National sex work policy and HIV prevalence among sex workers: an ecological regression analysis of 27 European countries

BackgroundSex workers are disproportionately affected by HIV compared with the general population. Most studies of HIV risk among sex workers have focused on individual-level risk factors, with few studies assessing potential structural determinants of HIV risk. In this Article, we examine whether criminal laws around sex work are associated with HIV prevalence among female sex workers.MethodWe estimate cross-sectional, ecological regression models with data from 27 European countries on HIV prevalence among sex workers from the European Centre for Disease Control; sex-work legislation from the US State Department's Country Reports on Human Rights Practices and country-specific legal documents; the rule of law and gross-domestic product per capita, adjusted for purchasing power, from the World Bank; and the prevalence of injecting drug use among sex workers. Although data from two countries include male sex workers, the numbers are so small that the findings here essentially pertain to prevalence in female sex workers.FindingsCountries that have legalised some aspects of sex work (n=17) have significantly lower HIV prevalence among sex workers than countries that criminalise all aspects of sex work (n=10; β=–2·09, 95% CI −0·80 to −3·37; p=0·003), even after controlling for the level of economic development (β=–1·86; p=0·038) and the proportion of sex workers who are injecting drug users (−1·93; p=0·026). We found that the relation between sex work policy and HIV among sex workers might be partly moderated by the effectiveness and fairness of enforcement, suggesting legalisation of some aspects of sex work could reduce HIV among sex workers to the greatest extent in countries where enforcement is fair and effective.InterpretationOur findings suggest that the legalisation of some aspects of sex work might help reduce HIV prevalence in this high-risk group, particularly in countries where the judiciary is effective and fair.

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HIV and STI positivity rates among transgender people attending two large STI clinics in the Netherlands

Sexually Transmitted Infections ◽

10.1136/sextrans-2020-054875 ◽

2021 ◽

pp. sextrans-2020-054875

Author(s):

Susanne Drückler ◽

Ceranza Daans ◽

Elske Hoornenborg ◽

Henry De Vries ◽

Martin den Heijer ◽

...

Keyword(s):

The Netherlands ◽

Gender Identity ◽

Sex Work ◽

Sexual Behaviour ◽

Sex Workers ◽

Hiv Prevalence ◽

Hiv Positive ◽

Gender Identities ◽

Transgender People ◽

Sexually Transmitted

BackgroundGlobal data show that transgender people (TGP) are disproportionally affected by HIV and sexually transmitted infections (STIs); however, data are scarce for Western European countries. We assessed gender identities, sexual behaviour, HIV prevalence and STI positivity rates, and compared these outcomes between TGP who reported sex work and those who did not.MethodsWe retrospectively retrieved data from all TGP who were tested at the STI clinics of Amsterdam and The Hague, the Netherlands in 2017–2018. To identify one’s gender identity, a ‘two-step’ methodology was used assessing, first, the assigned gender at birth (assigned male at birth (AMAB)) or assigned female at birth), and second, clients were asked to select one gender identity that currently applies: (1) transgender man/transgender woman, (2) man and woman, (3) neither man nor woman, (4) other and (5) not known yet. HIV prevalence, bacterial STI (chlamydia, gonorrhoea and/or infectious syphilis) positivity rates and sexual behaviour were studied using descriptive statistics.ResultsTGP reported all five categories of gender identities. In total 273 transgender people assigned male at birth (TGP-AMAB) (83.0%) and 56 transgender people assigned female at birth (TGP-AFAB) (17.0%) attended the STI clinics. Of TGP-AMAB, 14,6% (39/267, 95% CI 10.6% to 19.4%) were HIV-positive, including two new diagnoses and bacterial STI positivity was 15.0% (40/267, 95% CI 10.9% to 19.8%). Among TGP-AFAB, bacterial STI positivity was 5.6% (3/54, 95% CI 1.2% to 15.4%) and none were HIV-positive. Sex work in the past 6 months was reported by 53.3% (137/257, 95% CI 47.0% to 59.5%) of TGP-AMAB and 6.1% (3/49, 95% CI 1.3% to 16.9%) of TGP-AFAB. HIV prevalence did not differ between sex workers and non-sex workers.ConclusionOf all TGP, the majority were TGP-AMAB of whom more than half engaged in sex work. HIV prevalence and STI positivity rates were substantial among TGP-AMAB and much lower among TGP-AFAB. Studies should be performed to provide insight into whether the larger population of TGP-AMAB and TGP-AFAB are at risk of HIV and STI.

