Study finds no link between transgender rights law and bathroom crimes

Some activists are hoping to undo the state transgender antidiscrimination law through a ballot question.
Some activists are hoping to undo the state transgender antidiscrimination law through a ballot question.

A first-of-its-kind study being released Wednesday refutes the premise that the state’s transgender antidiscrimination law threatens public safety, finding no relation between public transgender bathroom access and crimes that occur in bathrooms.

Researchers at the Williams Institute, a think tank focused on gender identity at the UCLA School of Law, examined restroom crime reports in Massachusetts cities of similar size and comparable demographics and found no increase in crime and no difference between cities that had adopted transgender policies and those that had not. The data were collected for a minimum of two years before a statewide antidiscrimination law took effect in 2016.

Activists who want to undo that state law through a ballot question in the Nov. 6 election have focused their campaign message on bathroom safety concerns. They suggest that a new right for transgender people infringes on everyone else’s privacy rights, and could be abused by men who want to prey upon women and children in ladies’ rooms. The vote is being closely watched nationwide because it offers the nation’s first public referendum on transgender rights in the state that first introduced gay marriage.

Transgender activists bristle at the idea that the campaign casts them as potential sexual offenders and have argued that there is no evidence that the law threatens anyone’s safety.

Get Fast Forward in your inbox:
Forget yesterday’s news. Get what you need today in this early-morning email.

A spokesman for the Freedom for All Massachusetts campaign, which is working to preserve the law, said the Williams Institute study reaffirms that stance.

“It really takes the wind out of the sails of our opponents who have been trying to paint this false picture,” said spokesman Matthew Wilder.

Yvette Ollada, a spokeswoman for the “Vote No on 3” campaign, said she could not speak to the study before reviewing it, but she questioned its objectivity since the opposing campaign was anticipating its release.

“If it’s unbiased, wouldn’t they send it to both campaigns?” Ollada said.

Wilder said his group was notified that the study would be released only after it was complete. “This was a completely independent research project,” he said. “We didn’t even know it was underway.”

The Williams Institute studies gender identity and sexual orientation, but the lead researcher maintained that its work is not always positive for the LGBTQ community.

“We talked about it before we started this research: What happens if we find out there is some sort of danger in this law?” said lead author Amira Hasenbush “If we had found one, we would have published that, too.”

The peer-reviewed study, published in Sexuality Research and Social Policy, focused on the years before Massachusetts adopted a statewide law prohibiting discrimination in public accommodations based on gender identity. Prior to that time, select municipalities had adopted local ordinances that had a similar effect: allowing transgender women into ladies’ rooms and transgender men into men’s rooms.

“Massachusetts was like this perfect petri dish,” said Rachel Dowd, a spokeswoman for the Williams Institute. “Different localities started to adopt it, and there was enough that allowed us to look at crime statistics over two years. And right as we were wrapping up our research, Massachusetts passed the statewide law.”

Under the 2016 Massachusetts law, any public place with separate areas for men and women must let people use the space consistent with their gender identity — a term that refers not to their biology, but to their sincerely held gender identity, appearance, or behavior. The activists who want to repeal the law say it could be abused by male predators and threaten privacy and safety of women and girls.

But until now there has been no empirical data to bolster or negate their concerns.

To establish the scope of the issue, researchers used public records requests to obtain police incident reports and compare bathroom crime data in cities with antidiscrimination laws — Medford, Melrose, and Newton — with comparable towns that lacked them. They paired each city with communities that were comparable based on a host of data, including crime and population demographics, poverty, and voting trends.

Medford was compared to Beverly and Watertown; Melrose was compared to Beverly; and Newton was compared to Brookline and Arlington.

Then, rather than looking at numbers alone, the researchers compared the differences in each locality over time to judge whether a change in bathroom crime could be attributable to the enactment of a transgender accommodation law.

“We did pretty much the most comprehensive study you could do for the state of Massachusetts,” said Hasenbush .

The study notes its limitations — largely on the quality of the data. Each police department had a different system for record-keeping; some were able to search manually, some electronically, and the researchers had to review the records to identify the incidents.

Still, researchers concluded that there was no statistically significant relationship either in the number of crimes occurring in any individual locality with a transgender accommodations law or in comparison to its matched pair. In fact, the average number of restroom incidents was higher in localities without transgender accommodations laws.

Moreover, the study noted: “Reports of privacy and safety violations in public restrooms, locker rooms, and changing rooms are exceedingly rare.”

That’s not to say that incidents don’t ever happen, however, the authors note.

Beyond the study, police departments report that they are seeing more “peeping Tom” cases — a factor they attribute less to gender politics than to advancing technology and the tiny cameras that are increasingly being used to spy on women in bathrooms. In June, a woman reported that a man seemed to be using a pen-like device to videotape her through a hole in the wall of a bathroom at the Garment District, the resale clothing store near Kendall Square, said Cambridge police spokesman Jeremy Warnick. Police were able to identify, but not apprehend, a suspect.

However, anecdotal reports of crimes in bathrooms seldom involve suspects who are — or are pretending to be — transgender.

And anyone, regardless of gender identity, can be arrested for criminal activity in a bathroom, Wilder said.

“If people — transgender or not — go into these spaces with the intent of committing a crime, they are still going to be prosecuted,” Wilder said. “There are still laws that prohibit that.”



Unstable housing associated with low CD4 cell count and detectable viral load for HIV-positive women in US

Unstable housing is associated with an increased risk of a detectable viral load and low CD4 cell count among HIV-positive women, according to US research published in Social Science & Medicine. Women with unstable housing were around 50% more likely to have adverse HIV treatment outcomes than women living in more secure accommodation. Reasons for the poorer outcomes observed in women with unstable housing included poorer continuity of health care.

“We find that unstable housing drastically reduces both HIV suppression and CD4 T-cells for PLHIV [people living with HIV]; thus worsening clinical outcomes and further exacerbating health disparities,” write the investigators. “We show specific pathways for the effects, including use of any mental health/counselling, any healthcare, and continuity of care.”

Understanding the impact of socio-economic factors, including housing, on health is a research priority. Previous research has shown that PLHIV are at increased risk of experiencing unstable housing. However, the impact of homelessness on key HIV outcomes including viral load and CD4 cell count is unclear.

