Policy Proposal in Regards to Sex Workers as a Site of Disease Spread Essay

Executive Summary

Even though sex workers are seriously affected by AIDS and other sexually transmitted diseases in most parts of the world, they are also the most likely group to respond positively to HIV prevention campaigns. HIV prevention campaigns targeting sex workers can reduce the percentage of HIV infections that result from commercial sex activities and decrease the overall HIV spread across Victoria, Australia. In this document, I suggest that a comprehensive outreach programme targeting sex workers would help achieve an overall intervention and prevention of spread of STIs. Sex workers across Victoria need to be empowered by providing them with health education especially sexually transmitted infections, as well as, contraceptives. It is also important to make them access health facilities, counseling and drug rehabilitation services.

Statement of Issue

The central question in this social issue is how the Victorian government should respond to sex workers as a site of disease spread.

Background

Sex workers generally refer to those who work in the sex industry and provide sexual services. According to the International Union of Sex Workers, the term encompasses all those who work in the industry whether by coercion, choice or circumstance¹. It includes people who provide sexual services such as prostitutes, escorts, as well as, professional dominants; strippers, porn actors, erotic dancers and those who work in brothels; these, they generally refer to as people who work in adult entertainment. Depending on the region or country, activities of sex workers may be

1. 1. International Union of Sex Workers, Who are we? IUSW, 2009, Web.

According to Frances prostitution (sex work) is the oldest profession and exists in every society, Australia included². Frances believes that in the aboriginal society, sex work did not exist; however, it came with the European invasion which can be traced back to 1670s³. It became necessary to find female sexual partners for European soldiers and colonialists during the colonial period and the British colonial government had to craft a legislation which allowed them to provide veneral disease-free sex workers to soldiers. Prostitution spread in towns in the 20^th century as demand for sexual services increased among armed forces, working class male as well as merchant marine. Today, most regions in Australia have liberalized prostitution. Prostitution in Victoria is legalized and regulated by The Prostitution Control Act of 1994⁴ (Sullivan 2005). However, the increasing level of chlamydia and HIV/AIDS among young women has been of great concern in Victoria.

Those involved in commercial sex activities face various health risks which depend on the lives they lead or specific sexual practices they engage. HIV and STDs infections are the major health risks that they universally face in their sex activities. Generally, STDs including HIV/AIDS have considerable stress as well as illness, can be fatal and affect reproductive ability significantly. Although it is assumed that condoms are easily available, the question still remains as to whether they have easy access to them in their places of work which includes the streets, brothels, bars and other

2. 2. R Frances, “The History of Female Prostitution in Australia” in Perkins, R., Prestage, G., Sharp, R. & Lovejoy, F. (eds.) (1994) Sex Work and Sex Workers in Australia. University of New South Wales Press, Sydney. 1994, pp 27-52.
   3. Frances, p. 35.
   4. M Sullivan,What happens when prostitution becomes work? An update on legalisation of prostitution in Australia” Coalition Against Trafficking in Women, N. Amherst, Massachusetts, 2005.

entertainment areas or whether they actually use them. Sex workers usually engage with many sexual partners, and this may increase their chances of contracting HIV and other STIs especially if they do not consistently and correctly use contraceptives⁵. What puts most commercial sex workers at risk of contracting HIV is that some clients do not prefer contraceptives. According to International HIV & AIDS Charity less than a third of 86 countries in which sex workers interviewed reported that sex workers had used condoms in their last encounter with their clients⁶. In some cases, this is attributed to limited access to condoms or lack of real understanding of the looming consequences of not protecting themselves while providing sexual services. In other cases, sex workers are intimidated with refusal to pay for the services or violence if they do not agree to unprotected sex.

The situation is made worse for sex workers since they are normally stigmatized, marginalized or even criminalized by the society, and therefore, there is never legislations and policies which can protect them from clients who put them at risk of contracting HIV and STIs⁷. Thus, they can not easily access health, legal as well as social services whenever they encounter situations which leave them vulnerable to contracting STIs. For them to survive the intense emotional as well as physical burden of their activities, they sometimes inject themselves with narcotic drugs, and this leaves them at higher risk of being infected with HIV. They share the needles they use on the

5. 5. R Weitzer, Sex for sale: Prostitution,pornography, and the sex industry. Routledge Press, New York, 2000.
   6. World Health Organisation, ‘Violence against women and HIV/AIDS: critical intersections, violence against sex workers and HIV prevention’, Information series bulletin, no. 3, 2005. Web.
   7. C Pateman, The sexual contract. Polity Press, Cambridge, 1988, pp38-76.

streets and can become mentally unconscious such that they can not make proper decision⁸. In addition, unprotected sex attracts more pay and since most sex workers are desperate for income, they find it hard to refuse.

Statement of organizational interest on Sex Workers

The organization, which is a non-governmental, and operates within Victoria State, provides sexual health information as well as support to sex workers and all those who are involved in the sex industry. The sex worker organization provides HIV and STIs education and prevention programs. It has counseling specialists, outreach workers from all the sub-communities in Victoria, and sex industry peers. We seek to empower all those involved in the sex industry to be able to engage in safe sex practices while providing sexual services. Our aim is to help sex workers engage in practices which enable them take control of their health, and as a result reduce the level of HIV and STIs infection rates in the industry and the Victoria community as a whole.