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Correlates of HIV prevalence among female sex workers in four north and east Indian states: findings of a national bio-behavioural survey

International Journal of STD & AIDS ◽

10.1177/0956462418799018 ◽

2018 ◽

Vol 30 (2) ◽

pp. 120-130 ◽

Cited By ~ 1

Author(s):

Gunjika Misra ◽

Damodar Sahu ◽

Umenthala S Reddy ◽

Saritha Nair

Keyword(s):

Sex Work ◽

Sex Workers ◽

Female Sex Workers ◽

Uttar Pradesh ◽

Hiv Prevalence ◽

Indian States ◽

Factors Affecting ◽

East Indian ◽

Female Sex ◽

Behavioural Surveillance

The socio-demographic, sex work characteristics and the factors affecting HIV prevalence among female sex workers (FSWs) are not well known in low prevalence states showing rising trends within the HIV epidemic. This paper studies these attributes among FSWs in three north (Punjab, Rajasthan and Uttar Pradesh) and one east Indian states (Jharkhand). Integrated Biological and Behavioural Surveillance (IBBS) data, collected from 4491 FSWs in the study states, were analysed, with HIV status as the dependent variable and several socio-demographic, sex work, knowledge and agency characteristics as independent variables. Multivariate analysis found a number of factors such as age above 25 years (adjusted odds ratio [AOR] 5.0, 95% confidence interval [CI] 1.4–18.1), client solicitation in rented rooms (AOR 2.8, 95% CI 1.2–6.4) and the use of mobile phones for client solicitation (AOR 5.1, 95% CI 1.6–16.0) to be significantly associated with HIV risk. The study found low levels of HIV programme services uptake and HIV/AIDS knowledge among FSWs in the study states. There is an urgent need to focus on these risk factors for improving the effectiveness of the ongoing HIV prevention efforts and attaining the ‘Sustainable Development Goals’ goal of ‘Ending the AIDS epidemic’ by 2030.

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Proximity to sex work sites is not associated with higher HIV prevalence in the general population in Zimbabwe

10.21203/rs.3.rs-858354/v1 ◽

2021 ◽

Author(s):

Mariëlle Kloek ◽

Caroline Bulstra ◽

Sungai Chabata ◽

Elizabeth Fearon ◽

Isaac Taramusi ◽

...

Keyword(s):

General Population ◽

Sex Work ◽

Sex Workers ◽

Hiv Prevalence ◽

Demographic And Health Surveys ◽

African Countries ◽

Prevalence Data ◽

Individual Level ◽

Shortest Distance ◽

Survey Sample

Abstract In Zimbabwe, as in other East and Southern African countries, HIV prevalence is largely geographically heterogeneous. We determined if, and to what extent, this heterogeneity is associated with proximity to sex work sites by type of site (city, economic growth point, international, seasonal, or transport), using Demographic and Health Surveys location-specific HIV prevalence data—including 16,121 individuals (aged 15-49 years) from 400 sample locations—and Centre for Sexual Health and HIV/AIDS Research data on locations of 56 sex work sites throughout Zimbabwe. We conducted univariate and multivariate multilevel logistic regression to determine the association between sex work proximity—calculated as the shortest distance by road from each survey sample location to the nearest sex work site—and HIV seropositivity. We found no association between locations of sex work and heterogeneity in HIV prevalence in the general population, possibly explained by the mobile nature of both female sex workers and their clients as individual-level indicators of sex work were still significantly associated with HIV.

