Editorial:
Sex workers to pay the
price
BMJ 2006;332:190-191 (28 January),
doi:10.1136/bmj.332.7535.190
UK plans to
cut street prostitution will threaten
sex workers' health
In 2004 the UK Home Office
published a consultation paper on
sex work, after a review of the
Sex Offences Act (2003). The
paper, Paying the Price,1
was criticised by specialist services
for giving less priority to the
health of sex workers than before
and for focusing too much on
issues of criminal justice, and
by health researchers for its
unethical use of questionnaires
and interviews. The resulting Home
Office strategy2
published last week aims to
challenge the view that street
prostitution is inevitable;
achieve an overall reduction in street
prostitution; improve the
safety and quality of life of
communities affected by
prostitution, including those directly
involved in street sex
markets; and reduce all forms of
commercial sexual exploitation.
The strategy looks to the
controversial Swedish model that
criminalises men who pay for
sex, and uses police photographs of sex
acts and possession of
condoms as evidence of sex work. This
discourages sex workers from
using condoms and introduces tension and
potentially violence between
them and clients. The Home Office
proposes a range of
approaches for a variety of sex markets,
based on the sex of workers
and the locations where sex workers and
clients meet. But the
strategy does not explicitly tackle
health and human rights and
will not, therefore, tackle genuine
areas of vulnerability and
exploitation. Currently, children are
sexually abused, people are
trafficked and enslaved, and vulnerable
individuals, including those
with drug dependency or mental health
conditions, are coerced and
controlled, often by organised criminal
gangs. Neither adult sex
workers nor clients dare to report these
abuses for fear of exposing
their own involvement in sex work.
The proposed strategy rejects calls
to license premises which
comply with ordinary requirements of
workplace legislation on
health, safety, and labour. A licensing
system could ensure that
children were not employed, employees
were not in possession of
drugs, and foreign nationals had work
permits.
Instead the strategy focuses on
disrupting street sex markets.
Kerb crawling will be policed in
established red light areas
despite strong evidence that this will
simply displace sex work to
other locations and increase the
prevalence of acquisitive
crime.3
This will also reduce sex workers'
negotiating powers, make it
harder for them to find clients,
increase their time on the
streets, and force them to solicit more
directly— increasing the risk
of causing offence or distress to people
not looking for paid sex. These
conditions are directly linked
to increased violence, pressure to
abandon safer sex practices,
and increased public disorder, including
vigilante attacks.4
Sex workers are now uncertain about
their legal status and are
unsure whether the new Home Office
strategy has become law.
Outreach services and health researchers
have noted increased fears
among sex workers regarding the safety
and confidentiality of such
services.
Specialist healthcare services in red
light areas face an uncertain
future. Outreach work, provision of
condoms, needle exchange
schemes, and primary care for a
population rarely registered
with a general practitioner could be
compromised if the strategy
is enforced and sex workers become
reluctant to seek help. Without
access to specialist fast track
services for sexual health,
sex workers may face delays in receiving
treatment for sexually
transmitted infections, which could have
profound consequences both
for sex workers and the wider
population.
The recent increase in sexually
transmitted infections in the
general population in the United Kingdom
contrasts with a reduced
prevalence in female sex workers.5
And the prevalence of HIV
infection in sex workers, mainly
associated with injecting drug
use, remains low— between 0% and
3.5%.5
Sex workers have a
responsible approach to managing the
risk of sexually transmitted
infections, with a high prevalence of
condom use for commercial
vaginal sex (98%). The Home Office
strategy shows inadequate
understanding of risk, and the proposed
changes could increase
negative health outcomes, while limiting
patients' access.
Multiagency work by healthcare
professionals, police, social
services, and sex workers will be
disrupted if red light areas
are phased out as the strategists
intend. This will increase
the risks to sex workers, 87 of whom
have been murdered in the
United Kingdom since 1990.6
Collaborative working gives sex
workers the support to report
violent clients and other predators
who aim to coerce and control
them. The lack of detail in the
strategy about implementing the
new approaches, especially regarding
indoor sex work, leaves most of
the sex workers we have spoken
to feeling uneasy that they will
have to wait and see how the
strategy affects their access to health
care and their contact with
the criminal justice system.
