Would Legalizing Prostitution Improve Public Health

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A combination of keywords and terms from MESH keywords and headers was identified, which included different terminology for population, high-income countries, and quantitative results. This was to ensure that articles related to health outcomes and legislation were included in the research. Search terms are listed in Table 1. Internationally, the official public health position on the decriminalization of the sex trade is clear. The World Health Organization, Amnesty International, Human Rights Watch, UNAIDS and the Global Commission on HIV and the Law agree that decriminalization is the right choice for every country in the world. Research from countries as diverse as Kenya, New Zealand, South Africa and Canada suggests that decriminalizing sex trafficking can reduce HIV, prevent violence and reduce stigma. What else can be said on this issue, at least from a public health perspective? ____ 1 Lucy Platt, Pippa Grenfell, Rebecca Meiksin et al., “Associations Between Sex Work Laws and Sex Workers` Health: A Systematic Review and Meta-Analysis of Quantitative and Qualitative Studies,” PLOS Medicine 15, No. 12 (December 2018), doi.org/10.1371/journal.pmed.1002680. 2 Thomas Manch, “No Human Trafficking in New Zealand`s Sex Industry, But Migrant Abuse Is Widewide, Report Finds,” Stuff, April 17, 2018, www.stuff.co.nz/national/crime/103129627/no-trafficking-in-nz-sex-industry-but-migrant-abuse-is-widespread-report-finds. 3 Max Ehrenfreund, “When Rhode Island Accidentally Legalized Prostitution, Rape Reduced Sharply,” The Washington Post, July 14, 2014, www.washingtonpost.com/news/wonk/wp/2014/07/17/when-rhode-island-accidentally-legalized-prostitution-rape-and-stis-decreased-sharply/. 4 The trapping model is a form of decriminalization of sex work that eliminates criminal penalties for the sale of commercial sexual services, but not for purchase. Unfortunately, the trapping model does not reduce the health and safety risks workers face and can exacerbate them, according to research.

5 “Assessment of Review of Application of Article 64A of the Sexual Offences Order (Northern Ireland) 2008: Offence of Purchase Sexual Services,” Northern Ireland Department of Justice, 17 September 2019, www.justice-ni.gov.uk/sites/default/files/publications/justice/assessment-of-impact-criminalisation-of-purchasing-sexual-services.pdf. The included items collected data from a number of high-income countries. Four or more studies were conducted in the following countries: Argentina [41,42,43,44,45.46], Australia [27,29,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64], Canada [65,66,67,68,69], Hong Kong [70,71,72,73,74,75,76,77], Italy [78,79,80,81], Japan [82,83,84,85,86], Singapore [87,88,89,90], Spain [91,92,93,94,95,96,97,98,99], Netherlands [100,103,104,105,106,107] and United States [108,109,110,111,112,113,114,115]. Two studies were found in each of the following countries: England [116,117], New Zealand [118,119], Portugal [120,121] and Scotland [122,123]. A study was conducted in Belgium [124], Chile [125], Czech Republic [126], Denmark [127], Estonia [128], Hungary [129], Panama [130], Puerto Rico [131], South Korea [132] and Switzerland [133]. Some studies were multijurisdictional, e.g. Australian studies comparing three or more states [27,53,54,55,56]. Studies have reported a number of health outcomes. Mental health problems were most commonly reported [29,41,42,43,44,45,46,48,49,50,52,53,54,56,57,58,59,60,61,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,115,116,117,120,121,122,123,124,126,127,128,129,130,131,131,133]. These included higher stress levels than among non-sex workers in the United States (n = 176) [115], social isolation of Asian sex workers in Western Australia (n = 94) [63] and high rates of mental disorders among sex workers in Switzerland (n = 193) [133].