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HIV testing behaviour and HIV prevalence among female sex workers in Ukraine: findings from an Integrated Bio-Behavioural Survey, 2013–2014

Sexually Transmitted Infections ◽

10.1136/sextrans-2018-053684 ◽

2019 ◽

Vol 95 (3) ◽

pp. 193-200 ◽

Cited By ~ 1

Author(s):

Anna Tokar ◽

Iana Sazonova ◽

Sharmistha Mishra ◽

Pavlo Smyrnov ◽

Tetiana Saliuk ◽

...

Keyword(s):

Hiv Testing ◽

Sex Work ◽

Sex Workers ◽

Sexual Partner ◽

Female Sex Workers ◽

Hiv Prevalence ◽

Factors Associated ◽

Female Sex ◽

Living With Hiv ◽

Test Result

ObjectivesUkraine has one of the largest HIV epidemics in Europe, with high prevalence among female sex workers (FSWs). We aimed to identify factors associated with HIV testing and receipt of the test result in the last 12 months, HIV prevalence and self-reported positive status among FSWs in Ukraine.MethodsWe used data from an Integrated Bio-Behavioural Survey among FSWs conducted in 2013–2014. The survey methodology combined three sampling strategies: time and location sampling, respondent-driven sampling and key informant recruitment. We used multivariable regression to identify factors associated with self-reported HIV testing in the last 12 months, HIV prevalence and self-reported positive status among FSWs living with HIV. Explored factors included: age, age at first sex, age at entry into sex work, education, marital status, employment status beside sex work, condom use with last paying or non-paying sexual partner, drug or alcohol consumption and sex work venue.ResultsRecent HIV testing was low overall with only 63.2% of FSWs reported having tested and received their test result in the last 12 months prior to the survey. HIV prevalence was 7.1% overall, but only 45.0% of FSWs living with HIV were aware of their HIV status. Testing in the last 12 months with receipt of test result was less common among FSWs who used drugs ever in life (adjusted OR (AOR) 0.7, 95% CI 0.6 to 0.9), women soliciting clients indoors (AOR 0.8, 95% CI 0.7 to 0.9) and those not using a condom with last paying sexual partner (AOR 0.3, 95% CI 0.2 to 0.5). HIV positivity was associated with history of ever using drugs (AOR 2.3, 95% CI 1.4 to 3.6) and soliciting clients outdoors (AOR 1.5, 95% CI 1.1 to 2.0). Women working indoors were less aware of their positive status (AOR 0.1, 95% CI 0.1 to 0.9).ConclusionHIV prevalence is high among FSWs in Ukraine, and testing and knowledge of one’s status remain insufficient. HIV testing programmes need to expand with strategies to reach specific subgroups of FSWs.

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Decriminalisation of sex work in the post-truth era? Strategic storytelling in neo-abolitionist accounts of the New Zealand model

Criminology & Criminal Justice ◽

10.1177/1748895820918898 ◽

2020 ◽

pp. 174889582091889 ◽

Cited By ~ 1

Author(s):

Lynzi Armstrong

Keyword(s):

New Zealand ◽

Occupational Health ◽

Sex Work ◽

Sex Workers ◽

Policy Making ◽

Empirical Studies ◽

Health And Safety ◽

Occupational Health And Safety ◽

Sex Work Policy ◽

Knowledge Claims

In the context of on-going debates regarding sex work laws, in most jurisdictions forms of criminalisation continue to dominate. Despite decades of sex workers calling for the decriminalisation of sex work and collectively organising against repressive laws, decriminalisation remains uncommon. New Zealand was the first full country to decriminalise sex work with the passing of the Prostitution Reform Act in 2003, which aimed to improve occupational health and safety. Several empirical studies have documented positive impacts of this framework. However, despite this, neo-abolitionists persistently describe the New Zealand model as a failed approach. This article examines neo-abolitionist knowledge claims regarding the New Zealand model and in doing so unpacks the strategic stories told about this approach, considering the implications for sex work policy making.

