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The movie How to Survive a Plague recently won the award for Best Documentary from the IFP Gotham Independent Film Awards and is nominated for an Oscar. You can see it at Maysles Cinema in Harlem this weekend.

The movie tells the story of the activism by ACT UP in the 1980s and 1990s to get research developing treatments for HIV on the federal agenda. How to Survive a Plague reminds the viewer that even as the President referred to Stonewall in his inauguration speech last week, it was once acceptable for religious leader Pat Buchanan to use the threat of the virus to tell gay people to be celibate. The people most affected by the virus, including gay people, were extremely marginalized in the early years of the epidemic.


One of the people featured in the movie is Garance Franke-Ruta, now Senior Editor with The Atlantic, who was a teen activist with ACT UP. Franke-Ruta attended a few meetings with Prostitutes of New York (PONY) as part of the Women's Committee of ACT UP. Terry McGovern, founder of the HIV Law Project and a member of ACT UP during the years described in How to Survive a Plague, who is now at Columbia University's Mailman School of Public Health, recalled that, "All of the women's stuff early on included sex workers. People from PONY were doing part of the organizing around the expansion of the CDC definition of AIDS to include symptoms experienced by women, and they were part of everything that went on around women's issues."


Members of PONY and ACT UP overlapped, but the enthusiasm and insistence of ACT UP's emissaries was viewed with skepticism by some of the sex workers of PONY. Tracy Quan, author and PONY member, contrasted two aspects of collaboration. In addition to ACT UP's Women's Committee, PONY participated with Gran Fury, ACT UP's unofficial propaganda arm, in an art show aimed at shaping the image of people living with HIV, mounted at the New Museum of Contemporary Art. Quan said, "We had a more collaborative relationship in my experience with Gran Fury. The ACT UP Women's Committee, I didn't feel it that way. I felt it was more like feminists wanting to shape the PONY agenda," essentially seeing these meetings with the Women's Committee as an attempt to make PONY the sex worker wing of ACT UP.


Sex worker rights is a hard cause to find support for among women's organizations now. Quan is sanguine about this, saying, feminists "recognize that we can't really be controlled by feminism. It upsets some people who are looking for alliances with women's organizations, but it's a healthy sign. We needed them to get started but we have moved into a human rights area away from strictly seeing sex work as women's rights." Some feminists have attacked sex workers. Sienna Baskin, co-director of the Sex Workers Project at the Urban Justice Center, said, "While some feminists include sex workers in their vision for gender equity, other feminist institutions shy away from or directly oppose sex workers' struggle for rights. Some feminist scholars even disparage the sex workers rights movement, claiming that its leaders are victims of a 'false consciousness' or are trying to harm women."


Melissa Gira Grant, a journalist and former sex worker, describes the achievements sex workers have made in HIV prevention, saying, "We turned the tide, along with sex workers around the world, from being seen as 'vectors of disease,' to experts with valuable solutions." However, she agrees with Baskin and points out the ways that some well-known feminists use their influence to attack HIV programs lead by sex workers. "But now I see that balance slipping back, as some organizations and their leadership attempt to link sex workers to what they want to call 'sex trafficking.' In these campaigns that make no distinction between forced labor or migration and prostitution, they also attack sex workers' public health and community organizing projects, like the work done by peer health educators in brothels in India, which Gloria Steinem, on a recent trip to a red light district there, accused of being 'pimps' and 'traffickers.' Why are anti-trafficking advocates disrupting sex workers' health projects? Why are they comparing a condom one sex worker gives another to 'giving a mouth guard to a battered woman,' as one anti-trafficking organization in Washington, DC told a sex worker at a HIV prevention program?"


Feminists are not the only people one could expect to support sex worker organizing but who do not. Today, gay men and HIV organizations have achieved a level of mainstream respect that might never have been accomplished without ACT UP. Sex workers have turned to HIV organizations and gay organizations seeking support, meeting space, and shared agendas. However, members of the Sex Worker Outreach Project in New York described a distinct lack of support from gay organizations and from feminists. Sarah Jenny Bleviss said, "Mainstream gay rights and women's groups have made little effort in my decade of sex worker organizing to reach out and bridge connections. The solidarity is not there and I think it is in part because we are still dealing with some of the most stigmatized among the marginalized. We've had better luck connecting with the labor movement."


