President Bush recently signed a $15 billion aid package geared toward the prevention and treatment of the HIV/AIDS epidemic that is ravaging countries through out Africa and the Caribbean. While financial help is desperately needed, some sections of the legislation are controversial at best, and negligent at worst. Fully one-third of the funds must go toward promoting abstinence and groups that seek to work with prostitutes will basically be denied any funds. Furthermore, in a frightening nod toward dismantling church and state separation, religious groups are allowed to reject any specific disease-fighting protocol they find objectionable.
Such stipulations do not make for a very culturally sensitive program. In a number of African societies many women have no choice but to sell their bodies in order not to starve. In fact, widespread commercial sex work is part and parcel of the HIV/AIDS epidemic, so to deny funds to this sector defeats the whole purpose of the measure. The epidemic is also fueled by women’s lack of power in sexual relations. Public health specialists view abstinence counseling as generally ineffective, so why is it mandatory part of the aid package? The travesty of this legitimized prejudice is that sick and at-risk people will be denied access to desperately needed care, in order that someone’s idea of sexual morality may be imposed. A public health program such as this would thankfully never see the light of day within our borders, at least not today. Tomorrow might be another story.
As a nurse, I find it appalling that persons who are likely to have already contracted the virus or remain at high risk to do so (female sex workers), are going to be denied access to care simply because they eke out a living in a manner that some find distasteful. I cannot tolerate such discrimination. Nursing practice involves caring for the whole person and upholding a standard of cultural competence and nondiscrimination. We cannot and do not deny care based on factors such as occupation or sexual behavior, so how can this be allowed outside our borders? Legally hamstringing access to care in terms of Western Puritanical and (some might argue antiquated) ideas about proper sexual behavior is a form of legitimized negligence. I really feel badly for health care personnel in organizations like Doctors Without Borders, the World Health Organization or Red Cross— anyone whose hands are going to be directly tied as a result of these restrictions. As for me here on the sidelines, I can only wince in anguish and outrage.