Program highlight (C13) The health impacts of sex work criminalization: a review of the evidence
Lucy Platt is Professor of Public Health Epidemiology, London School of Hygiene and Tropical Medicine. Her research focuses on examining how social and health policies and interventions influence people who sell sex and/or inject drugs’ vulnerability to blood-borne viruses, sexually transmitted infections (STI) and other health harms. Much of this work has focused on the UK, Russian Federation, East Africa and India and currently in Myanmar, Afghanistan and Colombia.
Professor Platt is also presenting in the 2-day pre-conference consultation on ‘Gender in public health and safety’. Find out more and register for the event here.
Presentation title: The health impacts of sex work criminalization: a review of the evidence
Session C13 on Sex work at 2pm on 22 October.
Co-authors: Grenfell, Pippa London School of Hygiene and Tropical Medicine; Meiksin, Rebecca London School of Hygiene and Tropical Medicine; Elmes, Jocelyn London School of Hygiene and Tropical Medicine; Sherman, Susan Johns Hopkins Bloomberg School of Public Health; Sanders, Teela University of Leicester; Mwangi, Peninah Bar Hostess Empowerment and Support Programme; Crago, Anna-Louise University of Toronto.
Background: Sex workers are at disproportionate risk of violence and sexual and emotional ill-health, harms that have been linked to criminalisation.
Research Objectives: We synthesised evidence on the extent to which sex work laws and policing practices, affect sex workers’ safety, health and access to services, and the pathways through which these effects occur, in order to inform evidenced-based policy-making.
Methods: We conducted a systematic review (quantitative and qualitative). We searched bibliographic databases for research with sex workers of all genders and terms relating to legislation, police and health. We operationalised criminalisation into categories of lawful or unlawful police repression of sex workers or their clients, including criminal and administrative penalties. We included quantitative studies measuring associations between policing and outcomes of violence, health and service access, and qualitative studies exploring related pathways. We conducted a meta-analysis to estimate the average effect of experiencing physical/sexual violence, HIV/sexually transmitted infections (STI) and condomless sex, among individuals exposed to repressive policing compared to those unexposed. We synthesised qualitative studies iteratively, inductively and thematically. We reviewed 40 quantitative and 94 qualitative studies.
Results: Meta analyses suggest that on average sex workers who had experienced repressive policing were at increased risk of sexual/physical violence from clients or partners (OR=2.99 95% CI=1.96-4.5, n=5204), increased risk of HIV/STIs (OR=1.87, 95% CI=1.60-2.19, n=12506) and more likely to practice condomless sex (OR=1.42 95% CI=1.03-1.94, n=9447) compared to those who had not experienced repressive policing. The qualitative synthesis showed that criminalisation and repressive policing disrupted sex workers’ work environments, safety and risk reduction strategies and access to health services and justice, including where clients are criminalised. Criminalisation and regulation frameworks exacerbated stigma, racial, economic and other inequalities. In decriminalised contexts, sex workers’ relationships with police and justice access have improved and they report being better able to refuse clients and insist on condom use.
Conclusions: The public health evidence clearly shows the increased harms associated with sex work criminalisation—including laws and enforcement targeting the sale and purchase of sex, and sex work organisation. These demonstrably harmful sex work policies and laws must be reformed urgently if sex workers’ right to health is to be realised.