Investigators from the US therefore used data obtained from the large Women’s Interagency HIV Study (WIHS) and funding data from the Housing Opportunities for People with AIDS (HOPWA) programme to determine the relationship between unstable housing, a detectable viral load (above 200 copies/ml) and low CD4 cell count (below 350 cells/mm3).

The study population consisted of 3082 WIHS participants who received care between 1995 and 2015 at sites in the Bronx, Brooklyn, Chicago, Washington DC, Los Angeles and San Francisco. Unstable housing was defined as living in the previous 12 months on the street, beach, a shelter, a welfare hostel, a jail or correctional facility, or in a halfway house.

About a third of participants were high school graduates, 57% were African American and 23% Hispanic, 33% were married or living with a partner, 30% had ever injected drugs and three-quarters reported using recreational drugs.

The availability of resources to address housing instability among people living with HIV was estimated with funding allocations to Housing Opportunities for Persons with AIDS (HOPWA). This is a federal programme which provides housing and supportive services (such as substance abuse treatment, job training and assistance with daily living) to people living with HIV who have a low income.

For each location and each year, the researchers calculated HOPWA funding per 1000 people newly diagnosed with HIV. There was considerable variability in HOPWA funding between study sites.

The investigators’ model examined the impact of unstable housing on the two key HIV treatment outcomes after taking into account HOPWA funding allocations.

The study participants attended 57,323 follow-up appointments. Unstable housing was reported at 4.8% of these visits. Viral load was suppressed at 48% of visits, with CD4 cell count was above 350 cells/mm3 at 56% of visits.

The probability of unstable housing fell with increasing HOPWA funding. Lower HOPWA funding allocations were strongly associated with an increased likelihood of unstable housing, a relationship that remained robust after taking into account covariates such as age, education, relationship status and drug use.

The investigators’ calculations showed that unstable housing had a negative impact on health, decreasing the probability of viral suppression and of an adequate CD4 cell count, both by 8%. When HOPWA allocations were included as the key variable, unstable housing reduced viral suppression by 51% and it decreased the likelihood of having a CD4 cell count above 350 cells/mmby 53%.

The authors also examined the potential pathways between unstable housing and adverse viral load and CD4 cell outcomes. Unstable housing was shown to affect use of healthcare resources and continuity of care. It was associated with 25% less use of counselling and mental health services, 37% less use of any healthcare services and a 76% reduction in the probability of seeing the same provider.

“This paper shows a strong negative effect on viral suppression and adequate CD4 cell count, and it elucidates specific channels by which unstable housing can affect these HIV treatment outcomes,” conclude the researchers. “These findings suggest that increasing efforts to improve housing assistance, including HOPWA allocations, and other interventions to make housing more affordable for low-income populations, and HIV-positive populations in particular, may be warranted not only for the benefits of stable housing, but also to improve HIV-related biomarkers.”

Author: Michael Carter


This is what Ontario elementary school students will learn in sex ed — and what they used to learn

Here’s everything parents need to know about what kids will learn about sex versus what they learned under the 2015 curriculum

Under Premier Doug Ford, Ontario elementary schools have ditched the 2015 sex ed curriculum. Instead, they’re using an interim document from 2010, which is an updated version of the 1998 health and physical education curriculum. (High schools will continue to use the 2015 version.) Here’s everything parents need to know about what kids will learn about sex versus what they learned under the 2015 curriculum.


2015 curriculum:
Grade 1: how to identify major body parts using proper names, including penis, testicles, vagina and vulva.

Grade 5: students learn the male and female reproductive systems, including how to identify the uterus, clitoris, scrotum and testicles.

Interim curriculum:
No reference to proper names of genitalia anywhere in the curriculum.


2015 curriculum:
Grade 4: physical changes during puberty, including breast development in females.

Grade 5: male and female reproductive systems, including in-depth explanations of menstruation, ejaculation and egg fertilization.

Interim curriculum:
No reference to breast development anywhere in the curriculum.

Grade 5: students learn about menstruation and spermatogenesis, but it’s not clear in how much detail.


2015 curriculum:
Grade 6: students learn about wet dreams and vaginal lubrication and that masturbation is a normal, healthy way to discover one’s body.

Interim curriculum:
No reference to masturbation anywhere in the curriculum.


2015 curriculum:
Grade 3: students learn that gender identity and sexual orientation make people unique.

Grade 6: stereotypes based on gender and/or sexual orientation are harmful.

Grade 8: students learn about gender identities, including male, female, two-spirit, transgender, transsexual and intersex.

Interim curriculum:
Grade 7: students learn it’s harmful to use homophobic put-downs.

The introduction states students of all genders and sexual orientations should feel included in health-related activities and discussions. But there is no reference to gender stereotypes or specific gender identities, including transgender, anywhere in the curriculum.


2015 curriculum:
Grade 2: students consider Indigenous teachings to learn about basic human development.

Grade 4: students learn about various cultural traditions associated with puberty.

Grade 6: students consider Indigenous teachings, including the Medicine Wheel metaphor, as a way of learning about healthy relationships.

Grade 8: students learn about Indigenous two-spirit gender identity.

Interim curriculum:
Grade 4: students learn Indigenous teachings that can help strengthen relationships; no examples are given.


2015 curriculum:
Grade 4: students learn that internet and cellphone use may expose them to people who ask for sexual pictures.

Grade 5: students learn about sexual harassment and that sharing sexual photos of others online is illegal.

Grade 7: students learn about the risks of sexting and how this can affect one’s well being, as well as future relationships and/or jobs.

Interim curriculum:
Grade 4: students learn about risks of using the internet, including “online predators.”

Grade 7: students learn that sending sexually explicit photos (the term sexting is not used) can affect future relationships and/or jobs.


2015 curriculum:
Grade 7: students learn that abstinence can mean different things for different people, and they should be clear about what they are comfortable with.

Grade 8: identify and explain factors that affect decisions about sexual activity, including personal limits, peer pressure, desire, acceptance of gender identity and sexual orientation and risk of pregnancy.

