Mandatory Testing: The Fear That Feeds The Falsehood, by Veronica Monet

Any discussion of legalizing or decriminalizing prostitution in the United States, inevitably leads to the controversy surrounding mandatory testing of prostitutes for STIs and HIV. Although the sex worker’s rights organization, SWOP-USA () is launching a tri-city (San Francisco, Berkeley and Oakland, California) effort to decriminalize, prostitution is currently illegal in the United States, with the exception of a few licensed brothels in rural counties of the state of Nevada.

According to the Nevada State Health Division AIDS Program sex workers in Nevada’s licensed brothels, must be screened prior to working for Chlamydia, Gonorrhea, Syphilis, and HIV. If they are found positive for Chlamydia, Gonorrhea, or Syphilis, they cannot begin work until they are adequately treated, followed-up, and tested negative on a subsequent test. For HIV, they are barred from working for life. Once a sex worker begins working in the Nevada brothels, they are tested weekly for Chlamydia and Gonorrhea, and monthly for Syphilis and HIV. (1)

Many US states have laws pertaining to the mandatory testing of individuals convicted of sex crimes, including prostitution. The details can be found at the web site for <a href=”http://www.ncsl.org/programs/health/mandtest.htm”>The National Conference of State Legislatures</a>. If a sex worker is found to be HIV-positive, they are barred from work, and if they do not give up prostitution, they can be severely punished. As Karen Bastow wrote in 1995: “Under a California law requiring mandatory testing, if a prostitute tests positive, subsequent prostitution convictions carry three-year sentences, whether the prostitute practiced safe sex or not….In another US state, Florida, an HIV-positive prostitute was charged with manslaughter despite the fact that all her customers tested seronegative and she had used condoms consistently.” (2)

To the majority of laypersons (and consequently the bulk of the voting population) mandatory testing seems like the least that should be expected from sex workers whether they work legally or not. It is a foregone conclusion that prostitutes spread disease and therefore need to be controlled in some manner if we are to maintain public health safety. In fact, many otherwise liberal individuals and groups will champion the opportunity to test and tax prostitutes as major incentives to legalize.

It matters little that scientific data does NOT support the common belief that sex workers are major contributors of sexually transmitted infections in the USA. The Centers for Disease Control conducted several tests for HIV seropositivity in prostitutes with the consistent conclusion that “risk factors for AIDS in female prostitutes may be similar to those in other women living in these [tested] geographic areas.” (3) In other words, although the US government would love to prove otherwise, US prostitutes spread no more disease than US housewives and college girls. Some evidence even supports the contention that the presence of prostitutes DECREASES the incidence of STIs as Rita Brock and Susan Thistlethwaite point out in their book, <span style=”font-style:italic;”>Casting Stones</span>: “When the Chicken Ranch, the famous Texas brothel, was closed, the number of gonorrhea cases in the general population rose substantially. Venereal disease also rose substantially when brothels were closed from 1917 to 1920. U.S Department of Public Health statistics have been consistently reporting that only 5 percent of sexually transmitted disease in the United States is related to prostitution, compared to 30 to 35 percent that is transmitted among sexually active teenagers….The National Research Council notes: ‘Many people fear that prostitutes (who by definition have multiple sex partners) will not adopt safer sex practices with their clients and will therefore be the conduit through which HIV infection will spread to the heterosexual population. Yet existing data on prostitutes do not support this concern.’ “

An Ineffective Measure
Mandatory testing is fraught with a multitude of issues that suggest that it is not only ineffectual in reducing the incidence and spread of STIs but it may actually cause the spread of more disease. The 1800s saw a rash of Contagious Disease Prevention Acts first in England and then in the United States. Rather than reduce the spread of venereal disease, “the incidence of venereal disease rose steadily during the period until the act was repealed…” (5) As Priscilla Alexander points out “many studies have found the rate of infection is higher among registered than unregistered sex workers, and condom use is higher among unregistered sex workers than in those [who are] registered.” (6)

As the recent scare in the Los Angeles porn industry so aptly illustrates, testing for HIV, whether mandatory or voluntary, means little when it comes to the prevention of disease. Although an unnamed male performer was tested for HIV every three weeks, adult movie producers were forced to shut down when he tested positive for HIV. About 45 actors and actresses who had had sex with this performer or persons who had had sex with him, put themselves on voluntary quarantine as a result. Dr. Jonathan Fielding, director of public health and health officer for Los Angeles County, said that the discovery shows that screening programs are not perfect and the only way to prevent AIDS is not to have unprotected sex. As any health care professional knows, there is a window between infection and seroconversion when no amount of testing can guarantee that HIV will not be spread during sexual contact. Whether prostitution is linked with the increased spread of disease or not mandatory testing will never be a solution. Mandatory testing is illogical and unscientific due to seroconversion rates as well as current statistics which establish the practice as ineffectual in preventing the spread of disease. In addition, mandatory testing has the net result of discouraging targeted populations from seeking medical intervention because of the fear and stigma that it inculcates. Compound this with the false sense of security that can and does lead tested individuals to engage in unprotected sex and testing becomes a sure fire formula for disaster. So why does the myth of mandatory testing persist?

