Sex workers who face repressive policing are more likely to experience violence and poorer health and well-being.
This is according to new research helmed by Lucy Platt, Associate Professor in Public Health Epidemiology at the London School of Hygiene & Tropical Medicine (LSHTM); and co-authored by Pippa Grenfell, Assistant Professor of Public Health Sociology at LSHTM. It was published in PLOS Medicine.
To gather literature, the team searched databases of peer-reviewed journals from 1990 to 2018, for research on sex work, legislation, policing and health. Only studies reporting data provided by sex workers themselves were included. Data included in the review came from 33 countries.
The researchers specifically reviewed the effects of criminalization and police repression, examples of which included recent arrest, prison, displacement from a work place, confiscation of needles/syringes or condoms, and extortion, sexual or physical violence by police officers.
Using techniques including meta-analysis (pooling results from included quantitative studies), the team were then able to estimate the average effect of being exposed to repressive policing compared to no such exposure. The team also identified the main pathways through which these effects occurred in different legislative contexts (synthesizing results of included qualitative studies).
A systematic review found that sex workers who had been exposed to repressive policing (such as recent arrest, prison, displacement from a work place, extortion or violence by officers) had a three times higher chance of experiencing sexual or physical violence by anyone, for example, a client, a partner, or someone posing as a client. They were also twice as likely to have HIV and/or other sexually transmitted infections (STIs), compared with sex workers who had avoided repressive policing practices.
Sex workers who had avoided repressive policing were 30% less likely to engage in sex with clients without a condom – a risk factor for HIV and STIs. Although prevalence is highly variable in different contexts, in low and middle income countries, sex workers are on average 13 times more at risk of HIV, compared to women of reproductive age (age 15 to 49), so their ability to negotiate condom use is important.
“Where some or all aspects of sex work were criminalized, concerns about their own or their clients’ arrest meant that sex workers often had to rush screening clients negotiating services, or work in isolated places, to avoid the police. This increased sex workers’ vulnerability to theft and violence,” said Platt, lead author. “At the same time, police frequently failed to act on sex workers’ reports of such crimes, or blamed and arrested sex workers themselves, meaning that offenders could operate with impunity and sex workers were reluctant to report to the police in future. These experiences were reported time and again across a wide range of countries.”
The research also showed that repressive policing not only further marginalised sex workers as a population, but it also reinforced inequalities within sex-working communities, as police often targeted specific groups or work settings.
Grenfell, co-author, said: “It is clear from our review that criminalization of sex work normalizes violence and reinforces gender, racial, economic and other inequalities. It does so by restricting sex workers’ access to justice, and by increasing the vulnerability, stigmatization and marginalization of already-marginalized women and minorities.
She added that decriminalization of sex work is “urgently needed”, but other areas must also be addressed.
“Wider political action is required to tackle the inequalities, stigma and exclusion that sex workers face, not only within criminal justice systems but also in health, domestic violence, housing, welfare, employment, education and immigration sectors,” Grenfell said.
The researchers conclude that reform of demonstrably harmful policies and laws is urgently needed to protect and improve sex workers’ safety, health and broader rights.
But while the authors say that while legislative reforms and related institutional shifts are likely to require long-term efforts, immediate interventions are also needed to support sex workers. This includes the sustained and renewed funding and scale-up of specialist and sex-worker-led services that can help to address the multiple and diverse health and social care needs of people who sell sex around the world.