Interim curriculum:
Grade 7 and 8 students learn about the possible consequences of “risky (sexual) behaviours” and are taught abstinence is a “positive choice” for adolescents.


2015 curriculum:
Grade 7 and 8: students learn the proper names for STIs, including HPV, herpes, chlamydia, gonorrhea, Hepatitis B, and HIV and AIDS. They also learn how to identify STI symptoms, and how to prevent STIs and pregnancy.

Interim curriculum:
Grade 7 and 8: how to identify and prevent “common” sexually transmitted diseases (using the non-preferred term STDs). Students also learn about HIV and AIDS and how to prevent pregnancy.


2015 curriculum:
Grade 6: students learn that general consent is defined as a clear “yes” and that “no” or an uncertain response is understood as no consent.

Grade 7: students learn about clear communication with romantic partners.

Grade 8: students learn about consent during sex, and that consent to one sexual activity doesn’t mean consent to all sexual activities.

Interim curriculum:
No mention of consent.

Author: Alexa Taylor

There Might Be an Alternative AIDS Conference in 2020



na Brown of the Southern AIDS Coalition (left) and Charles King of Housing Works protest the AIDS 2020 conference location
Gina Brown of the Southern AIDS Coalition (left) and Charles King of Housing Works protest the AIDS 2020 conference location while attending AIDS 2018 in Amsterdam, the Netherlands (Credit: Sean Black for A&U)

“You need to know how sad I am about where we find ourselves,” says George Ayala, Psy.D., executive director of the Oakland, California-based MPact Global Action for Gay Men’s Health and Rights. “How did we get to a place in the global HIV response where the needs and desires of public health elites matters more than the concerns of people around the world who are actually living with or at risk for HIV?”

Ayala is talking about the decision on the part of the International AIDS Society to hold the 2020 edition of the biennial International AIDS Conference (IAC) — the world’s largest forum about the epidemic, drawing some 20,000 people — in the U.S., specifically in California’s Bay Area. That decision, announced in March, drew an immediate backlash, with a wide array of HIV/AIDS activists in the U.S. and abroad saying that it was wrongheaded and even dangerous to hold the conference in the U.S. while the Trump administration is pursuing policies hostile to immigrants, foreign visitors (particularly from majority-Muslim countries), LGBTQ people, and HIV high-risk and high-incidence populations, including sex workers and drug users.

Major protests over the decision broke out at the 2018 IAC in Amsterdam. And now, even as IAS says it is going forward with plans to hold the conference in both San Francisco (wealthy, expensive, touting dramatic HIV reductions in recent years) and Oakland (poorer and more people of color, with only a fraction of San Francisco’s HIV resources), Ayala and a broad network of activists worldwide are moving forward with planning a simultaneous conference outside the U.S., likely in Mexico City or Tijuana. Thatconfab, they say, will prioritize the concerns and solutions of communities affected by HIV over those of researchers and public health officials.

A Diverse Outcry

Activists point out that the majority of global networks of people living with HIV or at high risk — including MPact, Positive Women’s Network, Positive Trans, International Treatment Preparedness Coalition, and International HIV/AIDS Alliance — oppose the conference being held in the Bay Area. The primary objection appears to be against holding it in the U.S. at all during the Trump era, given the difficulties that many people from poorer countries may have obtaining visas in the first place — or actually getting into the country upon arrival.

On top of that, “All that has to happen to put the HIV entry ban back on is an executive order,” says JD Davids (a staffer at TheBody who will be transitioning out in mid-September), a trans HIV activist who is part of an emerging coalition, HIV Power Shift, seeking to center affected communities over policymakers and researchers. And, based on precedent, it’s highly conceivable that Trump might reinstate the ban by tweet perilously close to the conference date in order to sow bureaucratic chaos and curry favor with his base. If that happens, “conference organizers would seriously weigh the impact of this policy change,” Megan Warren, the IAC conference organizer, wrote in an email. But activists wonder how the IAC — a massive feat of planning, contracts, and budgets — could change its location on such short notice.

Protesting IAC Conference Locations Is Not New

This is not the first time that the location of the IAC has drawn ire from activists. First imposed in 1987, at the height of AIDS-phobia, the U.S. ban on HIV-positive people coming into the country led to major protests of the IAC when it was held in San Francisco in 1990 — and to moving the 1992 conference site from Boston to Amsterdam. In 2000, many protested the IAC taking place in South Africa while its president, Thabo Mbeki, was publicly denying that HIV caused AIDS — but South African AIDS activists demanded it be held there as a global rebuke to Mbeki’s denialism. In 2012, Obama finally ended the U.S. HIV travel ban in time for the conference to be held in Washington, D.C. However, ceding to conservatives, he still banned entry to sex workers and drug users, few of whom managed to attend, with the rest holding their own conferences in Kolkata, India, and Kiev, Ukraine, respectively.

That particular ban still stands; such folks would have to lie on U.S. visa applications — a risk if customs and border entry officials scan their online or social media presence. According to New Orleans-based Kelli Dorsey, an independent sex-worker activist who was formerly the executive director of Different Avenues, an advocacy group for girls and women who engage in underground trades such as sex work, that’s exactly what’s been happening recently to Canadian sex workers who have been stopped at the U.S. border.

To have only a handful of sex workers and drug users at IAC 2020 would be “a dramatic loss,” says Dorsey. “We’ll miss out on learning how those folks are running programs in order to strengthen our own programs.”

The inability of foreigners to get to the conference is not the only reason many activists oppose it being held in the Bay Area. They worry that, media-wise, it will be completely overshadowed by the Democratic National Convention (DNC), which takes place the following week.

“Who [in the media] will have time to go all-in on the AIDS conference?” asks Dázon Dixon Diallo, M.P.H., who heads Atlanta-based SisterLove, which supports women of color living with or at risk for HIV, and is founder and convener of Women NOW, a global HIV/AIDS conference for women of African descent. “The opposition! They’ll say, ‘Look at all the crazies coming to that sanctuary city in Nancy Pelosi’s backyard.’ We would rather the international AIDS community come to the U.S. when we have different national leadership and we’ve cleaned up our house.”