Experience of violence [41,46,47,77,98,108,114,133], stigma [27,44,51,63,118], drug use [29,41,56,66,80,98,110,123,129,131), sexually transmitted infections (STIs) and blood-borne virus (BBV) rates [41,42,43,44,48,49,52,53,57,61,64,67,69,73,75,78,79,80,82,83,84,85,86,88,89,91,92,93,94,95,96,97,100,101,102,104,105,106,107,109,110,111,112,113,116,117,120,121,122,122,122,123,124,126,127,128,130,132] and use of Health [ 27,29,45,47,48,55,65,71,72,76,77,102,113,116,117,119,125] were also reported. Two of the five studies that reported experiences of stigma as a health outcome also found that experiences of stigma were a risk factor for reducing health service use by sex workers [27,118]. For example, Abel`s study found that sex workers often did not disclose their profession to health care providers for fear of stigma, resulting in less comprehensive health assessments [118]. The regulation of the sex industry is the subject of significant debate, with a complex array of cultural, political and social factors influencing regulatory patterns, which vary considerably from country to country and within countries. This systematic review examined the available evidence on the relationship between different approaches to regulating the sex industry in high-income countries and the associated impact on the health status of sex workers. Objectives included identifying health outcomes for sex workers, including sexual health, substance use, and experiences of stigma and violence. An electronic search of eight scientific databases revealed 95 articles that met the admission criteria. The findings suggest that sex workers in legalized and decriminalized countries showed better health outcomes, including awareness of health conditions and risk factors.

A commentary by Steen et al. in the recent Lancet series notes that “repressive and counterproductive policing,” including the arrest and detention of trafficked persons for “rescue” purposes, has outpaced much more effective responses in several countries. The understandable but destructive and simplistic mandate to “save and restore” sex workers is also imposed in the public health field, where providers are now tasked with identifying and responding to potential victims of sex trafficking. Certainly, health care providers have a duty to observe and assist patients in abusive situations of all kinds. They also have a duty to understand the complexities of the human experience, respond to the needs identified by patients, and pretend that patients are experts in their own lives, whatever they may be. Decriminalization has led to increased condom use rates and allows sex workers to organize community-based health practices that have been shown to improve health and reduce the risk of acquiring HIV. It also allows sex workers to file complaints and the police to deal with illegal acts such as assault, theft of services, employment of minors or coercion. In this decriminalized environment, sex workers can be strong allies in the fight against human trafficking, intimate partner violence and child abuse, as they can report incidents to police and social services without risk of arrest. We are grateful to the Curtin University Faculty Librarian for his technical assistance in using database search methods and strategies. SEATTLE, Washington – Looking at sex work through the lens of women`s empowerment versus oppression, there is evidence that legalizing prostitution can have individual and economic benefits. In the Netherlands, prostitution has operated under an effective regulated system for almost two decades. Regulatory practices that restrict sexual behaviour are essential to understanding how different societies perceive sex and sexual activity, and to understanding the benefits of legalizing prostitution.

Peer-reviewed articles on sex worker health and sex industry legislation were obtained electronically from the following academic databases: PubMed, ProQuest, Scopus, Current Contents Connect and Ovid (including Medline, Embase, PsycINFO and Global Health). The databases were selected in consultation with the university librarian and cover a wide range of clinical, social science and health policy documents. ♦ Rhode Island inadvertently decriminalized indoor prostitution in 1980 to clarify sex work laws. In 2003, the loophole was noticed by legislators and indoor sex work was criminalized again in 2009. A study published by the National Bureau of Economic Research found that during the six-year decriminalization period, the number of reported rapes in Rhode Island decreased by 31 percent and the national incidence of gonorrhea by 39 percent.3 Laws governing the sex trade have been reviewed for their impact on public health and safety. Inconclusive evidence was found specifically related to violence, exploitation and sexual health around the world and supports the following conclusions: Through the efforts of dedicated researchers and activists over the two decades between 1988 and 2009, public health professionals, medical institutions, and virtually everyone working in the field of HIV/AIDS have learned why harm reduction practices are essential. Services for people who use drugs have begun to improve, although they are still insufficient, mainly because they are severely underfunded. Progress has been made. For studies published in the early 1990s, the impact of the HIV epidemic on research practice during this period became evident. Studies this decade have been largely epidemiological, focusing on HIV prevalence and the role of sex workers as a vector of transmission [97,101,105,110,111,122,123,131].