPFAR Ambassador:
Ambassador Deborah Birx
Office of the U.S. Global AIDS Coordinator and Health Diplomacy
U.S. Department of State
SA-22, Room 10300
Washington, DC 20522-2210
    • Staying in contact with your PEPFAR country team via email, phone, or ideally in-person meetings to communicate key populations programming and data concerns even after the Country Operating Plan is submitted.
    • Participating in PEPFAR quarterly review civil society consultations, set to take place every three months starting in October 2015, and insist that the PEPFAR country team provide key populations data a minimum of 2 weeks in advance of the meeting


Just Sign on The Dotted Line- The Anti-Prostitution Loyalty Oath – Carol LeighVimeo.


Talking points for PEPFAR Feedback


-Leading women’s, GLBT, anti-trafficking, HIV prevention, and development organizations are supportive of decriminalization including UNAIDS, the World Health Organization, the International Women’s Health Coalition, the Association for Women in Development, the Global Alliance Against Traffic in Women, the Global Fund for Women, the Elton John Foundation, and the International Community of Women Living with HIV. (see for an expanded list). We urge the US to remove anti-prostitution language and support strategies now accepted as best practice in anti-trafficking, women’s development, gender equality, and HIV prevention work. 

The requirement to oppose prostitution and the ban on funding for advocacy to reduce the criminalization of sex workers is at odds with PEPFAR’s mission of reducing HIV/AIDS. Decriminalization of sex work has been shown as the most effective method for averting new infections in sex workers and clients (modeled 33-46% reduction), more effective than anti-retroviral scale-up, safer work environments, or elimination of sexual violence. (Lancet, 2014)

Pledge undermines PEPFAR’s own prevention goals and strategies vis-a-vis sex workers detailed in the Guidance: The anti-prostitution requirement undermines not only overall prevention goals but also prevention strategies specific to sex workers (who have been recognized as a key population) detailed throughout the plan. (see p. 33, 44, 102, 105, 173, 232 for details of PEPFAR strategies relevant to sex workers).

Sexworkerprotest300x200The anti-prostitution requirement and ban on funding for sex worker advocacy directly contradict PEPFAR’s understanding of how stigma, discrimination, and laws and policies undermine HIV responses among key populations. In particular: “Stigma and discrimination as well as harmful laws and policies reduce access to and use of essential health services and undermine efforts towards effective responses to HIV/AIDS. PEPFAR is committed to joining others to end stigma and discrimination against people living with HIV/AIDS, vulnerable and key populations and to increasing their access to, and uptake of, HIV prevention, treatment, and care services.” (p. 33) and the HVOP goal of “[e]ngagement with the government and civil society organizations to reduce criminalization of key populations” (p. 173)

-Ban on direct or indirect funding (through sub contracts) to community-based organizations that do not oppose prostitution undermines access to and meaningful inclusion of sex worker populations: local, community-based organizations that provide services to sex workers through peer-led, harm reduction, or empowerment frameworks are categorically excluded from PEPFAR funding. These organizations often already have access to and trust of hard-to-reach sex worker populations. These organizations are well-equipped to support data collection/population surveillance, STI testing, community education around prevention, linkage to care, and linkage to job training and other resources to support exit from the sex trade. The implicit ban on partnerships with these community-based organizations (through sub contracts) is extremely detrimental to PEPFAR’s objectives regarding sex workers.

The anti-prostitution requirement undermines PEPFAR’s goals for sustainable HIV prevention funding and the integration of PEPFAR funding into existing health care delivery systems. It does so by banning grants to existing national and local healthcare delivery programs engaged in harm reduction programming with sex workers; our concern is that this programming will be carried out by large international development organizations that are exempt from the anti-prostitution pledge and thus threaten national and local NGO ecosystems, increasing reliance on international funding and programming.

-Discriminatory Exemptions from Anti-Prostitution Pledge: The policy exempts the Global Fund to Fights AIDS, Tuberculosis & Malaria, World Health Organization and any United Nations agency, so it is condescending and offensive to suggest grassroots organizations, who are at the forefront of the fight against HIV/AIDS, cannot come to similar conclusions.

– Brazil refused to sign the pledge in 2005, resulting in rejection of $40 million in HIV funding.

-Inaccurate Portrait of Prostitution and Determinants of Sex Trafficking: The U.S. government’s policy is based on the assumption that “[prostitution is] inherently harmful and dehumanizing, and contribute to the phenomenon of trafficking in persons.” This contradicts the advocacy of leading global, European, and U.S. anti-trafficking networks, including the Global Alliance Against Traffic in Women, La Strada International, and the Freedom Network-USA as well as the experiences of organizations working with people in the sex trade.

Sex Workers are Key Population Globally: Sex workers are internationally recognized as a group that must be worked with in order to achieve the goal of zero transmissions which is impossible to do if particular policies alienate this very community. PEPFAR recognizes this and it is difficult to understand the continued contingency of funding receipt to anti-prostitution beliefs.

Pledge violates Human Right to Bodily Autonomy: Almost every international human rights convention that the United States has agreed to recognizes the Right to Bodily Autonomy, including the ICCPR; the anti-prostitution pledge is a direct violation of this internationally recognized human right.

– Impedes HIV Response in Nations Disproportionately Impacted by HIV/AIDS: According to the UNAIDS 2016-2021 Strategy Plan, in East and South Africa, MSM, Female Sex Workers, IDU and transgender people contribute to 12-30% of all new HIV infections in PEPFAR-funded countries, including Kenya, South Africa, Mozambique, and Swaziland, yet these populations remain “remain under-served, under-involved and underrepresented in the response” to HIV.

– Impedes HIV Response vis-a-vis Sex Workers in Regions Reliant on PEPFAR Funding: In West and Central Africa, reliance on “international funding (Global Fund and PEPFAR) is at 70%.” While HIV prevalence among FSW is exponentially higher than the general population, targetted interventions as well as extremely limited HIV surveillance among sex workers in the region is inhibiting the regional response to HIV, and it is imperative for PEPFAR as a major contributor to the HIV response in this region to support evidence-based programming for reducing HIV prevalence in sex worker populations.

– Inserts a problematic United States Definition of trafficking into an HIV Prevention Guidance: PEPFAR definitions (see pg. 244) “for purposes of this provision:  Commercial sex act means any sex act on account of which anything of value is given to or received by any person. Sex trafficking means the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act.” This definition is not in line with international standards and agreements on what constitutes trafficking because it fails to include elements of “force, coercion and fraud.”

Center for Health & Gender Equality’s  Anti-Prostitution Pledge Fact-Sheet on the Anti-Prostitution Pledge