During my trip to Vietnam last summer, I met a woman who had been a sex worker and who, after learning she was HIV positive, had become a counselor to other sex workers. I asked her why stopping the spread of HIV among prostitutes in Vietnam was so hard when awareness of the disease was fairly high there and condoms were widely available.

She told me, “If you could have condom-less sex with a man you do not know, who you do not want to touch your body, who will touch you in a way that will bring you no pleasure, for the same amount of money that you will be paid to do that five times with five men wearing condoms, what would you choose?”

I suddenly felt faint in the 110 degree heat. I’d been so naive to think that preventing HIV among sex workers was merely a matter of education and latex. Women knowingly risk exposure to HIV to economize the number of times they have to have sex with a stranger (they could make, say, the equivalent of $10 for one act of unprotected sex with one man, or $10 for five acts of protected sex with five men). It was, for them, all about the money—a conscious choice to lessen the atrocities of an act that was their only means of survival.

Our government dispenses PEPFAR (President’s Emergency Fund for AIDS Relief) money to Vietnam. But America’s ideological and morality-based restrictions on the kinds of programs PEPFAR can fund prevent the money from helping the sex workers. Yet until the women can find alternate means of feeding themselves and their families, and as long as there are men who will pay a premium for skin-on-skin sex, HIV will thrive.

My hope was restored after we sent writer Lucile Scott to profile the female sex workers of Pune, India. As she reports in “Taking Care of Business”, they have found a foolproof way of getting clients to pay for protected sex: Give them no choice. The women have decided that their longevity is worth having safer sex, even if that means having more of it with strangers. Thanks to community workers who empowered the women to value their health and band together over safe sex, anyone looking to get laid without latex in Pune is pretty much out of luck.

Frank talk about sex is so taboo in India that the government generally avoids addressing prostitution. Which means that sex workers aren’t forced underground. They can devise their own business strategies—such as demanding condoms. Consequently, the rate of new infections has plummeted in Pune. As is true in Vietnam, PEPFAR dollars cannot be directly applied to helping Pune’s sex workers in their quest for safer sex. But I have a suggestion. Perhaps our administration could recognize that for women who are so desperate for money that they sell their bodies, the question of sex work isn’t about promiscuity. It is about abject poverty forcing people to risk their lives. So, if PEPFAR dollars cannot be used to teach safer sex, or to develop programs to unionize sex workers, or to enforce condom usage and support the distribution of condoms to sex workers, perhaps the money could be used to help feed, clothe and house these women (and men). Because, I bet, that given the choice, most people would choose to have neither unprotected nor protected sex with strangers for a few rupees or, as the Vietnamese call their currency, a little dong.