This past June, the U.S. Supreme Court handed down a decision that had incredible implications for public health policy and sex workers rights. I wrote about the ruling at the time that it happened, noting that in siding with the plaintiff in Alliance for Open Society International (OSI) vs. United States Agency for International Development (USAID), the justices affirmed that forcing AIDS NGOs to take an anti-prostitution oath to receive federal funding was a violation of the right to freedom of speech and association.

I mentioned in passing that this constitutional right only applies U.S. citizens and, therefore, only to U.S.-based organizations. Foreign-based AIDS NGOs would still have to take the “Anti-Prostitution Loyalty Oath” in order to receive U.S. government aid. I assumed, however, that American organizations operating overseas would instantly change their policies and increase their outreach to sex workers, fostering change in other countries, too.

I eagerly researched the issue and found…close to nothing. If the changes were happening, they weren’t being reported yet. In digging through sex work organizing sites, however, I found something else: the extent to which the important work was already being done, without America’s help. I cross-referenced the official list of countries receiving America's conditional financial aid with the members list of the Global Network of Sex Work Projects and discovered the extensive work that foreign sex workers were doing by and for themselves. The advocacy and outreach of these women-fronted organizations deserves at least as much attention in U.S. sex work spaces as the work that our own organizations are doing, especially given the neo-imperialism frequently perpetrated by American NGOs.

I selected three organizations from other continents to highlight here. The choices were largely random but were based in part on the amount of English-language information available on each and the extent to which the prevention and treatment of HIV/AIDS featured in their work. These few organizations are but a small sample of the vital, life-saving worker organizing taking place right now, and it's to all our benefit to familiarize ourselves with their efforts.

Guyana is a small country in the northeast corner of South America, the only nation on the continent with English as an official language. It’s considered part of the Anglophone Caribbean due to its colonial history and is populated mostly by people of Indian, African, and indigenous descent. In 2008, the newspaper of the capital city of Georgetown, Stabroek News, published an article discussing the formation of the country’s first sex worker organization. Reporter Oluatoyin Alleyne describes the initial meeting of what would come to be known as the Guyana Sex Work Coalition as a gathering “organised by the Caribbean Vulnerable Communities Coalition (CVC) and Guyana RainBow Foundation,” featuring “a group of twenty sex workers and MSM [men who have sex with men].” Though there is obvious overlap between the gay/ queer male community and sex work community, the groups share more than certain members in common. In Guyana, both sex workers and MSM are criminalized and face harassment, abuse, and, therefore, more difficulty in accessing STI treatment and prevention resources.

The organization was formed as a response to these life-threatening issues. It's led by Executive Director Miriam Edwards and President Cracey Fernandes, who the Guyana Times describes as being “U.S.-trained in combating trafficking in persons.” Echoing many spokespeople of the groups who receive United Nations funding, Fernandes notes in the interview that, "We are not here to promote sex workers but to support sex workers." Fernandes went on to mention the work the organization is currently doing in educating police officers to address the grievances of sex workers, as well as partnering with healthcare providers. The Coalition offers testing and counseling as part of what Edwards notes is an effort to equalize "access to prevention, care and treatment services."

The work is done with the help of the United Nations Population Fund, the International Labour Organisation, private European donors, and the Guyanese government itself. Explaining the government's work with the criminalized population, the Guyana Times says that, “Due to the growing trend [of HIV cases in a certain district], the Health Ministry has put Region Four on its priority list, along with the female commercial sex worker population and the men who have sex with men population.” This intervention is key to Guyana meeting the level of HIV reduction outlined in United Nations Millennium Development Goals, according to UNAIDS country director Dr. Roberto Brant Campos. The American government's response, however, is still to withhold funding.  As an op-ed in the paper explains, there is "ambiguity [in the matter of supporting versus condemning sex trade workers] that we believe has gotten the government on the Americans’ bad books. That ambiguity lies in the area of consent. Meaning that where do you draw the line between those adult females that consciously chose to work in the sex trade (sex workers) and those taken from their homes and forced into it?"