Petra Boynton,
non-clinical lecturer in healthcare
research
University College London
(p.boynton@pcps.ucl.ac.uk
)
Linda Cusick,
reader in substance use
Institute for Applied Social and
Health Research, University of Paisley
(linda.cusick@paisley.ac.uk
)
Competing
interests: LC is the academic
representative on the
board
of the UK Network of Sex Work Projects.
Reviews
p 245
References
- Home Office. Paying
the price. London: Home Office,
2004.
www.homeoffice.gov.uk/documents/paying_the_price.pdf
- Home Office. A
coordinated prostitution strategy
and a summary of responses to paying
the price. London: Home Office,
2005.
www.homeoffice.gov.uk/documents/cons-paying-the-price
- Hubbard P. Community
action and the displacement of
street prostitution: evidence from
British cities. Geoforum
1998;29: 269-86.[CrossRef][ISI]
- Sanders T. The risks
of street prostitution: punters,
police and protesters. Urban
Studies 2004;41: 1703-17.[CrossRef][ISI]
- Day S, Ward H. Sex
work, mobility and health in Europe.
London: Kegan Paul, 2004.
- Kinnell H. Violence
and sex work in Britain. In: Day S,
Ward H, eds. Sex work, mobility
and health in Europe. London:
Kegan Paul, 2004.
Rapid Responses:
|
Prostitution
Strategy
- A
Missed
Opportunity |
30
January
2006 |
|
Sam Ramaiah,
Director of
Public
Health
Medicine/Medical
Director
Walsall
Teaching
Primary Care
Trust,
Lichfield
House, 27-31
Lichfield
Street,
Walsall, WS1
1TE
Send
response to
journal:
Re:
Prostitution
Strategy - A
Missed
Opportunity
|
The
safety of
sex workers
in
prostitution
as well as
the
neighbourhoods
in which
this
activity
takes place
is paramount
and
therefore
there
appears to
be general
agreement
that
tolerance
zones are a
better
option to
achieve this
objective. I
am therefore
like Boynton
and Cusik1
disappointed
that the
Home Office
has missed
an excellent
opportunity
to consider
this in its
strategy.
It may be
worth
sharing our
experience
in Walsall
which has
its own
prostitution
and
associated
problems.
During the
mid 1990’s
and late
90’s there
was
considerable
anger
amongst the
community
which was
experiencing
the direct
affects of
prostitution.
We initiated
a
qualitative
study to
obtain the
views of
residents
and sex
workers so
that a
robust
strategy
could be
developed.
Findings of
this study
surprised
many as
these
included
hitherto
unknown
facts. For
example more
than half
the sex
workers and
their
clients were
Walsall
residents
which was
contrary to
the
perception
of many that
prostitution
was an
imported
problem.
This finding
alone made
individuals
and agencies
to own the
problem.
Secondly a
large
majority of
community
representatives
and sex
workers
believed
that
tolerance
zones were
the best way
for safety,
health and
indeed
prevention.2
A
multi-agency
task group
has been in
existence
led by the
police for
implementing
many of the
recommendations
arising out
of this
study. It is
true to say
that the
prostitution
problem and
its impact
on the
community
are better
managed and
a great deal
of trust has
been
established.
Some
innovative
programmes
have been
initiated
involving
theatre in
education
programme in
schools to
discourage
children
from
prostitution;
community
arts team
intervention
to identify
sex workers
aspirations
and an
active
rehabilitation
process.
Clearly we
could not
pursue
tolerance
zone
proposal as
there was no
legal
framework to
do so. Hence
my
frustration
with the
current
strategy.
Sex work
is an
extremely
dangerous
activity and
the use of
harm
reduction
principles
can help to
safeguard
sex workers
lives.3 An
opportunity
to establish
tolerance
zones as an
effective
option in
this process
has been
lost in the
recent
strategy.
References 1
Boynton P.
Cusik L. Sex
Workers to
Pay the
Price.
British
Medical
Journal,
2006, 332,
190-192 (28
January
2006).
2 O’Neill
M, Campbell
R, James A
et al. Red
Lights and
Safety
Zones. In
Bell D,
Jayne M ed.