Today, gay people are in most places less stigmatized and less criminalized than sex workers, more respected in the mainstream. Quan points out that, "This collaborative and friendly relationship with Gran Fury was before men were getting married and pushing strollers. Gay men were engaging in recreational party sex and sex workers were providing recreational sex, outside procreation. But there is this whole wing of gay culture now that is very family-values oriented." Some sex worker activists speculate that gay organizations may not want to be tainted with the lack of respectability of sex workers. Will Rockwell, a male sex worker and member of SWOP-NYC, points out that the gay mainstream tends to "sanitize" those it champions as victims, comparing the lack of attention to gay hustlers killed while working to the greater attention paid to victims of anti-gay bullying. He wrote a piece in New York's Gay City News pleading with the gay mainstream to consider how its "politics of respectability" had systematically excluded many of the most vulnerable members of the LGBT community, obscuring a legacy that included LGBT sex workers at its roots. Rockwell has noted that the "Compton's Cafeteria Riot and Stonewall consisted of hustlers and sex-trading transgender women of color throwing bottles." Sex workers face high levels of HIV and violence but remain underserved by HIV programs and anti-violence efforts. Support from feminist and gay organizations could make an enormous difference in these struggles.

From the Margins to the HIV Establishment

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Watching How to Survive a Plague, I was struck by the footage from the Sixth International Conference on AIDS, which shows some of the same people at the conference as working today in HIV treatment, policy, research and programming, both among the government research wonks and the activists, some of whom have become wonks. This footage also includes sex workers, who have been part of the gay rights movement and AIDS activism from the beginning. Members of the AIDS Coalition to Unleash Power (ACT UP) and Prostitutes of New York (PONY) overlapped and held different roles in the different organizations. This aspect of HIV activism is sometimes neglected, sometimes to save the positions now held by former sex workers, out of not knowing everyone's whole lives, and sometimes perhaps out of stigma an discrimination.

Sex workers have supported activism in response to HIV out of need, and as part of ACT UP and other organizations. Sex workers and gay rights activists were already mingling and moonlighting together prior to the advent of HIV. The Stonewall riot included many people who sold sex among the cross-dressers and others at the Stonewall Inn. A few years earlier, many transgender sex workers were part of the riot at Compton's Café in San Francisco. These were seminal events of the gay rights movement.

Seeing the movie is to be transported to another time, an era in which HIV patients were rejected by health care providers, hospitals and funeral parlors. A world in which Senator Jesse Helms condemned gay people for "sodomy" and wanted gay and lesbian people to "keep their mouths shut." A world in which it was acceptable for Pat Buchanan to use the threat of the virus to tell people to be celibate and when George Herbert Walker Bush told people to change their behavior, essentially parroting Buchanan in telling gay people to stop having sex. Since the late 1980s and early 1990s when this footage was taken, this has changed and gay people are more visible and hold positions of respect and power in our society. The AIDS pandemic galvanized a movement because this was a matter of life and death. Now that there is successful treatment, it is easy to forget that much of a generation of gay men were killed by the virus between 1981 and 1996, affecting the lives of everyone who loved them. The fact that the hateful statements of Bush and Helms are unthinkable in US politics today is in great part due to the work of ACT UP and other activists, including sex workers who have been part of AIDS activism all along.

How to Survive inspired me and depressed me. Seeing what a group of motivated people accomplished fairly quickly is encouraging. Seeing that a small group within the affected populations still bears disproportionate burden of HIV, in the US in general, in places with more severe epidemics such as specific urban centers like Harlem and Washington, DC, and in places where marriage is considered a risk factor because HIV prevalence is so high, mostly in but not limited to countries in Southern Africa. Key populations at higher risk of HIV include not only men who have sex with men but also sex workers and people who inject drugs. Sex workers and people who use drugs have not made the same strides as gay people have in many places; many sex workers and people who like drugs hide these activities. They do so with good reason: they could lose their jobs, their homes and custody of their children. These are all things that gay men and women faced here until very recently.

I was depressed when thinking that sex workers and drug users are still fighting to be at the table in the ways that men who have sex with men have achieved at least in some places. Even though sex workers and people who use drugs have been part of mobilizing against HIV for thirty years, they have not had the same support from the people who have become mainstream AIDS advocates in the same way since men who have sex with men have been able to affect the HIV pandemic.

There are sterling exceptions, and many are in this important movie. They are role models for a movement for the necessary movement to bring other remaining marginalized groups to the discussions that form policy on HIV, which affects their lives in the form of the disproportionate HIV burden they carry, which is now in this country and elsewhere becoming more prevalent among women in general. One clip includes a man in a clinical trial at a demonstration asked about the trial, and the fact that there were no people of color and no women in the trial. This has changed, and is critical now that we know that African American women in the US are five times as likely as other women to contract HIV. Gay men fought to be present at discussions of HIV research and to help set the agenda; it's necessary that the coalitions working on these issues make the effort to include all affected communities, especially sex workers and people who use drugs.


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