A new study from researchers at the London School of Hygiene and Tropical Medicine (LSHTM) has found that criminalisation and repressive policing of sex work, including in countries with the 'Nordic Model', is linked to increased risk of violence, HIV and sexually transmitted infections. The study concluded that reforms are needed to protect and improve sex workers’ safety, health and broader rights. The research is described by LSHTM as "first systematic review to examine the impacts of criminalisation on sex workers’ safety, health, and access to services".
Researchers found that sex workers who experience 'repressive policing', including arrest, imprisonment and extortion by police, were three times more likely to experience sexual or physical violence from anyone, including clients, partners, or someone posing as a client. They were twice as likely to have HIV or another sexually transmitted infection as sex workers who had not experienced this type of punitive law enforcement.
The study found that sex workers who had avoided repressive policing were 30% less likely to engage in sex with clients without a condom. Sex workers in low and middle income countries are around 13 times more likely to be living with HIV, and ability to negotiate condom use is critical.
The systematic review and meta-analysis was published in the journal PLOS Medicine, led by Lucy Platt, associate professor in public health epidemiology, and Pippa Grenfell, assistant professor of public health sociology. The researchers gathered data from peer-reviewed journals published between 1990 and 2018 on sex work, legislation, policing and health. The review uses data from 33 countries, and only studies reporting data provided by sex workers themselves were included.
The research showed that criminalisation of the clients in Sweden and Canada, known as the 'Nordic Model', did not improve sex workers’ safety or access to services. Conversely they found that in New Zealand, following decriminalisation, sex workers reported being better able to refuse clients and insist on condom use, having found improved relationships with police and managers.
The study also showed criminalisation can exacerbate inequalities within sex worker communities. Under legalised models, such as in Guatemala, Mexico, Turkey and Nevada (USA), some sex workers were afforded access to safer working conditions but the majority of sex workers were excluded from this. They also found that police often targeted specific groups or types of work places, further reinforcing these inequalities.
Pippa Grenfell, co-author and Assistant Professor of Public Health Sociology at LSHTM, said: “It is clear from our review that criminalisation of sex work normalises violence and reinforces gender, racial, economic and other inequalities. It does so by restricting sex workers’ access to justice, and by increasing the vulnerability, stigmatisation and marginalisation of already-marginalised women and minorities.
You can access the full study on our website here, or on the PLOS website. The research team have also published a 2-page summary of the findings, which you can access here. You can also read a summary of the findings on the LSHTM website.