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(New York) – Louisiana state laws and practices that prohibit access to sterile syringes and criminalize sex work contribute to an uncontrolled HIV epidemic and an extremely high AIDS death rate, Human Rights Watch said in a report released today. The AIDS death rate in Louisiana is more than double the US average. New Orleans police regularly interfere with sex workers who carry condoms, putting them and their clients at risk of HIV.

The 57-page report, “In Harm’s Way: State Response to Sex Workers, Drug Users, and HIV in New Orleans,”documents government violations of the right to health and other abuses of at-risk populations in New Orleans. It calls for changes in state and local laws and policies that stigmatize, discriminate against, and facilitate police abuse of sex workers and drug users, and interfere with health services for people at high risk for HIV. The report was released in advance of the third annual Southern Harm Reduction and Drug Policy Conference, which opens in New Orleans on December 12, 2013.

“The HIV epidemic in New Orleans is one of the worst in the US, and proven strategies for addressing it are being ignored,” said Megan McLemore, senior health researcher at Human Rights Watch and the report’s author. “People who use drugs can’t get clean needles, and police are confiscating condoms from sex workers and those suspected of sex work, such as transgender women.”

The southern United States has the fastest-growing HIV epidemic and the largest number of people dying of AIDS of any region in the country. Louisiana’s two largest cities, Baton Rouge and New Orleans, have the second and third-highest rates of new HIV infection in the nation. In New Orleans, 40 percent of people with HIV are not receiving treatment.

Louisiana has an estimated 45,000 people who inject drugs, a quarter of them in New Orleans. Yet the city has few services, such as syringe exchanges, shown to reduce HIV and hepatitis infections among injection drug users. The city’s one public syringe exchange receives no government funding and is open for only two hours a week. Because state criminal law prohibits possession of syringes for non-medical use, the exchange operates under a cloud of legal uncertainty. Volunteers from small “underground” exchanges risk arrest to deliver clean needles to people who need them, sometimes by bicycle.

The Human Rights Watch report is based on interviews conducted in 2013 with 170 New Orleans residents who acknowledged exchanging sex for money, drugs, or life necessities. One-third of those interviewed were transgender women and three-quarters were African-American. Researchers also interviewed police, public defenders, state and local government officials, public health providers, and advocates for people living with HIV.

“New Orleans and the state of Louisiana should be leading the charge against HIV by funding programs that have been proven to prevent HIV,” said Deon Haywood, executive director at the New Orleans-based non-profit Women With A Vision, a co-sponsor of the harm reduction conference. “But when it comes to saving the lives of people who use drugs, it’s left to advocates to do the work of the New Orleans Health Department.”

Sex workers interviewed by Human Rights Watch described abusive and unlawful police behavior. In addition to harassing sex workers for carrying “too many condoms,” police frequently profiled transgender women as sex workers and subjected them to vulgar and degrading verbal abuse as well as extortion for sexual favors. “Police went through my purse and called me a ‘thing’ and asked what I needed all those condoms for,” one transgender woman told Human Rights Watch.

Louisiana law prohibits “crimes against nature,” defined as the solicitation of oral or anal sex. The law, which refers to such sex as “unnatural acts,” until recently required those convicted under these statutes to register as sex offenders. In some cases, these laws impose more severe penalties than anti-prostitution laws.

People of color and members of the lesbian, gay, bisexual and transgender, and intersex (LGBTI) community reported stigma and discrimination in enforcement of these laws, which also impedes HIV prevention efforts.

“The ‘crimes against nature’ laws are nothing less than state-sponsored homophobia,” McLemore said. “They should be repealed without delay.”

The frequent arrest and detention of sex workers, transgender women, and injection drug users interfered with their ability to access and maintain their HIV medications, Human Rights Watch said. LGBTI people in particular also reported frequent assaults by other inmates and other unsafe conditions at the Orleans Parish Prison.

One transgender woman told her social worker that she was arrested for prostitution 10 times in three years, with each arrest interrupting her appointment with an HIV clinic. In jail, she received no HIV medication.

Most of those interviewed by Human Rights Watch lacked access to basic housing and health care services. Statewide, injection drug users are among those most likely to develop AIDS within six months of an HIV diagnosis, an indication of late testing and alienation from the health care system.

The decision by Governor Bobby Jindal to not expand the federal Medicaid program in Louisiana is a missed opportunity to improve access to HIV care, Human Rights Watch said. In addition, the state’s housing trust, designed to support low-income housing with state investment, is desperate for funds.

Louisiana should decriminalize adult, consensual sex work in the interest of public health and human rights, Human Rights Watch said.

“Louisiana’s government should choose improved public health over punishment for sex workers, drug users and others at high risk for HIV,” McLemore said. “For too long the state has neglected investing in health care and other basic human needs.” 

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