Diallo is also among those who feels that, if the conference has to be in the U.S., it should be in a city in the South, which is still struggling with its epidemic, rather than San Francisco, which has been able to get its HIV epidemic relatively under control due to its disproportionate whiteness and wealth (and which is also expensive for visitors). “The minute you nationalize San Francisco’s story of ‘the epidemic is over,’ it will silence the voices of millions of others over the world. It’s not time to tout success until we’re all reaching it.”


Voices of Support

All this is not to say that everyone in the U.S. HIV community opposes IAC coming to the Bay Area, which hosted the conference in 1990. “This is a really important moment to reflect on the progress we’ve made here in San Francisco since then and to share best practices, as well as to highlight the disparities between us and Oakland and the rest of the U.S.,” says Joe Hollendoner, the new CEO of San Francisco AIDS Foundation (SFAF), which lobbied hard to have the conference in the area.

According to Hollendoner, “Wherever you have the conference, there are challenges for people gaining entry.” He says that when the IAC was held in Toronto in 2006, more visa requests were rejected by Canada than were by the U.S. in 2012 when the conference was in D.C. He says that U.S. Representatives Nancy Pelosi and Barbara Lee have promised to do everything they can to get as many conference-goers into the country as possible. And he says he is confident that, should Trump capriciously reinstate the HIV travel ban shortly before the conference, “we have a base of support of elected officials who will fight like hell to make sure that Trump’s tweet will not become a reality.”

Says Rob Newells, executive director of AIDS Project of the East Bay, which serves a large clientele of color: “I’m OK with it being here. I’m born and raised in Oakland, I’m a militant person by nature, and this is a place about resistance and protest. And my perspective is that, yes, there all these issues with the conference being in the U.S. and, yes, the U.S. is perpetrating lots of bad things now — and we need the international community to come in ahead of the DNC and help us push on these issues like sex work and drug use. We can’t separate our HIV activism from our political activism. Running away from these issues doesn’t help solve them.”

A Bay Area conference is also supported by Marsha Martin, D.S.W., formerly D.C.’s AIDS czar and now community coordinator for the Fast-Track East Bay Getting to Zero initiative to end the epidemic. “A joint conference collaboration between two cities, as in San Francisco and Oakland, has never been done before,” she notes, saying that the conference will “absolutely” be evenly mixed between the two cities and that non-science sessions will not be marginalized to Oakland so that researchers and VIPs won’t have to go there. “No one wants San Francisco to dominate,” she says.

“Both cities’ long history of activism and commitment to change is really important now in our country,” she continues. “If we don’t have it here, I believe we’ll miss an opportunity, much like when the conference went to South Africa in 2000” to rebuke HIV denialists.

Unanswered Questions

Of course, it’s too early to say whether immigration policies or other circumstances in the U.S. could worsen to the point where having the conference in the Bay Area becomes completely untenable. And it’s also too early to know exactly what the possible alternate conference in Mexico might look like or how it will get people there, although Ayala says he envisions it being much smaller — perhaps 2,500 to 5,000 people — and that he and others are already talking with the IAC about making some satellite connections between the Bay Area and Mexico.

But Ayala stands by his decision to spearhead what might add up to a boycott of IAC by at least some U.S. activists. “It is not OK for IAS to continue with business as usual,” he says. “Not OK for them to continue to justify to themselves the need for large, trade-show style conferences in the global north, to select host countries that are overtly hostile to people living with HIV and key populations” (such as sex workers and drug users).

And, in many ways, it appears that in this most fraught time in the U.S., the split over AIDS 2020 is a split between the large, well-funded institutions of HIV/AIDS — the pharma companies, the big research centers, and the major AIDS service organizations, such as SFAF and the IAS itself — and networks made up primarily of individuals living with, or at risk for, the virus itself, often in poor parts of the world.

“Even if they can get visas, what’s going to happen to them when they arrive at our border for the conference?” asks Diallo. “This controversy isn’t really just about the conference. It’s about who has the power to decide where these conferences are held. We have to open up the table and share more of that power to make these decisions.”

Tim Murphy has been living with HIV since 2000 and writing about HIV activism, science and treatment since 1994. He writes for and has been a staffer at POZ, and writes for the New York Times, New York Magazine, Out Magazine, The Advocate, Details and many other publications. He is also the author of the NYC AIDS-era novel Christodora.



Governments have failed Canada’s sex workers—and they’re running out of patience

The Conservatives’ Bill C-36 made it harder for sex workers to do their job safely—and despite their promises, the Liberals haven’t fixed the problem, either

Traffic moves along a street on Feb. 25, 2002, in the Downtown Eastside of Vancouver. (Don MacKinnon/Getty Images)

“Am I next? Is he watching me now?”

For years, Sarah De Vries was a sex worker in Vancouver’s now-infamous Downtown Eastside. In her diary, she chronicled her struggles with addiction, as well as the situation in the neighbourhood, in which police were either ever-present—arresting drug users and sex workers wherever they congregated, or belittling them for their profession—or simply nowhere to be found. Still, she had plans to get her life together and get out of the neighbourhood. But as she wrote in her diary, she worried she’d never get the chance.

“So many women, so many I never even knew about that are missing in action,” she wrote in that same entry, in December 1995. “It’s getting to be a daily part of life. That’s sad.”

De Vries disappeared three years later. Police believe that she was murdered on Robert Pickton’s farm, east of the city. She was one of the many women whose disappearances remain, on paper, unsolved; while Pickton was charged with her death, her case was eventually stayed.

De Vries’s journal, read aloud by her sister at a commission of inquiry into Vancouver’s missing women, was cited directly in the commission’s final report. Wally Oppal, who headed up that commission, would describe the neighbourhood as a “zone bereft of justice and outside the rule of law” where, for decades, the murder of sex workers was just a “daily part of life.”

But surprisingly— incredibly—there’s been good news, recently: There hasn’t been a recorded murder of a sex worker in Vancouver in nearly a decade.

“It has been a long hell of a journey,” says Susan Davis, the director of the B.C. Coalition of Experiential Communities, who has worked as a sex worker in Vancouver for more than three decades.

