Sex workers
have long struggled to be regarded as leaders in the prevention of HIV, not as
vectors of disease from which the public must be protected.  This challenge extends to the few counties in
the United States where
prostitution is regulated and permitted under law — in rural Nevada,
where the possible expansion of the brothel industry has US sex workers
hoping at last to be given a central role in governing their own industry,
rather than being seen as at-risk women who require protection from themselves.

In January,
the key lobbyist for Nevada’s legal brothel
industry, George Flint, obtained the backing of state Senator Bob Coffin for a bill to impose
a statewide tax on Nevada’s 25 legal brothels.  Flint’s
aspirations are two-fold: gain the favor of Nevada citizens who face bracing budget
cuts, and reinforce the status of brothels as legitimate businesses
contributing to the economy and community welfare. His tax proposal also has
the support of Las Vegas Mayor Oscar Goodman, who has asked Flint
to work on a model bill to create highly regulated legal brothels in Las Vegas, where
prostitution is currently illegal.  While
Senator Coffin intends to hold public hearings on prostitution at some point through
the Senate Taxation Committee, Flint’s
proposal is due to be heard by the state legislature this month.  All of this has sex workers and advocates
wondering: if the brothel business is going to be taxed and  expanded, who will be involved in developing
new regulations?  Will it be sex workers?

Sex worker
advocates’ concerns about brothel regulations go back to the early days of the
HIV/AIDS pandemic, when Nevada’s current system of mandatory HIV/STI testing
and quarantining brothel workers from the public were put into law without the
consultation of the workers themselves. Nevada state law mandates that sex workers
in the legal brothels must undergo monthly HIV and syphilis tests and weekly
gonorrhea and chlamydia tests.  In
addition, some county and municipal codes stipulate that sex workers may not
leave the brothels for more than 24 hours without being tested again.  Some brothels do not permit workers to be
off-premises at all in evening hours, unless accompanied by a chaperone. "Girls
do leave all the time, to go to town, to get their nails done," said George
Flint, "but I’m a huge fan of girls staying on-premises. Without the controlled
environment that the brothel provides, they may turn tricks outside without safety
things [condoms]."

Sex workers
don’t object to being tested for HIV and STIs on principle, sociologists Barb
Brents and Kate Hausbeck of the University
of Nevada – Las Vegas found in their
research with brothel workers. But workers and health advocates argue that
regulations governing their workplaces were put into place as a reaction to
public misperceptions about HIV, and that these practices have not been updated
now that more accurate information on HIV transmission and prevention has
emerged.  "The current system is old and
ineffective," said Amanda Brooks, who
has worked at a legal brothel in Nevada.
"It’s time for the brothel industry to enter the 21^st century." 

The Nevada brothels’
mandatory HIV testing laws were established in the mid-80’s, in response to
concerns that tourism dollars would be lost in the panic over HIV.  State law stipulates that all new workers to
the brothels must test negative for HIV as part of a pre-employment screening
conducted at approved testing sites, in addition to testing every thirty days
of continued employment.  Even as these
regulations were first adopted into law, the state Department of Public Health
maintained that the compulsory testing was passed "as a symbolic gesture," said
Barb Brents.  "It was a gut reaction to
the AIDS crisis."  In a 2006 interview,
Rick Reich, Communicable Disease / AIDS Services Supervisor for the Clark
County Health Department, said of the mandatory testing law, "[W]e test these
people so often, it’s almost like we over-test them. That doesn’t stop the
infections from coming into the brothels by the customers.  That’s where the mandatory condom use comes
in."

The one existing Nevada brothel regulation that effectively
keeps sex
workers safe was pushed for by workers themselves — a statewide
mandatory
condom policy.  Sex
workers had been demanding that condom use be made mandatory across the
brothel system in order to make uniform the safety practices they
already knew worked best, but it wasn’t until 1987, after compulsory
HIV/STI testing had been adopted into law, that brothel owners realized
their competitive advantage was at risk
unless a statewide condom policy was in place.
"In my understanding, it was the workers
that wanted [mandatory condoms]," said Cheryl Radeloff, assistant
professor of
Women’s Studies at Minnesota State University – Mankato, who has
studied the
Nevada brothels. "They were scared of being exposed to HIV," which
testing the workers
alone cannot prevent from occurring.  The practice remains effective,
both for prevention and to demonstrate what workers can accomplish
collectively.  As Radeloff observed, "the workers all bought in to this
law because it was the workers who most wanted it."  

Sex workers have also questioned
the messages about testing and the sexual health information they receive from
their employers.  Amanda Brooks, who
worked in a brothel this summer, wrote that
she was told by the health care providers referred to her by the brothel that
she would not be tested for hepatitis because "Mexicans and Asians carry
hepatitis" and she appeared to be white. 
Said Brooks, "We weren’t given accurate basic health information at my
brothel."

"Look at
the tests that are pushed," said Cheryl Radeloff.  "We can’t use throat and urine cultures for
testing gonorrhea and chlamydia because the law stipulates a cervical specimen
is to be taken.  And with HIV – we can’t
use rapid tests, because there’s no provision for them in the law. There’s a
lag between the law and best practices." In addition to the weakness of relying
on twenty year old laws to set current public health standards, sex workers
have not yet been considered to be important in the design and implementation
of brothel health policy. Asked Radeloff, "Where’s the advocacy for workers
within the brothel system to take roles as peer advisors and mentors?" 

"As workers
and health advocates, we can push for an update to the current system, for an
assessment of best practices in brothel health," said Naomi Akers, executive
director of St. James Infirmary,
a peer-run occupational health and safety clinic for sex workers. Akers also
worked in the Nevada
brothels for several years. Currently, brothel workers are responsible for the
costs of their own tests.  Additionally,
if a worker leaves the brothel for more than twenty-four hours, she must be
re-tested for HIV before being allowed to return to work.  However, the brothels currently use the ELISA
HIV test, which may not detect the antibodies that cause HIV for up to three
months.  "If you leave the brothels for
just twenty four hours, it doesn’t make any sense," said Akers. "The RNA PCR
test is what we offer for HIV screening in our clinic. It has a shorter window
period for detection, and tests for the presence of the virus itself."

As brothel
workers carry the cost of their own test, this twenty-four rule may have more
to do with encouraging workers to stay on-site and work continuously rather
than pay to be tested and lose work while waiting for results.  Said Susan Lopez, director of the Sex Workers’ Outreach Project-Las Vegas, "Sometimes
it feels like they just want to keep the ‘dirty whores’ out of the city so that
they don’t infect the public," and even with overwhelming evidence that sex
workers are not any more responsible for the transmission of HIV, these attitudes
remain.  In fact, there are sex partners
involved in the Nevada
brothel system who aren’t tested: the clients. "I’m sure over the years,
statistically speaking, that I had a client who was HIV positive," said
Akers.  "And still, with condom use, it’s
entirely possible for workers to remain HIV negative."

"The
rhetoric that needs to be crushed right off the bat is that women need to be
confined," said Brents. "There is just an acceptance of this being the way
things are. But to hear George Flint talk, there’s the sense that now that we
could do it right." Now that Flint needs to convince
legislators to support his bill giving even more legal status to prostitution
in Nevada,
shifting the public’s perception of brothel workers — from that of outsider threats
to contributing members of the community – could not be better timed.            

To date, no sex workers have been
included in the brothel regulatory boards, though Flint said he is open to this.  But as sex workers and advocates have said, being
willing to listen to sex workers is not enough. 
Rather, ensuring sex workers have an equal voice in lobbying for policy
based on evidence over unfounded fears should be his first step in proving his
commitment to a better brothel business.