One of the most moving and memorable moments at this conference was the plenary on Thursday morning. Yesterday I wrote about Dr. Cheryl Over’s presentation on sex work and HIV. The speaker that followed Overs was Debbie McMillan. She gave a beautiful presentation that wove together her personal story with moments of intensely insightful observations about the relationship between drug policy, sex work, criminalization, stigma and HIV. She told the audience about her history and life as a transgendered African-American woman who used drugs and was incarcerated for sex work. Now McMillan is a trans activist, sex worker advocate, writer and community organizer. She is studying for her undergraduate degree at the University of the District of Columbia where she sits on the Dean’s list and is a member of the Honor Society. As McMillan said, she embodies the people at the heart of the HIV crisis.  Like other speakers at this conference, she emphatically reiterated the need to have people most affected by HIV at the centre of program planning and implementation. Again and again we’ve heard the same important message.

McMillan left home for the streets at 14 because of the stigma of being a transgendered woman. She worked in the sex trade, was arrested and incarcerated. As she said, she used drugs to dull the pain of discrimination, loss and the difficult working conditions in her business. There were many points at which she could have contracted HIV, but she believes it was in prison where she was housed in a men’s cellblock. A travesty of discrimination.

McMillan’s talk revealed the outlines of a just and fair policy for people who use drugs and are sex workers. She reminded her audience that criminalization of drug use and sex work combined to make her life unsafe. And mass incarceration worsened an already dire public health situation. A treatment program for LGBTTQ persons helped her quit using drugs; that program, where she says she felt accepted for the first time, is no longer available due to lack of funding. Her commitment to alleviate the isolation and discrimination faced by sex workers, particularly those with HIV, lead to her work with HIPS, an outreach agency for sex workers in Washington DC. She now works for Transgender Health Empowerment in DC.

She closed her talk by urging political leaders to eliminate policies founded on moral judgment rather than public health. That includes the U.S. travel ban for people who use drugs and/or do sex work. As well as addressing multiple and intersecting forms of discrimination that heighten the risk of contracting HIV, and the serious reconsideration of the criminalization of drug use and sex work.