The changes can be traced back to 2012, when Vancouver police drafted a new policing strategy that completely overhauled how they deal with sex workers, and the sex trade more broadly. The new strategy was the direct result of the commission of inquiry, the one headed by Oppal and informed by De Vries’ diary. These guidelines—which outline how police should “use discretion” in dealing with complaints regarding prostitutions, has meant that in Vancouver, sex work is effectively decriminalized.

“No sex workers on the street have been arrested in Vancouver on the street in a very long time,” Davis says. “The john stings, as they’re called, do not occur here either.” It’s not perfect, she says—but it’s been a success.

But Vancouver is a lone exception to the rule in Canada. Go outside Metro Vancouver—where police, by their own policy, are largely unconcerned with enforcing Canada’s laws around sex work—and it’s a totally different scenario.

An escort who gave her name as SB is silhouetted against a window as she poses at a downtown Vancouver apartment, Feb. 12, 2017. (Jonathan Hayward/CP)

Across Canada, sex workers are still regularly being charged with crimes because of their profession. Their clients, too, are being targeted by police. A safe, indoors working environment is inaccessible to many women and men who work in the trade. And although statistical reporting is sparse, violence against sex workers has certainly not stopped in the rest of Canada like it largely has in Vancouver. Indeed, in 2017 alone, there were the murders of Sisi Thibert, a transgender sex worker in Montreal; Victoria Head, a sex worker and a mother from St. John’s; and Josie Glenn, a 26-year-old from London.

According to a research project conducted by York University masters student Arlene Jane Pitts in 2015, sex workers have in recent years “not witnessed any decrease in police harassment and instead stated it had increased,” largely pointing to enforcement of other criminal prohibitions, like drug possession.

Pitts’s research, comprised of in-depth interviews with six street-involved sex workers, suggests that Canada’s new laws—ones that supposedly decriminalized sex work, complying with a major Supreme Court ruling on the matter—have only made things worse.

That legislation, Bill C-36, came into effect in 2014 under Stephen Harper’s Conservative government, and it was opposed by all opposition parties at the time, including Justin Trudeau’s Liberals, who contended that the legislation was unconstitutional and failed to comply with that Supreme Court rulingDuring the 2015 federal election campaign, Trudeau vowed to undo or fix various criminal justice reforms brought in by his predecessor, painting the Tories’ tough-on-crime agenda as heartless and damaging. And when they won, they affirmed that work would be under way on these issues. “I definitely am committed to reviewing the prostitution laws, and sitting down with my officials to assess the best options, and with those they affect directly,” Justice Minister Jody Wilson-Raybould told the Tyee in 2015, shortly after her appointment to cabinet.

But now—three years after the Liberals won a majority government, four years after C-36 came into force, five years after the Supreme Court ruled that Canada’s long-standing prostitution laws were unconstitutional, and six years after shifts in policing strategy started producing meaningful change in Vancouver—any plans for reform appear to have stalled, despite government consultations about a year ago. And now, with just a year left before the next election, there is scant time left to introduce new legislation.

In short, sex workers feel like they’ve been forgotten—again. “It’s very difficult to be on the outside with people talking all about you, with people making decisions about your life, and having no say whatsoever,” says Davis.

After years of patience with the Liberals, sex workers are beginning to speak out again, frustrated by the lack of outcome from the consultations. A constitutional challenge to the Harper-era laws is facing a Charter challenge in a London, Ont. courtroom, which promises to extend into years of further legal wrangling. The Pivot Legal Society, an intervenor in the Bedford case, told the National Post in January that it was considering another challenge.

“We always have to force our way to the table,” Davis says.

Susan Davis.

Things were different in 2013, when sex workers in Canada were optimistic. In what is now known as the Bedford ruling, the Supreme Court ruled in favour of a coalition of sex workers in declaring the existing criminal regime around sex work unconstitutional, striking down the previous criminal prohibitions as directly and indirectly harmful to sex workers, and concluding that any societal benefit that may come from ending the sex trade cannot be comparable to the damage caused to sex workers by criminalization. The country’s highest court gave Ottawa a one-year grace period to revise the laws, if they so wished; if they did nothing, as many sex work advocacy groups recommended, sex work in Canada would be decriminalized and unregulated at the national level, akin to what is happening in Vancouver.

While research is limited, some peer-review studies back up the assertion that decriminalization does reduce violence and improve health outcomes for sex workers. A 2016 study, published in peer-reviewed medical journal The Lancet, studied the correlation between HIV transmission rates amongst sex workers and government policies on the sex trade.

Controlling for a variety of other factors, the researchers write that “countries which have legalized some aspects of sex work have significantly lower HIV prevalence among sex workers than those which have not.”

Real-world examples, including Vancouver, appear to be evidence to that end. New Zealand decriminalized sex work more than a decade ago, with a 2012 parliamentary report from that country concluding, despite setbacks, “key evidence indicates that the decriminalization of prostitution has impacted favourably on various aspects of sex work for many.”

“Decriminalization is the only way forward,” Davis says.

Harper’s Conservative government had other ideas. It was after the Bedford ruling that the government brought in Bill C-36, an act which sought to comply with the letter of Bedford by criminalizing not the workers themselves, but their clients, which is generally referred to as the Nordic Model, so named after countries like Iceland and Sweden that have moved to criminalize the purchasing of sex work. The model aims to support the women and men of the sex trade, without putting their safety in jeopardy.

MacKay stressed the Conservative government’s solution would be a made-in-Canada approach, but it took inspiration from that model, adding a section to the Criminal Code which punishes purchasing sex work with a maximum penalty of five years in prison. And it did produce some change: In 2015, not long after the new legislation came into effect, police in Cape Breton arrested 27 men in a prostitution sweet they dubbed “John B Gone.” Police in Edmonton have run similar stings with some regularity. Other police forces across the country may be running similar operations, although public reporting on these operations is spotty, and can often be lumped in with operations to break up human trafficking rings.

But the made-in-Canada portion of the law goes beyond simply criminalizing the purchasing of sex. Bill C-36, among other things, criminalizes advertising someone’s sexual services, or accepting money to place such an ad, as well as profiting from someone’s sexual services. Those prohibitions technically exempt sex workers and some direct staff they may hire. But the bill also criminalizes communicating for the purposes of prostitution anywhere next to a schoolground, playground, or daycare, with a maximum penalty of six months in prison. Those conditions cover, of course, wide swaths of urban Canada.

