Sex Worker Advocacy

Power of Evidence
A movement to decriminalize sex work gets a boost from a multi-nation study
by Larry Buhl

At the XX International AIDS Conference, Richard Horton from The Lancet holds up the journal’s special-theme issue on HIV and sex work. Photo by IAS/Steve Forrest
At the XX International AIDS Conference, Richard Horton from The Lancet holds up the journal’s special-theme issue on HIV and sex work. Photo by IAS/Steve Forrest

Presentations at a session on HIV prevention strategies for sex workers, which took place at the XX International AIDS Conference two months ago in Melbourne, Australia, showed that decriminalization of sex work could significantly decrease global HIV infections among female sex workers.

The study was part of a series of papers by The Lancet that underscores the need to address one of the highest risk groups of HIV—sex workers—to impact the HIV epidemic.

Researchers who studied HIV among female sex workers in Canada, India, and Kenya concluded that structural changes, like decriminalizing sex work, give sex workers greater control over their environment. That control makes it safer for them and their clients.

Anna-Louise Crago, a doctoral candidate at the University of Toronto, was an editor of the Lancet series. As a former sex worker, Crago has a firsthand understanding of the challenges faced by this population.

Crago says that sex workers reported that perpetrators knew that they could not access police protection. “The antagonistic relationship with police that criminalization creates and the abuse by police that criminalization fuels across many contexts creates a climate of impunity for violence against sex workers, by police and by their clients.”

Because sex work is a crime almost everywhere in the world, men and transgender people who trade sex are driven underground and face unsafe situations, according to Steffanie Strathdee, Associate Dean of Global Health Sciences at the University of California San Diego School of Medicine and one of the leaders of the Lancet series. In talking with A&U, she pointed out how laws against sex work and the environments sex workers face enhance an already perilous situation.

“They fall prey to abusive johns and police. They face an increasing risk of violence, and due to fear of arrest they are less likely to insist on limits and safeguards, including condom use. Imagine if you are a sex worker on the streets trying to escape the police, you’re going to work in more remote environments where you can’t be found, and that leaves you prey to abuse by clients.”

The controversial policy of condoms as evidence—police “proving” that suspects are engaging in sex work by finding condoms on their persons—is just one example of the system working against the health and safety of sex workers.

“Police may think they are doing a good thing by taking condoms away, and may not realize in fact they are not going to prevent this person from having sex,” Strathdee continues. “They are just going to have unprotected sex or reuse condoms and that isn’t going to help anyone.”

The Lancet series on sex work and HIV comes on the heels of a World Health Organization (WHO) report that urges governments to decriminalize behaviors to better address the spread of HIV:

In the report summary, the WHO said; “Countries should work toward decriminalization of behaviours such as drug use/injecting, sex work, same-sex

Courtesy: The Lancet
Courtesy: The Lancet

activity and nonconforming gender identities, and toward elimination of the unjust application of civil law and regulations against people who use/inject drugs, sex workers, men who have sex with men and transgender people.”

The WHO says that sex workers are fourteen times as likely to have HIV as other women, and transgender women fare the worst: they’re almost fifty times as likely to have HIV as other adults.

Megan McLemore, a senior researcher in the Health and Human Rights Division of Human Rights Watch, points out that some individuals belong to more than one of these high-risk groups and that transgender sex workers face dire conditions.

“Transgender people are highly susceptible to HIV because the environment of risk disproportionately affects trans people,” McLemore says. “When you combine employment discrimination, getting kicked out of houses, you have a lot of people who have to engage in sex work for survival.”

McLemore says what unites these groups is that their activities are either illegal or heavily stigmatized in many parts of the world. That means that they are unlikely to seek out medical help or advice simply because they don’t want to be arrested for being gay or having sex for money.

McLemore and other decriminalization advocates say the proclamations from the WHO and the Lancet series have significant implications for HIV prevention because they take the onus of protection off the individual and castigate legal systems that make it difficult, if not impossible, to prevent the spread of HIV among the sex work population.

A few parts of the world have attempted to address the dangers to sex workers by changing their laws. New South Wales, Australia, decriminalized sex work in 2009. So far New Zealand has not experienced any repercussions from decriminalization, although sex worker advocates agree that not a lot of research has been done since 2009 and that the rate of HIV and other STDS in that country were low to begin with.

In December, Canada’s nine Supreme Court justices unanimously struck down laws targeting sex work. The Court proclaimed that Canada’s laws caused unreasonable harm to sex workers’ safety and health. But the battle isn’t over yet. The Court gave the government twelve months to respond and the legislature has introduced legislation to re-criminalize sex work. Because conservatives have a majority in the parliament there is a good chance they will succeed in reversing the Court’s ruling.

“We have a very right-wing government here and the Prime Minister is close to his evangelical base and is an evangelical,” Crago said. “Sex workers may have to go back to court if it is re-criminalized, and show that the laws are unconstitutional.”

Short of complete decriminalization, or even legalization, it is possible that changing some police policies could have a positive impact on the health and safety of sex workers. One of these policies is condoms as evidence. Not surprisingly, this policy often keeps sex workers from carrying protection.

Human Rights Watch released a 2012 report on the condoms-as-evidence policy in four cities, Washington, D.C., New York, San Francisco, and Los Angeles, and since then has had success in changing policies, McLemore tells A&U.

“In San Francisco the prosecutor has agreed not to use condoms as evidence in misdemeanor [investigations] and police have agreed not to confiscate condoms. In New York City, a bill has not yet passed, but prosecutors in four of five boroughs have agreed to not use condoms as evidence. In D.C., while not admitting they had done it in the first place, the police reassured the community by issuing cards saying they would not confiscate [condoms] and a number with a complaint line for any abuse by metro police.”

In part of Nevada, sex work is tolerated, and some areas around the world have permissive attitudes like red light districts where police turn a blind eye.

But McLemore and Strathadee agree that complete decriminalization will have the biggest impact on the health of sex workers and that it needs to happen on a multi-country level.”
With the WHO declaration and the Lancet study, the movement to de-criminalize sex work has gotten a boost. But Crago admits there is still a lot of work to do.

“The discussions around sex work often happen in very sensationalistic and moralistic terms that devalue or silence sex workers’ voices. Hopefully we are moving to the point where their voices are heard and respected. I think many people regardless of how they feel about sex work understand the value of evidence, and I think the evidence is clear and convincing that criminalizing sex work has a devastating effect on sex workers’ health.”

Larry Buhl is a radio news reporter, screen- writer, and novelist living in Los Angeles. His podcast on employment issues, “Labor Pains,” can be found at


  1. Full decriminalization of all aspects of consensual sex work
    Means No One That Is Already a Victim Will Not Be Re-traumatized With Arrest!

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