In City of
Quarters –
Urban
Villages in
the
Contemporary
City.
Aldershot,
Hants, 2004.
3 Rekart
ML. Sex Harm
Reduction.
Lancet,
2005, 366,
2123-2134.
Competing
interests:
None
declared |
|
Second
Oldest
Crime |
4
February
2006 |
|
Susan L.
Liang,
Hotel
manager
Big Surf
96815
Send
response to
journal:
Re: Second
Oldest Crime
|
Far from
being the
oldest
profession,
prostituting
women, girls
and boys for
their
vaginas,
rectums or
mouths, is
the oldest
crime next
to murder.
When the
Indo-European
steppe
nomads came
into Europe
from the
Eurasian
steppes,
they
"plundered"
every other
tribe --
that is,
they stole
their
resources,
which
included
women and
children
i.e. they
raped and
murdered
their way
into Europe.
The Celts
were one of
these Indo-
European
peoples.
The still
remaining
legacy of
the
Indo-European
nomadic
tribes to
Europe and
America is
the attitude
that those
who were and
are
conquered
(or without
choice as to
whether they
should be
murdered
and/or
raped) were
of no
consequence,
being
"inferior."
From these
tribes, we
have
inherited
gender
discrimination....
If you go
back in
history, you
will find
that most
languages
share
Indo-European
roots -- for
the reasons
above.
To
condone rape
as it has
"evolved" in
the present
form of sex
on demand,
is to take
the side of
the "john"
-- the
ideologically
privileged
Indo-European
male that he
must have
what he must
have,when he
wants to
have it,
whether it
is criminal
or not --
even if it
involves
supporting
the
pimps/traffickers/assaulters/rapists/murderers
in their
high
lifestyles.
That
blurs the
line between
good and
evil,
sociologically,
and within
families,
kissing up
to males
even when
they are
wrong.
The
problem is
with
insufficient
funding for
UK
prosecutors
to go after
traffickers
and johns.
At war
with pimps
of children,
and children
who are now
women and
men,
Susan
Liang
Honolulu,
Hawaii
Competing
interests:
Girlfest
Hawaii,
volunteer
Safezone
Foundation,
volunteer |
|
The
prostitute
in
front
of
you. |
5
February
2006 |
|
Steven Ford,
GP
Haydon &
Allen
Valleys
Medical
Practice.
NE47 6HJ
Send
response to
journal:
Re: The
prostitute
in front of
you.
|
Sir
The
average
clinician in
almost every
discipline
will have
consultations
with women
(and men)
who have
used sex to
acquire
money, goods
or services.
Which of us
gives this
much thought
- or, come
to that,
which of us
does that
exclude? A
number of
years ago a
qualified
medical
practitioner,
who had been
engaged in
prostitution
herself, had
an article
published in
the BMJ -
it's beyond
belief that
she would be
unique. What
percentage
of the
population -
or our
profession -
has sought
or accepted
reward for
sex?
Having
started,
cautiously,
to ask the
relevant
questions as
part of a
sexual
history I
have
encountered
women who
have been,
who are and
who are
considering
being
prostitutes,
as well as
those who
have been
offered
money for
sex without
having asked
for payment.
Being
asked for
'career
guidance' in
advance of
going on the
game, was
amongst the
most
uncommon
consultations
that I have
had and, I
confess, my
first
response was
that 'Pretty
Woman' was
not a
recruitment
video.
Our local
GUM service
offers
quarterly
screening
for sex
workers, I
discovered,
a frequency
that caused
one of my
patients to
circulate
around the
region's GUM
clinics
substantially
more
frequently
than that,
as well as
availing
herself of
screening
with us.
Every GP
will have a
number of
past,
present and
future
prostitutes
as patients
- do you
know who
they are?
Ought you to
know? Are
you prepared
to provide
the relevant
care? What
is the
relevant
care?
The
government
has failed -
again - to
make real
progress on
a
substantive
issue and,
again, we,
amongst
others, will
have to
contribute
to picking
up the
pieces.
Yours
sincerely
Steven
Ford
Competing
interests:
None
declared |
Original link: http://www.bmj.com/cgi/content/full/332/7535/190