Monica Forrester, who works at Maggie’s, a Toronto-based outreach and advocacy group for sex workers, says C-36 has made life even harder for Canadian sex workers. The law’s prohibition on advertisements have made it “impossible” for self-employed workers who operate out of their own homes, she says. Workers who look for clients on the street, meanwhile—many of whom are “survival” sex workers, meaning they are often working in the trade out of necessity—have had to deal with johns afraid of being “targeted and criminalized” because they are seeking out sex workers.

“What have these new laws done to protect sex workers?” Forrester asked. “Nothing.”

Meanwhile, despite their campaign rhetoric about Bill C-36, the Liberals have yet to follow through with their promised reforms. When Maclean’s requested an interview with the justice minister over her government’s plans to fix the legislation, her office refused. Asked why the minister was unwilling to speak to the issue, her director of communications, David Taylor, wrote simply: “Not in the mandate letter. Not in the platform.”

Instead, the Department of Justice wrote a statement, telling Maclean’s that “this issue is challenging, but it is incredibly important and as such, it is something our government is committed to continue working on.” The justice minister’s office did confirm they held consultations on the law, but there has been no clear outcome or public report from those meetings. They provided no specifics, no timeline, and no commitment to follow through on their promise for a legislative fix. Davis, who was a part of those consultations, was encouraged by the government’s willingness to listen, but says she has not received any update or follow-up from Ottawa in the years since.

This inaction has had real-world impact. In the three years since Bill C-36 has come into force, the statistics show that prosecution for prostitution offences have slowed significantly, but they’ve not stopped. From 2015 to 2017, according to Statistics Canada, 166 people have been charged with prostitution-related offences, with most facing charges for communicating for the purposes of sex work or blocking traffic in order to communicate for sex work, a law that was not part of the Supreme Court challenge. For the sake of comparison, more than 2,000 people were charged with prostitution-related offences in 2010 alone.

But the statistics may not be telling the whole story. Many sex workers have said turning the criminal focus onto the johns means they have been more skittish to purchase sex, and thus have required increasing discretion. That makes screening clients hard, and pushes sex workers, especially those most vulnerable, further into the shadows.

And things have gotten even harder for sex workers worldwide recently, as U.S. law enforcement recently moved to shut down sites like Backpage and the personals section of Craigslist. A new package of laws, which purport to take aim at human trafficking, has made operating those websites virtually impossible. Without those platforms, screening clients is all the more difficult.

“Until the community is decriminalized, how are we to freely associate and ensure safety and work?” Davis asked.

Liberal Leader Justin Trudeau asks a question during Question Period in the House of Commons on Parliament Hill in Ottawa, Wednesday Oct 29, 2014. (Adrian Wyld/CP)

When I spoke to Davis, she was fatalistic about why sex workers have had so few political victories.

“In the end, it’s political gold for the Conservatives,” she says. As for Trudeau? “I understand why the Liberals are reluctant to go down this road.” In other words: Decriminalizing sex work doesn’t win many votes. Cracking down on it does.

“We need somebody to have the courage to do the right thing,” she says. But she isn’t optimistic that somebody is coming.

Even though Trudeau and his justice minister had endorsed changes to the laws brought in under C-36, his party nevertheless endorsed the idea underpinning the legislation, the Nordic model; their concerns were with the implementation. This, despite the fact that Liberal Party members, in April, voted to endorse a resolution calling on the government, their own party, to decriminalize sex work. Party leadership has not responded to it.

While one might expect the NDP to be the voice for decriminalization in this debate, the party is similarly unmoored in terms of specifics on the matter. Their membership, too, has tried to bring forward resolutions calling for the decriminalization of sex work, but the party has kiboshed efforts to actually have those resolutions adopted.

Maclean’s asked a spokesperson for leader Jagmeet Singh whether the party had adopted a specific position on sex work, but did not receive a reply.

Ultimately, sex workers don’t get to write the law in Canada—they just have to grapple with it.

“Sex workers are resilient and resourceful,” Forrester says. Sex workers, she adds, will look out for one another, even if the government won’t.

“And that will continue as long there’s a demand for sexual services in this business.”



Work to improve the HIV care continuum for black transgender women should concentrate on HIV diagnosis

Less than half of black transgender women living with HIV in the United States are aware of their HIV status, but most of those who have been diagnosed report that they engage with care and take HIV treatment. Rates of viral suppression, however, are sub-optimal, according to an analysis published in the Journal of Acquired Immune Deficiency Syndromes.

Researchers from the University of Pittsburgh recruited participants at Black Pride events in six American cities from 2014 to 2017. Most participants were men who have sex with men, but this analysis focuses on a sub-sample of 422 transgender women. They were all assigned male sex at birth and currently identified as female or transgender. All were black and had sex with men.

Their average age was 30 years. Social challenges such as problems accessing healthcare, incarceration, homelessness, sex work and limited education were frequently reported.

Researchers wished to characterise the HIV care continuum, as this has not previously been described in black transgender women.

HIV testing conducted as part of the study showed that 45% of participants were living with HIV (190 women). Just 41% of them (78) were aware of this.

Engagement with the next few stages of the care continuum was much better – 75 of the 78 diagnosed women were linked to care, 72 were retained in care and 65 were receiving HIV treatment. However, only 45 transgender women reported an undetectable viral load.

In percentages from stage to stage, the care continuum is therefore 41% diagnosed, 96% linked to care, 96% retained in care, 90% on treatment, 69% virally suppressed.

Only 24% of this group was diagnosed, in care and virally suppressed compared with the 90-90-90 target of 72.9%.

It appears that there are many barriers to transgender women learning their HIV status. The authors suggest that apprehension about receiving a diagnosis that will require them to use healthcare services where they may be stigmatised may be a factor. But once women take action to learn their status, most are ready to access HIV treatment and care.

The researchers examined factors that were associated with having undiagnosed HIV. In comparison with HIV-negative participants, undiagnosed participants were more likely to have been incarcerated (42% versus 32%) and to report being unable to access health care (54% vs 40%). After adjustment for other factors that could influence these results, these differences remained statistically significant.