The Coalition continues to work diligently for the rights of everyone in the sex industry. Its members met recently as part of the larger Caribbean Sex Worker Coalition, to restate their goals and demand "health ministries [...] partner with and train health-care workers to effectively provide services for sex workers, including unconventional health services, such as mobile clinics" and to make sure "that sex workers are not subjected to compulsory HIV testing by employers."

Irina Mishina, the Executive Director of sex worker rights group Legalife, is honest about her difficult experience in the sex trade. The Eastern European native talked to Olga Zelinska at the Pineapples and Caviar blog , explaining how she got involved in the post-Soviet nineties after entering an unhealthy relationship. “I fell in love for the first time. I worked on the night-shift of a bakery, baked bread. As a seamstress. And my boyfriend turned out to be an alcoholic,” she says. Even with multiple jobs, Mishina didn’t make enough money to support herself and her boyfriend, and so they became homeless. It was during this time that she started sex work to help them get by. She says that she was not involved in sex workers rights at the time but happened into it years later when a friend from childhood explained that he was doing HIV prevention work.

She eagerly joined him but found that this not-for-profit work paid poverty-level wages. Eventually, it opened the door to a better job for her with the All-Ukranian Harm Reduction Association in Kiev, the organization from which LegaLife was born. Mishina describes how this current work is influenced by her past experiences as a sex worker: “We work on a peer-to-peer basis. If I didn’t have personal experience of sex work, I don’t know…I just understand better what a girl is going through when she has those kinds of serious problems [...I]n any community, the advice of an equal is more effective.” Legalife, like Mishina herself, does not advocate for abolition, but “the prevention of social harms. Our work aims to give people the right to choose,” and to choose to work safely.

On their charity profile on the site What in the World Are You Doing?, LegaLife lists the ways in which its organization improves worker safety. The very first point on their list is engaging in HIV and STI prevention through the provision of educational materials and training workshops. Legalife has expanded nationwide by organizing with other HIV prevention and harm-reduction groups, making the fight against AIDS a central part of its agenda. It’s been so successful that LegaLife was appointed last year to Community Council, “an advisory body representing the interests and needs of groups at risk for HIV infection at national and international levels.”

SANGRAM defines itself first and foremost as "a practical training ground for other NGO’s and GO’s interested in working on HIV/AIDS in a rural context." Most of the HIV/AIDS prevention work that it does, however, is with those involved with or connected to the sex trade in India's southwest states. The peer-to-peer outreach to sex workers themselves is done largely by the interconnected organization VAMP, which is described as "separately registered and [with] its own board of members drawn from women in prostitution." Their strategies are documented in detail on their website and are the true definition of 'grassroots'. Peer educators each "[work] with 40 women in prostitution and sex work. Each peer charts her own condom distribution strategy."

Their work isn't limited to health initiatives, however. VAMP engages the sex worker community through comprehensive means, and the breadth of the work outlined in their informative PDF is impressive. They situate their work in the long history of sex work in India (especially in relation to British colonialism), acknowledge the local culture of sex work and sex workers, and connect their movement to local issues of work/ life balance for poor mothers and public health. Most striking is their strong defiance of United States policy.  In an article succinctly titled, "What India's Sex Workers Want: Power, Not Rescue,"journalist Michelle Chen describes how the group has "proudly defied PEPFAR, though the U.S. remains a major funder of HIV/AIDS programming in India." SANGRAM declined a $20,000 grant to ensure that the U.S. State Department wouldn't try to interfere with its sex worker outreach.

Meena Seshu, the founder and general secretary of the organization, is openly critical of the U.S. policy in Chen's article, pointing out how it not only undermines worldwide efforts to battle HIV/ AIDS but also sidelines efforts to improve sex workers' lives and working conditions. Seshu makes a critical point: that the injustice isn't just related global health but to the safety of sex workers in particular. It's a point that not even the defendants in the original Supreme Court case bothered to make; instead, as advocate Kate Zen discusses here, they took an explicitly anti-sex work stance. Chen points out, however, it is this very fight against HIV/AIDS that might finally force recognition of the importance of sex worker rights.

Even the World Health Organization has admitted recently that sex worker involvement is key in HIV initiatives. It's time that workers everywhere weren't just doin' it for themselves, all by themselves. It's time that the U.S. government and feminist NGOs stepped up to aid in this growing global movement for sex worker health and safety, too.