Decriminalise prostitution – it’s the best way to safeguard sex workers’ health

Sexual health nurse Louise Cahill explains why she asked RCN congress to back her call

Sexual health nurse Louise Cahill explains why she asked RCN congress to back her call

Picture: iStock

There is mounting evidence that the decriminalisation of prostitution would improve sex workers’ health and safety.

A recent systematic review of the associations between sex work laws and sex workers’ health, led by the London School of Hygiene and Tropical Medicine, found that sex workers who had been subjected to recent arrest, prison or displacement were three times more likely to experience sexual or physical violence and twice as likely to have HIV and/or other sexually transmitted infections (STIs).

The other side of the debate

Nurse Ellen Grogan, co-founder of the group Nordic Model Now!, is campaigning for implementation of an alternative to the full decriminalisation of prostitution. Read more

Both the World Health Organization (WHO) and United Nations AIDS guidelines recommend that countries work towards the full decriminalisation of sex work.

Fear of arrest deters reporting of violence

Of the estimated 80,000 sex workers in the UK, around 90% are women. Although it is legal to be a sex worker, it is illegal to work with others – something many want to do for safety reasons.

The fear of being arrested deters sex workers from reporting violence, and if a woman gets a criminal record it makes it harder for her to find other employment.

Sex workers can face distinctive health challenges. Fear of judgement and criminalisation, language barriers and unstable immigration status can make it harder for people to access healthcare even though their need is great – especially sex workers presenting with STIs, drug and/or alcohol dependency and mental health issues.

‘Decriminalisation in New Zealand has helped sex workers refuse clients and insist on condom use’

In 2003, New Zealand became the first country to decriminalise sex work. Five years later, a report by the government’s prostitution law review committee found no increase in prostitution or trafficking.

Further research in New Zealand, published in 2014, showed that decriminalisation has helped sex workers refuse clients and insist on condom use. Removing the fear of arrest or prosecution has made it easier for sex workers to report violence, and a 2014 study in The Lancet found decriminalisation could reduce new HIV transmissions by up to 46% globally over a decade.

Sex workers’ experience should count in this debate

In nursing, we acknowledge that experience makes people ‘experts’, whether it is those living with a particular illness or condition or people who have experienced homelessness or bereavement.

We advocate for their voices to be heard, and invite them to give insight into care delivery and policy – so why are sex workers shut out of this debate? In a world still obsessed with telling women what they should be doing with their bodies, decriminalisation focuses on empowering sex workers rather than giving governments greater control over them.

Decriminalisation is supported by the Global Alliance Against Traffic in Women, a network of more than 80 organisations from around the world. Through its international work on people trafficking, this organisation found that decriminalisation of sex work would help the fight against human trafficking.

Prostitution and sex trafficking

It is calling for sex work and trafficking to be delinked, a position backed by the Global Commission on HIV and the law, which states that ‘sex work and sex trafficking are not the same… the former is consensual, whereas the latter is coercive.’

The Global Alliance Against Traffic in Women says ‘sex workers are uniquely positioned to detect cases of exploitation and human trafficking, but the criminalised status means they would implicate themselves if they report cases of abuse.’

The Nordic Model, which decriminalised street-based sex workers and criminalised buyers, was introduced in Sweden in 1999 and aims to reduce prostitution. However, Jay Levy, who has conducted research in Sweden over several years on the outcomes of the criminalisation of the purchase of sex, found ‘no convincing empirical evidence that the law has resulted in a decline in sex work in Sweden, which was the law's principal ambition’.

‘As an evidence-based profession, we need to put aside any judgements and biases and follow the large body of research’

Dr Levy’s research countered the claim that sex workers have been decriminalised; sex workers can be prosecuted under procuring laws when they band together for safety. Landlords have been under police pressure to evict sex worker tenants – or face prosecution themselves. Most worryingly, he found harm reduction initiatives, such as giving out condoms, have been undermined.

What the UK can learn from other countries

In the UK, austerity policies have caused prostitution to increase. As poverty rises, more women turn to sex work to survive and feed their families.

Evidence from other countries also shows that criminalising buyers undermines safety; after Ireland’s sex purchase law was introduced, reported incidents of violent crime against sex workers rose by almost 50%.

In France, a two-year evaluation of a similar law found 42% of sex workers were more exposed to violence, and 38% have found it increasingly difficult to insist on condom use. In Norway, sex workers have faced evictions, prosecutions and increased stigma, with migrant workers particularly targeted.

The decriminalisation of sex work is backed by Amnesty International and Human Rights Watch, and by women’s organisations such as Sisters Uncut and Women Against Rape.

As nurses, we should be protecting human rights and lending our voices to those who need our support in securing them. As an evidence-based profession, we need to put aside any judgements and biases and follow the large body of research carried out by organisations such as the WHO and the United Nations, and call for the decriminalisation of sex work to improve health and promote equality.

RCN congress 2019: What’s on the agenda?

Louise Cahill is a sexual health clinical nurse specialist in Somerset. She presented a resolution at RCN congress 2019 (held in Liverpool, 19-23 May) calling on the college to lobby UK governments to decriminalise prostitution


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