Violation of Civil Rights
If one reviews all the instances where mandatory testing has been successfully introduced, an interesting pattern reveals itself. Mandatory testing has been applied to smaller disenfranchised portions of the population including immigrants, boxers, military personnel, prison inmates, persons convicted of sex crimes including prostitution, and legal brothel workers. Attempts to test the general population in specific instances such as marriage have been short-lived as the voters recognized it for the huge violation of their civil rights that it is. Mandatory testing for HIV was recommended for health care providers (including dentists and surgeons) early on when the public was more fearful of AIDS. Of course it never happened. The medical community is far too powerful to consent to losing their rights to privacy. However, some doctors are currently crying for the mandatory testing of patients, particularly pregnant mothers and their newborns.

I can only observe how typical it is that predominately male doctors wish to exert control over the lives and bodies of women in the name of public health. I do not think it is any accident that the public feels a need to control the lives and bodies of women employed in the sex industry, either. For all the proclaimed interest in preventing the spread of disease, no one is suggesting that we mandatorily test the men who purchase sexual services, let alone ALL men who have sex of any kind with anyone. Does one really need to point to the obvious sexism? If mandatory testing makes medical sense for vaginas (which it does NOT), then it must make medical sense for penises as well. One cannot deny that a population of government inspected sex workers might be a comforting thought for the consumers of sexual services. So while mandatory testing may serve some function as a marketing ploy for brothel owners and the governments which tax them; it cannot be promoted as a public health measure.

Us Against Them
Mandatory testing is the ineffectual cry of fear from those resorting to the oldest human frailty of thought and behavior: “Us against them.” Whether this way of thinking is applied to justify genocide, slavery, detention camps, or mandatory testing, it all boils down to a hateful attempt to separate oneself from a perceived “other” who serves as a scapegoat for conditions we all face as human beings. Sexually transmitted infections are spread by all humans regardless of their gender, race, and occupation – whether the sex act occurs for purposes of procreation, pleasure or profit. Germs don’t care about morals or dollar bills. That was true for the bubonic plague and influenza (which incidentally has killed far more people than AIDS) and it will always be true of any disease.

It is time for the general population to grow up, take responsibility and stop pointing a blaming finger at people who look different from them or lead alternative lifestyles. Educating the public on safer sex practices and away from their false sense of security (induced by prejudice and myth) will help to halt the spread of STIs. I recommend that sex workers be employed to educate the public on safer sex practices. Only sex workers have the experience and knowledge to transform safer sex into an erotic experience that others will wish to imitate.

Copyright Veronica Monet 2004

Notes

1. Rick Sowadsky, MSPH, Senior Communicable Disease Specialist, Nevada State Health Division AIDS Program. as quoted online in The Body: Answers to Questions about Safe Sex, Prevention and Transmission, December 3, 1996.

2. Karen Bastow as quoted in <a href=”http://www.walnet.org/csis/papers/bastow-aidslaw.html#testing”>HIV/AIDS Policy and Law Newsletter</a> 1995: 2 (2), copyright Canadian HIV/AIDS Legal Network, 1996.

3. Centers for Disease Control, MMWR Weekly Epidemiologic Notes and Reports Antibody to Human Immunodeficiency Virus in Female Prostitutes March 27, 1987 / 36(11) (pages 157-61).

4. Casting Stones: Prostitution and Liberation in Asia and The United States by Rita Nakashima Brock and Susan Brooks Thistlethwaite. Fortress Press, 1996. (pages 140-142).

5. Casting Stones: Prostitution and Liberation in Asia and The United States by Rita Nakashima Brock and Susan Brooks Thistlethwaite. Fortress Press, 1996. (pages 140-142)

6. April 2004 email to IUSW (;The International Union of Sex Workers) from Priscilla Alexander of the North American Task Force on Prostitution, 2785 Broadway, 4L, New York, NY 10025-2834

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