Decriminalizing Sex Work

Ending the epidemic depends on addressing the rights and needs of all

by Ryan McElhose

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Photo by T3 Photography/ https://tcubedphotography.wordpress.com/

Since 1955, the motto “To Protect and Serve” has been plastered on police cars all across the United States. In the book Who Do You Serve, Who Do You Protect: Police Violence and Resistance in the United States, the authors provide a poignant critique of this incomplete, popularized motto. “Who—or what—is being protected? Who is being served? What are police actually doing in the United States, and towards what ends?” This critique extends to how law enforcement in the United States criminalizes sex workers, infringing on both their occupational and human rights and impedes the progress to end the HIV epidemic. We cannot end the HIV epidemic in the United States unless we end criminalization of sex work.

Currently, prostitution (a form of sex work) is criminalized in forty-nine U.S. states and legalized within a small number of brothels in the state of Nevada. However, even in Nevada, prostitution outside of a highly-controlled brothel system is criminalized. Criminalization and policing of sex work increase risk of violence and victimization of sex workers, including sexual violence, stigma, social isolation, and discrimination.

Criminalization of sex work has a direct impact on the HIV epidemic in this country. Studies show that condom use goes down in places where clients of sex workers are treated as criminals and sex workers themselves face increased policing. As reported in both Human Rights Watch’s “Sex Workers At-Risk: Condoms As Evidence of Prostitution in Four U.S. Cities,” and Open Door Society’s “Criminalizing Condoms,” police confiscate and destroy the condoms of sex workers and outreach workers and cite condom possession as justification to detain or arrest people on charges related to sex work. Because of this practice, some sex workers opt not to carry condoms, fearing police harassment and detention, thus increasing risk of HIV transmission. Additionally, in some states, sex workers living with HIV face heavier sentences due to their status.

The stigma associated with criminalizing sex work also has negative effects in the healthcare setting. According to the National Center for Biotechnology Information, fifty-three percent of surveyed medical students said they were not adequately trained to address their patients’ sexual issues comfortably. Also, in a December 2015 report on U.S. transgender women in sex work, about half of the respondents reported harassment by medical providers; almost a third were refused treatment; and “mistreatment was consistently higher for those with sex trade experience across all medical settings, especially in the ER and rape crisis centers.” When sex workers receive demeaning and unprofessional treatment in health care settings, they may be less likely to remain in care. Providers that are well-versed in serving sex workers are critical to helping sex workers living with or at risk for HIV stay healthy.

Virtually no federally funded HIV prevention, treatment, and care services are targeted specifically to sex workers in the United States. The National HIV/AIDS Strategy Update does not mention sex workers even once. The National HIV/AIDS Strategy Update is not alone in need of more inclusive methodologies, policy recommendations, or actionable steps. Advocates, researchers, and policymakers must include the voices of sex workers to ensure that our strategies to end the epidemic are truly effective.

If we are committed to ending this epidemic, we cannot ignore the needs of sex workers. We need to ask ourselves: Are we protecting and serving the sex worker community? Criminalization of sex work perpetuates HIV stigma and does detrimental harm to people’s agency, families, occupations. Sex workers deserve choices, resources, and supportive policies. Ending criminalization of sex work is a critical piece to ending the HIV epidemic in this country.


Ryan McElhose is from Hinton, Iowa, and completed his BA in Sociology at the University of Kentucky in December 2016. Ryan currently holds the Pedro Zamora Public Policy Fellowship at AIDS United in Washington, D.C. Outside of work and school, Ryan is interested in long distance running, drinking slurpees, tennis lessons, anything produced by Shonda Rhimes, and multivariate statistics.