Similarly, analysis of factors associated with not being virally suppressed showed that poor treatment outcomes were more common in those recently incarcerated (59% vs 29%), homeless (71% vs 39%), using multiple illicit drugs (50% vs 18%), reporting physical assault (73% vs 47%) and receiving hormone treatment (86% vs 47%). These differences were statistically significant.

The finding that women receiving hormones were less likely to be virally suppressed may reflect women prioritising hormonal therapies for gender reassignment over HIV treatment, especially in the face of economic challenges.

More broadly, the researchers say that their findings underscore “the need for trauma-informed care”. Interventions should address the multiple challenges that black transgender women face and address the fundamental causes of poor health.

Author: Roger Pebody


People taking HIV-prevention pill may get more primary care

HIV pre-exposure prophylaxis (PrEP) is highly protective against HIV, and patients taking this daily pill may get more primary care, a U.S. study found.
When people take daily pills to minimize their chances of getting HIV, they are also more likely to get routine care like flu shots and recommended screenings for common health problems, a U.S. study suggests.

So-called HIV pre-exposure prophylaxis (PrEP) is highly protective against HIV, and patients taking this daily pill also tend to get tested and treated more often for hepatitis C and other sexually transmitted infections (STIs), researchers note in the American Journal of Public Health.

But many people who take PrEP have other unmet medical needs, noted lead study author Julia Marcus of the Harvard Pilgrim Health Care Institute and Harvard Medical School in Boston.

“Most PrEP users in the U.S. are gay and bisexual men, a community for whom experiences of discrimination contribute to a higher risk of mental health conditions, substance use and smoking,” Marcus said by email. “For this reason, PrEP users stand to benefit from the increased opportunities for non-HIV-related screening and treatment.”

All 5,857 patients in the study were treated at a community clinic in Boston specializing in care for sexual and gender minorities. They were all considered at high risk for developing HIV because they had been tested for rectal STIs.

A total of 2,357 people in the study, or 40 percent, received flu shots.

In addition, 4,353 patients, or 74 percent, were screened for tobacco use, and 4,211, or 72 percent, received screening for depression.

Researchers also looked at two tests for diabetes. About 15 percent of patients got a test assessing A1C proteins in the blood, which reflects average blood sugar levels over time, and 51 percent of patients got a different test that looks just at current blood sugar levels.

Compared to patients who didn’t take PrEP, those who did were 28 percent more likely to get flu shots. They were also 7 percent more likely to get screened for depression, and 6 percent more likely to get screened for tobacco use.

With PrEP, patients were 78 percent more likely to get a blood sugar test than other people in the study, but they were also 19 percent less likely to get the A1C test.

It’s possible that patients prescribed PrEP were more motivated to care for their health in other ways, or that doctors did more screening for these patients because they assumed they had a higher risk for certain conditions than other people, the study authors note.

The study wasn’t a controlled experiment designed to prove whether or how taking PrEP might influence other care that patients receive. It’s also possible that the impact of PrEP on primary care at a clinic for gender and sexual minorities does not reflect what would happen for patients treated in other settings.

“Provided these results hold across numerous clinics, these findings are exciting because PrEP utilization may allow providers to periodically assess other referrals that are needed for patients engaged in PrEP services,” said Matthew Beymer, a researcher at the University of California, Los Angeles, David Geffen School of Medicine and at the Los Angeles LGBT Center.

Patients taking PrEP typically have checkups every three months, and this offers more opportunities to provide care to many people who are healthy and don’t often go to the doctor, said Dr. Geoffrey Hart-Cooper, a pediatrician at Stanford Children’s Health in Menlo Park, California, and HIV prevention specialist at the San Francisco Department of Public Health.

“Building this patient-provider relationship over many visits can build trust and potentially lead to more open discussions about sensitive primary care topics such as sexual health, mental health and substance use,” Hart-Cooper, who wasn’t involved in the study, said by email. “Having a trusted provider can have a bigger impact than just HIV prevention – it can support a patient’s overall health.”


What To Say When Someone Says They Have HIV

If a friend or partner tells you that they have HIV, you might be unsure how to respond. But you don’t need to know all of the scientific terminology and latest data on HIV to offer comfort and support. Depending on the specific situation and tone, here are five things that you might consider saying when someone tells you their HIV status.

1. “Thank you for letting me know!”

If someone discloses their status to you, it’s a sign that they trust you, so do your best to be respectful and supportive in return. If you have questions, ask them how you can get informed about HIV. A small gesture to learn more will show that you care.

FHI 360

2. “It’s always good to know your status.”

Knowing your HIV status is an important part of taking care of your overall health. Offer the person encouragement for taking that critical first step. Sometimes a person may confide in you about their status in hopes you will feel comfortable enough to do the same. Feel free to share your status or the date of your last test.

FHI 360

3. “How can I help you stay healthy?”

Science has proven that people with HIV who take their medication as prescribed and achieve and maintain an undetectable viral load have effectively no risk of transmitting the virus to their sexual partners. The fact is that people with HIV who are in treatment not only help themselves stay healthy, but also protect their partners. Let them know that treatment can be as simple as taking one pill every day, and encourage them to take charge of their health.

FHI 360

4. “Is there anything I can do?”

If someone has been recently diagnosed, they might be feeling overwhelmed or confused. Tell them that they can reach out to you for support. Offer to accompany them to appointments or support groups if they are interested.

FHI 360

5. “I’m glad that you feel comfortable telling me about your status.”

Remind them that they are still the same person to you, and that an individual is not defined by his or her HIV status. Continue to treat them as you normally would in private and public, and remind them that you value their trust and will respect their privacy.

FHI 360



Zero HIV cases means zero HIV risk

From major disaster, conflicts and under-reported stories, we shine a light on the world’s humanitarian hotspots

How hard is it to say that HIV-positive people who have suppressed the virus through effective antiretroviral drugs do not pose any transmission risk to their sexual partners? Pretty hard, it seems, as just about every day I see some commentator fudge their response, with statements using terms such as “extremely unlikely” or “reduces the risk”.

