Third in her series of blog posts discussing key publications on sex worker's health, guest blogger and ESWA Intern Hanna Nyman this week focuses on academic research findings - and the conclusions are clear.
Public health research can contribute to gaining a deeper understanding of the underlying determinants of sex workers’ health, the mechanisms through which they exert their effects and the ways in which they can be addressed in order to improve sex workers’ health. The resulting findings can then be used to develop guidelines and tools aiming to improve sex workers’ health, such as those discussed in the first two blog posts of this series. Furthermore, they can also be transformed into powerful arguments supporting the broader sex workers’ rights movement. Therefore the following discussion will focus on summarising findings from an important academic article focusing on sex workers’ health.
Led by the London School of Hygiene & Tropical Medicine, Platt et al. (2018) conducted the first systematic review and meta-analysis of academic literature focusing on sex work laws and policing practices and their effects on sex workers’ safety, health and access to services as well as the mechanisms behind these effects. Their meta-analysis of quantitative studies compared the estimated average effect of experiencing physical or sexual violence, condomless sex and HIV or STIs among sex workers that were either exposed or unexposed to repressive policing practices. Outcomes of other quantitative studies that could not be analysed in this way, along with findings of qualitative studies, were synthesised and summarised in a narrative manner. In total, the review included 40 quantitative and 94 qualitative studies.
The findings of the meta-analysis showed that repressive policing was associated with an increased risk of physical or sexual violence, HIV or STIs and condomless sex. Furthermore, exposure to repressive policing was found to be associated with an increased risk of drug and alcohol use in all of the studies investigating this association. Few studies focused on emotional health but those that did found that repressive policing and criminalisation had negative implications on sex workers’ emotional health. Analysis of qualitative studies showed that criminalisation disrupted sex workers’ workplaces and safety strategies, institutionalised violence, coercion and extortion and restricted access to justice, reproduced multiple stigmas and inequalities and restricted access to health and social care and support.
First, the qualitative studies showed that criminalisation and repressive policing practices disrupted sex workers’ places of work and safety strategies by rushing or displacing screening of and negotiations with clients to more hidden locations and by hindering communication with other sex workers. Moreover, sex workers didn’t carry, use or access condoms consistently due to their confiscation or the use or possession of condoms as evidence of sex work.
Second, in contexts of sex work criminalisation and regulation, the prevailing police practices institutionalised violence against sex workers and restricted their access to justice. Sex workers reported direct violence and abuse at the hands of the police, including harassment, intimidation, humiliation, extortion and otherwise derogatory treatment and physical and sexual violence. Additionally, sex workers that reported violence against them were exposed to further criminalisation, such as arrests for or accusations of other offences as well as further violence and extortion. Together with the passivity of the police to take action regarding the reported crimes, this contributed to creating environments where violence and abuse against sex workers were normalised and left unchecked.
Third, repressive police practices reinforced the inequalities and marginalisation sex workers experience and created inequalities within sex worker communities due to targeting of certain sex worker populations. Across diverse settings, the police targeted street-based sex workers and in some contexts sex workers faced harsher punishments than their clients or managers. Police mistreatment and restriction of access to justice were found to be targeted at sexual and gender minorities, women, people who use drugs, BIPOC people and migrants, reproducing and adding to the inequalities and discrimination that these groups experience. Fourth, criminalisation and police enforcement restricted access to health and social services by displacing sex workers in hard-to-reach settings and by acting as a barrier to accessing services, for example, due to fears of being reported to the police.
Based on all of the above findings, the authors concluded that all forms of criminalisation of sex work and repressive policing deprioritise sex workers’ health, safety, rights and access to justice and are associated with sex workers experiencing extensive harm. They emphasise the urgency of the full decriminalisation of sex work and its recognition as a legitimate occupation as well as efforts to reduce the structural inequalities, discrimination, stigma, violence and exclusion that sex workers experience. Finally, while these processes are ongoing, sex workers’ needs for health and social services should be met with immediate interventions. Guidelines and tools aiming to do just this have been discussed in the previous two blog posts.
The science is clear: the criminalisation of sex work is harmful to sex workers’ health, and it is critical that laws and policies that concern sex workers are informed by scientific evidence. What I find most striking is perhaps not the evidence itself but the fact that, in many contexts, it is still ignored. It is high time to let the evidence speak for itself.
Platt, L., Grenfell, P., Meiksin, R., Elmes, J., Sherman, S.G., Sanders, T., Mwangi, P. & Crago, A. (2018). Associations between sex work laws and sex workers’ health: a systematic review and meta-analysis of quantitative and qualitative studies. PLoS Med 15(12), e1002680.