Realigning government action with public health evidence: the legal and policy environment affecting sex work and HIV in Asia

Gruskin, Sofia; Pierce, Gretchen Williams; Ferguson, Laura

doi:10.1080/13691058.2013.819124

Cited by 7 publications

(4 citation statements)

References 33 publications

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“…Our study identified several barriers to health care access among female Ugandan sex workers in Guangzhou. Consistent with studies among sex workers in China [ 26 ], Asian countries [ 27 ], and other countries [ 28 – 30 ], lack of legal status and a valid visa were key barriers to health service access among women in our study. Fear of being arrested and the perception that hospitals required a valid visa to obtain health care services discouraged women in our study from accessing hospital services.…”

Section: Discussionsupporting

confidence: 88%

Barriers to health service access among female migrant Ugandan sex workers in Guangzhou, China

Davis

Meyerson

Aghaulor

et al. 2016

Int J Equity Health

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BackgroundIncreased trade between China and Uganda has fueled trafficking of female Ugandans into China. These women may face challenges accessing health services. This study focused on examining barriers to health care access among female Ugandan sex workers in China.MethodsIn 2014, we undertook in-depth interviews with 19 female Ugandan sex workers in Guangzhou, China. Interviews focused on barriers to health service access and were analyzed using an a priori coding framework followed by open-coding to capture emergent themes.ResultsOut of 19 women, 12 women reported a history of being trafficked into China. None of the women had a valid Chinese visa. Fear of being arrested for lack of documentation discouraged women in this sample from accessing hospital services. Low pay, housing exploitation, and remittances contributed to participants’ lack of financial resources, which further inhibited their ability to access health services. Participants expressed feeling social isolation from the local community and reported mistrust of local individuals and organizations, including hospitals.ConclusionUgandan sex workers in China faced substantial structural barriers that limited health service access. Policy changes and the development of new programs are urgently needed to ensure these women have improved access to health services.

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Section: Discussionsupporting

confidence: 88%

Barriers to health service access among female migrant Ugandan sex workers in Guangzhou, China

Davis

Meyerson

Aghaulor

et al. 2016

Int J Equity Health

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“…The criminalisation of some or all aspects of prostitution remains the dominant legal approach globally,1 4 despite growing empirical evidence and clear international guidelines by the WHO, UNAIDS, UNDP and UNFPA calling for full decriminalisation of sex work as necessary to promoting the health and human rights of sex workers (see online supplementary materials for a summary of legal and regulatory responses to sex work).…”

Section: Introductionmentioning

confidence: 99%

Criminalisation of clients: reproducing vulnerabilities for violence and poor health among street-based sex workers in Canada—a qualitative study

Krüsi

Pacey

Bird³

et al. 2014

BMJ Open

126

131

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ObjectivesTo explore how criminalisation and policing of sex buyers (clients) rather than sex workers shapes sex workers’ working conditions and sexual transactions including risk of violence and HIV/sexually transmitted infections (STIs).DesignQualitative and ethnographic study triangulated with sex work-related violence prevalence data and publicly available police statistics.SettingVancouver, Canada, provides a unique opportunity to evaluate the impact of policies that criminalise clients as the local police department adopted a sex work enforcement policy in January 2013 that prioritises sex workers’ safety over arrest, while continuing to target clients.Participants26 cisgender and 5 transgender women who were street-based sex workers (n=31) participated in semistructured interviews about their working conditions. All had exchanged sex for money in the previous 30 days in Vancouver.Outcome measuresThematic analysis of interview transcripts and ethnographic field notes focused on how police enforcement of clients shaped sex workers’ working conditions and sexual transactions, including risk of violence and HIV/STIs, over an 11-month period postpolicy implementation (January–November 2013).ResultsSex workers’ narratives and ethnographic observations indicated that while police sustained a high level of visibility, they eased charging or arresting sex workers and showed increased concern for their safety. However, participants’ accounts and police statistics indicated continued police enforcement of clients. This profoundly impacted the safety strategies sex workers employed. Sex workers continued to mistrust police, had to rush screening clients and were displaced to outlying areas with increased risks of violence, including being forced to engage in unprotected sex.ConclusionsThese findings suggest that criminalisation and policing strategies that target clients reproduce the harms created by the criminalisation of sex work, in particular, vulnerability to violence and HIV/STIs. The current findings support decriminalisation of sex work to ensure work conditions that support the health and safety of sex workers in Canada and globally.

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“…In recent years, many international organizations and expert groups, including the World Health Organization and the Global Commission on HIV and the Law, among others, have endorsed the decriminalization of sex work among adults due to the welldocumented harms associated with the criminalization of sex work [1][2][3][4][5]. It has been associated with greater risk of experiencing violence, abuse, discrimination, and increased risk of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) among sex workers [1-3, 6, 7].…”

Section: Introductionmentioning

confidence: 99%

“…It has been associated with greater risk of experiencing violence, abuse, discrimination, and increased risk of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) among sex workers [1-3, 6, 7]. In areas where sex work is criminalized, street-based sex workers may be displaced to more isolated areas, where they are at an elevated risk of intimidation, violence, theft, and rape, as there are fewer witnesses to protect them [1,[7][8][9][10][11] and they experience a lack of legal protection [8]. When sex workers are more concerned about risk of violence, their ability to negotiate condom use is limited [1,8,10,11], as they must prioritize their immediate safety over risk for infectious disease acquisition [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting

et al. 2017

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Previous research indicates that criminalization of sex work is associated with harms among sex workers. In 2013, the Vancouver Police Department changed their sex work policy to no longer target sex workers while continuing to target clients and third parties in an effort to increase safety of sex workers (similar to "end-demand sex work" approaches being adopted in a number of countries globally). We sought to investigate the trends and correlates of rushing negotiations with clients due to police presence among 359 sex workers who use drugs in Vancouver before and after the guideline change. Data were derived from three prospective cohort studies of people who use drugs in Vancouver between 2008 and 2014. We used sex-stratified multivariable generalized estimating equation models. The crude percentages of sex workers who use drugs reporting rushing client negotiations changed from 8.9% before the guideline change to 14.8% after the guideline change among 259 women, and from 8.6% to 7.1% among 100 men. In multivariable analyses, there was a significant increase in reports of rushing client negotiation after the guideline change among women (p=0.04). Other variables that were independently associated with increased odds of rushing client negotiation included: experiencing client-perpetrated violence (among both men and women) and non-heterosexual orientation (among women) (all p<0.05). These findings indicate that despite the policing guideline change, rushed client negotiation due to police presence appeared to have increased among our sample of female sex workers who use drugs. It was also associated with client-perpetrated violence and other marker of vulnerability. These findings lend further evidence that criminalizing the purchase of sexual services does not protect the health and safety of sex workers.Word Count: 273

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Realigning government action with public health evidence: the legal and policy environment affecting sex work and HIV in Asia

Cited by 7 publications

References 33 publications

Barriers to health service access among female migrant Ugandan sex workers in Guangzhou, China

Barriers to health service access among female migrant Ugandan sex workers in Guangzhou, China

Criminalisation of clients: reproducing vulnerabilities for violence and poor health among street-based sex workers in Canada—a qualitative study

Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting

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