Would legal prostitution decrease sexually transmitted diseases?
Bebe Loff, LLB, PhD, Head of the Human Rights and Bioethics Unit in the Department of Epidemiology and Preventive Medicine at Monash University, Beth Gaze, LLB, LLN, Associate Professor of Law at the University of Monash, and Christopher Fairley, PhD, Director of the Melbourne Sexual Health Centre, wrote in the Nov. 18, 2000 The Lancet article "Prostitution, Public Health, and Human-Rights Law" that:
"Prostitutes overwhelmingly work outside the law. This has implications for their health that are hard to quantify. In one Australian study carried out in 1998, the prevalence of sexually transmitted bacterial infections was 80 times greater in 63 illegal street prostitutes than in 753 of their legal brothel counterparts.... Legally sanctioned encouragement of prostitutes to use condoms or access screening services, both major determinants of the prevalence of sexually transmitted diseases, is impossible because of their illegal status. Occupational health and safety law is applied to prostitutes in lawful brothels but not to their counterparts on the street."
Teela Sanders, DPhil, Senior Lecturer in Sociology at the University of Leeds, in the May 2006 Social Science & Medicine article "Female Sex Workers As Health Educators With Men Who Buy Sex," wrote:
"For too long there has been an assumption in the literature that because sex workers have multiple sexual partners they are automatically a health risk rather than framing the possibility that their access to a hard to reach population of male clients could present a gateway for information transfer and behaviour change....
The evidence of the legalised brothel system in Nevada highlights that sex work environments that are legitimated and bureaucratised have the effect of empowering sex workers to control their working conditions and interactions with clients. A legalised system that shared the responsibility for safe sexual practices with male clients and management as well as sex workers could facilitate the role of health education both informally and formally.... Only when the place of prostitution in society is not considered the plight of the immoral or destitute, but a fixed feature of sexual behaviour, will policy move from the tone of moral disapproval or public nuisance to a realistic perspective that facilitates the provision of safe sexual services as work."
Priscilla Alexander, Co-founder and Coordinator of the National Task Force on Prostitution, wrote in the Spring 1998 Journal of the American Medical Women's Association article "Sex Work And Health: A Question Of Safety In The Workplace" that:
"...[H]ealth problems associated with prostitution, such as sexually transmitted diseases (STDs) and violence, are commonly assumed to be 'risks of the trade.' In the first instance, this can and has led many people—ranging from public health practitioners to the ordinary person in the street—to assume that prostitutes bear the primary responsibility for the propagation of STDs in the general population.
...Individuals arrested on prostitution charges often modify their work behavior in an attempt to reduce their visibility to the police...[T]hey may agree to acts carrying higher risks if it means more money, in order to reduce the time on the street, and thus the likelihood of being arrested.... As a result, sex workers become more vulnerable to pressure to not use condoms, thereby increasing their risk of contracting STDs, including HIV.
Police may confiscate condoms during street arrests, sometimes to use as evidence but often more as a form of harassment.... In off-street establishments, fear of arrest on felony charges can cause management to discourage the use of condoms, which could be used as evidence that the establishment is in the business of prostitution...
The first occupational safety and health regulations of sex work businesses are being developed in Australia and the Netherlands. Harm reduction or minimization projects...are beginning to have a positive effect on the ability of drug users and/or sex workers to take better care of themselves and to get help if they have problems. As long as prostitution remains a crime, however, the ability of such programs to increase the safety of sex work will be constrained."
Realistic, Equal, Active, for Life (REAL) Women of Canada, in its Mar.-Apr. 2005 Reality newsletter article "Prostitution In Canada and Other Countries," wrote:
"In 1986, the Victorian Labour government [Victoria, Australia] legalized brothels, claiming crime would be eliminated, prostitutes' lives would be made safer, and there would be fewer health risks. None of this happened.
...Sexually transmitted diseases (STD) and AIDS increased. This was due to the fact that medical authorities examined only one of the partners in the sex act, which was self-defeating. Also, favourable medical results provided a false sense of security to clients, prostitutes and controllers. Medical examinations also provoked hostility and decreased cooperation from prostitutes who moved around too often to be monitored. If one did become infected with a sexually transmitted disease, another prostitute would replace her for the medical check up, using the infected woman's medical card."
Janice Raymond, PhD, former Co-Executive Director of the Coalition Against Trafficking in Women (CATW), wrote in the 2003 Journal of Trauma Practice article "Ten Reasons for Not Legalizing Prostitution And a Legal Response to the Demand for Prostitution," that:
"A legalized system of prostitution that mandates health checks and certification only for women and not for clients is blatantly discriminatory to women. Women only health checks make no public health sense because monitoring prostituted women does not protect them from HIV/AIDS or STDs, since male clients can and do originally transmit disease to the women.
It is argued that legalized brothels or other controlled prostitution establishments protect women through enforceable condom policies. In one of CATW's studies, U.S. women in prostitution interviewed reported the following: 47% stated that men expected sex without a condom; 73% reported that men offered to pay more for sex without a condom; 45% of women said they were abused if they insisted that men use condoms. Some women said that certain establishments may have rules that men wear condoms but, in reality, men still try to have sex without them. One woman stated:It's regulation to wear a condom at the sauna, but negotiable between parties on the side."
Cheryl Edwardes, LLM, former Attorney General for Western Australia, in the May 6, 2003 Australian Legislative Assembly, said:
"The community may accept that some level of prostitution is inevitable. However, that does not mean supporting anything that might result in more brothels and more prostitutes. It certainly does not mean tacit endorsement of a system that could send a wrong message to young women that prostitution is a desirable career option.... Words alone will not keep out the criminal element. Under this legislation [Prostitution Control Bill 2003], prostitution is to be legalised and more illegal brothels will operate, yet there is no indication in the legislation of how the Labor Government plans to ensure that STDs will not spread throughout the community. Simply talking about the dangers of unprotected sex will not stop it....
Condoms are not used 100 per cent of the time in the sex industry because there is a much lower percentage of use by street workers. Street workers have a greater dependence on drugs.... Unsafe practices continue. ...[U]p to 50 per cent of brothel workers are undertaking oral sex without using prophylactics. The figure is quite concerning because STDs can be transmitted in that way."