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My concern really would be with how deeply will the cultural, regional sub-context be taken in to account while implementing the PEPFAR Bill. The way it looks to me with so many clauses and sub-clauses it appears already to have a target group in mind at the cost of keeping certain groups beyond its reach as a form of 'disciplining' for not adhering in the first place (in the last five years!). And what worries me is that such a huge amount of money will go in to sticking to the "dos and don'ts" of the Bill rather than reaching substantially larger groups of people. Haven't we already seen this before? In conflict zones like Afghanistan ... in Iraq ... where so much money has gone yet women live lives not very different from the previous decade; and of course much too often also reflected in policies taken up by each of our own governments?
Countries in Asia and Africa already suffer from the burden of too many cultural practices and unfair, gender imbalanced value systems (the experience of development workers will show) which cannot be challenged but have to be worked around slowly and deliberately. When one invokes the prostitution pledge I wonder what happens to girls who have been unwittingly lured in to the sex trade in the first place and are unable to return back to their own communities (even when rescued) out of fear of ostracism or the 'shame' that they bring to the family. Thus, they are often compelled to return to the very life they fight to leave.
These are common narratives for almost every girl in the business and it is these narratives that make up the bulk of the sex workers in these countries. So are these young lives to be deprived of medical care and attention and continue to face persistent stigma and discrimination, (apart from the violence they endure) simply because they reconciled to sex work being the only economically viable means of survival. Even as local groups and communities fight social values to allow some sense of respect to these women in introducing this clause what in effect is being communicated is that they women do not deserve care and support because of the work they do. If that is not discriminatory behaviour then what is? What about men who might contract the virus from the sex worker? Are they also to be denied the aid? And finally down the same chain what about the spouse who contracts it from the husband? In countries like India and patriarchal set-ups such blanket bans only help to perpetuate the practices (which groups have spent years fighting) that while a woman (in this case a sex worker) can be punished for her trade (by limiting her accessibility to medical relief) men correspondingly do not have to bear that burden. So in condemning it for women it carries legitimacy for men -- an extremely disastrous situation in societies where women are socially and politically disenfranchised.
Married women form a very large component of the HIV infected population mainly because of the fact that girls are married very early to men much older to them (and often already sexually active). In the absence of information on the subject -- since sex itself is a taboo subject as is the use of contraceptives in such traditional, patriarchal set-ups where the value of women is judged by the number of male children they bear -- they very rarely are equipped to protect themselves from infections.
More often than not since women in such set ups have very little access to information, groups working on contraception are also the information providers on HIV/AIDS especially since these are subjects that women themselves are hesitant to talk about. Pre- and post-natal care become the entry points to discuss other issues like reproductive and sexual health, HIV/AIDS within these communities and even abortion as an Family Planning tool is commonly used especially in countries like India where it has been legalized for long.
What would be the implications of the Global Gag Rule here? For many women in the lack of any other access to information on family planning (since many traditional families even condemn the idea) it is very often midwives who also act as the carriers of information on various issues like HIV. Again with women contracting the virus so often from their spouses and coming to know of it during a pregnancy the GGR in effect is snatching from them their only access to information and help on the subject, especially since they are often better positioned to prevent new infections among women and youth - the two most vulnerable groups currently.
Besides, to me the hypocrisy of it all lies in the fact that how can something that can not be implemented in the host country (as the GGR can not be applied to US organizations as it raises the issue of unconstitutionality) be force-fed to other nations and yet be used as a position to prevent funding abroad? Is there really no underlying conscientious compulsion to link domestic policies and their enforcement with the moral position beyond the national borders -- particularly since morality has such an important role to play by way of 'abstinence' earlier and the continuing 'anti-prostitution pledge.'
My concern is that clauses and sub-clauses in programmes that fail to take in to account the specifics of the cultural and social milieu where they need to be implemented is a way of ensuring their failure. Flexibility needs to be at the core of these programmes. But then whom are we attempting to impact ultimately? All those who require this care or simply those (women specifically) who have made morally correct choices. And where are the definitions of these morally correct choices emanating from?
And this is what makes it imperative that the language of aid does not enjoy such ambiguity that it becomes more a tool to deny groups rather than be more inclusive.
