Clearly within policy arenas there are mixed perspectives on the impacts of the PEPFAR restrictions with regards to sex work. However, real world prevention care and treatment of HIV and AIDS for sex workers does not occur in policy arenas but rather on the ground, in venues and avenues far removed from policy discourse. Meanwhile, although policymakers reflect on the intent or the outcome of the pledge, on the ground the policy has and may continue to have consequences. As a result of the pledge, in many instances information sharing about successful programming with sex workers has nearly ceased. Sex work programming has become a taboo topic; organizations that receive other funding are likely to be interested in or to seek US government contracts and funds. Others with specific missions have reigned in all activities unrelated or tangentially related to their missions; this has affected many sex work projects the world over. The anti-prostitution pledge has prevented the sharing of information about successful programming and prevented scaling up successful operations.