The harm reduction approach is shortsighted, doomed to failure, and ethically lacking. It fails to recognize that many prostitutes are unable to negotiate condom use with their clients but often are forced to provide whatever services the client may want. In addition, it is common knowledge that prostitutes are often paid more if they agree to have sex without a condom. In fact, a study in Calcutta India found that prostitutes who regularly use condoms suffer a 79% reduction in their earnings over prostitutes who do not use condoms.1 A 79% loss of income is a huge motivator to forego the use of condoms!
Furthermore, advocating regular testing for sexually transmitted infections ignores the biological characteristic of latency. Latency refers to the fact that every type of infection—including sexually transmitted infections—has a period of time before it begins to manifest itself. In addition, for every test performed to identify a sexually transmitted infection there is a period of time between when the infection occurs and when the test will be able to detect it. This is called the “window period.” According to the CDC, for HIV testing, the usual window period is 4-6 weeks, but may be as long as 3 months.2
Even if a prostitute is being tested every week for HIV, she will test negative for at least the first 4-6 weeks and possibly the first 12 weeks after being infected. If we assume that he or she takes only 4 weeks to become positive, because there is an additional lag time of 1-2 weeks to get the results back, there will be at best a window period of 6 weeks for a prostitute. The average prostitute services between 10-15 clients per day. This means that while the test is becoming positive and the results are becoming known, that prostitute may expose up to 630 clients to HIV. This is under the best of circumstances with testing every week and a four-week window period. It also assumes that the prostitute will quit working as soon as he or she finds out the test is HIV positive, which is highly unlikely. This is not the best approach for actually reducing harm. Instead, in order to slow the global spread of HIV/AIDS we should focus our efforts on abolishing prostitution.