Such woolly statements are no help to people living with HIV.

From the very early days of effective HIV treatment, researchers noticed a correlation between increases in access to treatment and decreases in new infections. It took until 2008 for scientists to poke their heads far enough above the parapet to state that someone on antiretroviral therapy who was undetectable could not transmit HIV sexually, in what later came to be known as the Swiss Statement.

Since then, successive studies have searched for a case of transmission from someone who is virally suppressed; yet all the studies have failed to find a single case.

The understanding that HIV cannot be sexually transmitted when the virus is undetectable has gone from concept, to confidence. Now, with the results of the PARTNER 2 study, which found no transmission of HIV following 75,000 condomless sex acts, it has moved to certainty.

The final slide in the report presentation at the AIDS 2018 Conference in Amsterdam in July employed the same phrase that activists have used to celebrate the impact of HIV treatment as prevention, “Undetectable equals Untransmittable”.

At the conference, Dr Alison Rodger, an honorary consultant in infectious diseases and HIV at the Royal Free Hospital in London, summed it up perfectly. “You would have to have condomless sex for 419 years to have transmission,” she said. “The risk is effectively zero. U equals U.”

For those of us who live with the virus, this simple message has changed our lives.

Many of the commentators who are wary about declaring that “U equals U” are happy to admit that HIV can’t be transmitted by everyday domestic interactions but they still balk at saying the same about sex when the virus is undetectable. We know that HIV can’t be transmitted by kissing, spitting or by sharing teacups because no cases have ever been found. After all these years, “no cases” is sufficient to give us confidence that these are not transmission routes.

We can now say the same thing about sex when the positive partner is undetectable. And this is important.

Since the AIDS crisis first hit, many people’s sex lives have been tainted by fear. The sex we have, which should be an expression of intimacy, passion, lust, tenderness and joy, has all too often been accompanied by thoughts of “Is this safe enough?”, “Will I be OK?” or “Will he be OK?”

Treatment as prevention has made our sex not merely safer, but safe. It has granted us freedom from the fear of passing the virus on during our most intimate moments.

The goal of HIV treatment is a long and healthy life; its preventative impact is a side effect – but what a great side effect it is. “U equals U” underlines the importance of expanding access to treatment and of improving its uptake and adherence for all people living with HIV worldwide.

HIV stigma remains a public health crisis resulting, in extreme cases, in murder and suicide. It should be a public health duty to inform all of us who are living with the virus, and all of those whom we encounter, that effective treatment prevents transmission.

It is vital that when we educate people about HIV we rely on facts rather than fear. The news that HIV+ people on treatment present no risk of sexual transmission is too valuable, too exciting and too important for it not to be shared, understood and celebrated as far and as widely as possible.

by: Matthew Hodson


DNA technology provides novel strategy for delivery of complex anti-HIV agent

DNA electroporation technology successfully used to direct expression of anti-HIV immunoadhesins and to modulate their function in vivo

The Wistar Institute
Scientists have applied synthetic DNA technology to engineer a novel eCD4-Ig anti-HIV agent and to enhance its potency in vivo, providing a new simple strategy for constructing complex therapeutics for infectious agents as well as for diverse implications in therapeutic delivery.

Scientists at The Wistar Institute have applied their synthetic DNA technology to engineer a novel eCD4-Ig anti-HIV agent and to enhance its potency in vivo, providing a new simple strategy for constructing complex therapeutics for infectious agents as well as for diverse implications in therapeutic delivery. This critical development was published online in the journal EBio Medicine.

The development of a safe and effective HIV vaccine has proven critically challenging. Researchers are exploring passive immunization of laboratory-produced immunoadhesins as well as traditional gene therapy methods for delivery of these complex therapeutic molecules. Immunoadhesins are designed antibody-like molecules specifically engineered to efficiently neutralize diverse forms of HIV by binding with high affinity to the virus envelope.

“These complex therapeutics are difficult to deliver through traditional strategies and achieving full activity in vivo using DNA technology is also challenging,” said lead researcher David B. Weiner, Ph.D., executive vice president, director of the Vaccine & Immunotherapy Center and W.W. Smith Charitable Trust Professor in Cancer Research at The Wistar Institute. “We demonstrated that a combination of plasmids can be designed to produce a novel protein as well as its modifying enzyme, allowing them to collocate with each other and create a highly functional immunoadhesin.”

Electroporation of synthetic DNA (DNA/EP) consists of the application of small, controlled directional electric currents into the skin or muscle to facilitate optimal uptake of DNA molecules and local production of the DNA-encoded proteins. Using this technology, Weiner and colleagues were able to achieve robust and long-term in vivo expression. A single injection of the synthetic DNA formulation produced functional eCD4-Ig for several months in a mouse model.

Previous studies have shown that a particular modification of the immunoadhesins, called sulfation, favors their binding to the HIV envelope; therefore, co-expression of the TPST2 enzyme that operates this modification is necessary to enhance the anti-HIV potency of the produced eCD4-Ig. The team proved the ability of synthetic DNA to encode the TPST2 enzyme as well as the instructions to direct the produced TPST2 to the cell compartment where the eCD4-Ig molecule is manufactured. The combined delivery resulted in production of sulfated eCD4-Ig immunoadhesin that exhibited enhanced potency.

“This is the first report on the use of synthetic DNA to encode an enzyme that can effectively carry out its activity and modulate biological functions of a target protein with high efficiency in vivo,” said Weiner.

Collectively, these study results provide an important advancement for the field of HIV immunization and open the path to further applications for in vivo delivery of biologics.

This work was supported by the National Institutes of Health Integrated Preclinical/Clinical AIDS Vaccine Development Program (IPCAVD) grant U19 Al109646-04. Additional funding was provided by the Martin Delaney Collaboratory for HIV Cure Research and the W.W. Smith Charitable Trust Foundation.

Ziyang Xu from The Wistar Institute and Megan C. Wise from Inovio Pharmaceuticals, Inc., are first co-authors of this study. Other co-authors from Wistar include Hyeree Choi, Alfredo Perales-Puchalt, Ami Patel, Edgar Tello-Ruiz, Jacqueline D. Chu, and Kar Muthumani.