Want to Combat AIDS? Decriminalize Sex Work, Researchers Say
By Samuel Oakford
July 24, 2014 | 10:10 pm
Efforts to prevent HIV usually consist of proactive interventions — but when it comes to sex workers, leaving them alone may be the best prescription of all. A study presented by researchers at the 20th International AIDS Conference in Melbourne this week determined that decriminalizing sex work would have “the greatest effect on the course of HIV epidemics” across the world.
Female sex workers in low- and middle-income countries are more than 13 times as likely to contract HIV than women outside the industry, and are at high risk of transmitting the virus to others. In order to lower HIV rates worldwide, researchers at the conference argued, countries should make improving the circumstances of sex workers a top priority.
The study, which was published by the British medical journal The Lancet as the first in a series partly funded by the United Nations Population Fund, found that criminalization makes sex workers more likely to be beleaguered or abused by police and less likely to use condoms or seek treatment for HIV and other diseases.
Using a statistical model informed by previous surveys, the researchers calculated the potential diminishment in HIV infections over the next ten years in three cities — Vancouver, Canada; Mombasa, Kenya; and Bellary, India — should they decriminalize the trade. They found that this policy would lower HIV’s prevalence among sex workers in Vancouver by 37 percent, by 33 percent in Mombasa, and by 46 percent in Bellamy.
“We did a systematic review of the literature of the past five years,” Steffanie Strathdee, director of the University of California at San Diego’s Global Health Initiative and one of the paper’s authors, told VICE News. “Our evidence from the modeling supports full decriminalization.”
Public health advocates hailed the study’s conclusion.
“It highlights, for the first time, the intimate connection between a criminalized status and the risks that are associated with it,” Marine Buissonniere, director of the Open Society Public Health Program, told VICE News.
The World Health Organization earlier this month called for decriminalizing the “behavior of key populations” at risk for HIV.
“In places where sex work is criminalized you tend to find a community that is extremely vulnerable and marginalized, where they are subject to abuse in the healthcare system and more generally don’t enjoy the same set of human rights,” said Buissonniere. “When a country criminalizes either sex work or drug use it tends to push people underground and away from services.”
Though countries like the Netherlands and Germany have legalized sex work in defined contexts, and nations like Denmark have decriminalized it in certain circumstances (soliciting on the street is still illegal), the only two places in the world to have fully decriminalized it are New Zealand the Australian state of New South Wales. The distinction is important — decriminalization removes all “prostitution-specific regulations imposed by the state,” while legalization introduces new laws and regulations that are less punitive. In the latter framework, sex workers without proper permits or access are still forced to work underground.
“Legalization actually replicates some of the same problems that criminalization does,” Strathdee said. “The perspective is about taxes and control and not about human rights. Even in legalized environments there are police crackdowns.”
Countering a common concern voiced against reform, the number of sex workers in New Zealand hasn’t changed significantly since the profession was decriminalized in 2003. In New South Wales, which decriminalized sex work in 2009, sex workers actually have a lower prevalence of HIV than in the rest of the country.
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