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HIV prevalence and characteristics of sex work among female sex workers in Hargeisa, Somaliland, Somalia

AIDS ◽

10.1097/01.aids.0000386735.87177.2a ◽

2010 ◽

Vol 24 (Suppl 2) ◽

pp. S61-S67 ◽

Cited By ~ 23

Author(s):

Kelsi Kriitmaa ◽

Adrienne Testa ◽

Mohamed Osman ◽

Ivana Bozicevic ◽

Gabriele Riedner ◽

...

Keyword(s):

Sex Work ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Prevalence ◽

Female Sex

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The Continued Criminality of Selling Sex: A Trajectory of South African Sex Work Law Reform

Journal of African Law ◽

10.1017/s0021855321000280 ◽

2021 ◽

pp. 1-23

Author(s):

Amanda Spies

Keyword(s):

South Africa ◽

South African ◽

Sex Work ◽

Sex Workers ◽

Legal Regulation ◽

Law Reform ◽

Constitutional Rights ◽

The South ◽

Sex Work Policy ◽

Rights Discourse

Abstract This article explores the regulation of sex work in South Africa and follows the trajectory of the South African Law Reform Commission (SALRC) in investigating whether sex work should be decriminalized. The legal regulation of sex work is a hotly contested topic. South Africa currently criminalizes the selling and buying of sex, but policy reform has been on the cards since the SALRC launched its project on the topic in the early 2000s. As most sex work policy responses are grounded in feminist theory, the article analyses the main theoretical ideologies and questions the influence of these ideologies in structuring sex work law reform in the South African context. The author calls for a more inclusive understanding of feminism and sex work, and the need to acknowledge the importance of rights discourse in furthering political growth and protecting sex workers’ constitutional rights.

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Sex work, containment and the new discourse of public health in French colonial Levant

Medical History ◽

10.1017/mdh.2021.26 ◽

2021 ◽

Vol 65 (4) ◽

pp. 330-346

Author(s):

Pascale N. Graham

Keyword(s):

Public Health ◽

Sex Work ◽

Sex Workers ◽

Health Knowledge ◽

Venereal Disease ◽

Commercial Sex Work ◽

Colonial State ◽

Novel Approach ◽

Sex Work Policy ◽

French Colonial

AbstractThis article addresses how French academics, doctors and state bureaucrats formulated sex work as a pathology, an area of inquiry that had to be studied in the interest of public safety. French colonisation in the Levant extended the reach of this ‘expertise’ from the metropole to Lebanon under the guise of public health. Knowledge produced by academics was used to buttress colonial state policy, which demanded that sex workers be contained to protect society against medical contagion. No longer drawing conclusions based on speculation, the medical establishment asserted its authority by harnessing modern advances in science and uniting them with extensive observation. ‘Empirical facts’ replaced ‘opinions’, as doctors forged new approaches to studying and containing venereal disease. They accomplished this through the use of statistics and new methods of diagnosing and treating maladies. Their novel approach was used to treat sex workers and to support commercial sex work policy both at home and abroad. Sex workers became the objects of scientific study and were consequently problematised by the state in medicalised terms.

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New Localism: Implications for the Governance of Street Sex Work in England and Wales

Social Policy and Society ◽

10.1017/s1474746412000176 ◽

2012 ◽

Vol 11 (4) ◽

pp. 483-494 ◽

Cited By ~ 6

Author(s):

Tracey Sagar ◽

Jodie Croxall

Keyword(s):

Social Exclusion ◽

Sex Work ◽

Sex Workers ◽

Local Governance ◽

Critical Examination ◽

England And Wales ◽

Community Cohesion ◽

Sex Work Policy ◽

Street Sex Work

This article focuses on the escalating shift in power from the centre to ‘community’ with specific regard to the local governance of street sex work. With reference to reforms in local governance and sex work policy, we question what localism may mean for street sex workers as both vulnerable members of the community and also anti-social subjects. Our critical examination suggests that street sex workers are susceptible to increasing marginalisation and social exclusion. To counter this, it is argued that there needs to be greater attention and investment towards improving community cohesion and democracy for ‘all’ within the localist agenda.

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