Pre-existing policy/legislation

One positive thing that the Victoria government has undertaken to acknowledge that prostitution is part of the society by enacting The Prostitution Control Act of 1994⁹. This legislation legalizes and controls the operation of escort agencies, as well as, brothels within the state. According to the legislation, a brothel or escort agency has to acquire a permit from the local council and not a license. This allows the licensing authority to investigate any previous criminal activity that the applicant could

8. 8. G Delanty, Community (second edition) Routledge: London and New York, 2003, pp 18-37.
   9. Consumer Affairs Victoria, Regulatory impact statement: Proposed prostitution control regulations. Department of Justice, Melbourne, 2006, Web.

have been involved in. However, brothel owners are not allowed to obtain a liquor license meaning that those who work in these brothels have the opportunity to provide their services while sober-minded. The legislation also prohibits contracting of minors (under 16 year-old prostitutes) or allowing under 16-year olds to enter the brothels¹⁰. It also forbids brothels and escort agencies from advertising their services, as such are deemed to influence minors and other vulnerable groups to engage in prostitution activities¹¹. In cases where a brothel is operated by one or two sex workers, the individuals do not need to obtain licence for their operation, but have to be registered with the relevant authority.

The legislation only seeks to make prostitution legal in Victoria and eliminate criminalising of activities of sex workers. However, it prohibits a sex worker from providing sexual services while infected with any STI (Consumer Affairs Victoria). This helps limit the spread of STIs. It also helps protect sex workers from abuse which comes as a result of being under the influence of alcohol or being taken advantage because they are drunk. It also protects minors from being exploited or coerced to work in the sex industry. One of the major objectives of this legislation was to do away with the criminal connection to commercial sex. However, according to Sullivan (2005) illegal as well as abusive operations still continue to exist. It is estimated that Victoria has more than 300 illegal brothels. It is possible that in these unlicensed brothels, illegal sex activities could be on going.

10. 10. M Sullivan,What happens when prostitution becomes work? An update on legalisation of prostitution in Australia” Coalition Against Trafficking in Women, N. Amherst, Massachusetts, 2005.
    11. Z Bauman, Community: seeking safety in an insecure. World Polity: Cambridge, 2001, pp 6-23.

The legislation has no provisions which target promotion of health of sex workers. It does not address issues such access to contraceptives, health information regarding HIV and other STIs, social services, as well as, protection from clients who put the lives of sex workers at risk of contracting sex-related diseases¹².

Policy options

Sex workers have to be acknowledged as a priority population in prevention of STIs infection and spread within Victoria State. Previous studies conducted by the Melbourne Sexual Health Centre has proved that systems that have regulated and taken control measures in the sex industry experience low prevalence of HIV and other STIs among sex workers¹³. The policy options for this problem should include.

• Weekly mandatory tests for all those who work in the sex industry within Victoria.
• Enacting a law criminalising any client activity that exposes sex workers to STIs infection.
• Establishing comprehensive outreach programs for all sex workers within Victoria.

Assessment of policy options

Weekly mandatory tests

Compulsory weekly tests will help achieve early diagnosis, and as a result put the infected sex workers on early treatment. This will reduce the rate of spread and hence prevalence of STIs particularly HIV and Chlamydia. Current legislation only requires that sex workers not to engage in provision of sexual services while infected.

12. 12. S Doshi, Sex workers on the front line – of prevention, insistence on condoms keeps HIV under control in India but clashes with U.S. funding restrictions. The Centre for Public Integrity, Washington DC. 2006.
    13. LM Baker, P Case, & DL Policicchio, General health problems of inner-city sex workers: A pilot study.Journal of the Medical Library of Association, Vol. 91, no. 1, 2003, pp 67-71, Web.

The program will have long-term consequences as it will enable early intervention programs or treatment to be initiated once the disease is detected.

On the contrary, implementing mandatory weekly tests on sex workers within the state could prove to be a daunting task. People tend to rebel to mandatory legislations or requirements. Besides, the program will require additional law enforcement officers and medical experts to conduct the regular tests.

Criminalising of inappropriate client activities

Sex workers and clients alike are bound to benefit from such legislation. The law aims to protect sex workers from being forced to perform unprotected sex with clients whose status they have no knowledge of. It will be an offense to coerce, intimidate or force a sex worker to engage in unprotected sex whether by client or the brothel manager/owner.

Such legislation could face one major setback. Most sex workers especially those in the business due to their low economic status are likely to be influenced by the amount of money that unprotected sex attracts¹³. This means that it will be difficult to achieve significant reduction in infection rates among sex workers, making it hard to control the spread of HIV and other STIs.

Comprehensive outreach programs

Establishing outreach programs targeting sex workers across Victoria will increase awareness and regular testing. It will also empower sex workers to use contraceptives consistently and correctly, and better understand the risks associated

14. 14. A McClelland, & P Smyth, Social Policy in Australia: Understanding for Action, Second edition. Oxford University Press: Oxford, 2009, pp 2-19.

with non-usage of contraceptives. It will also help sex workers avoid practices such as use of drugs and alcohol which makes them vulnerable to being infected with STIs¹⁴.

The project requires large amounts of money to establish and maintain, and this could affect its implementation. Getting specialists who will engage sex workers in these programs is expensive.

Recommendation

Adoption of a comprehensive outreach program will be the most appropriate initiative that the government needs consider. The Victoria government has recognized that there have been annual rise in significant STIs in Victoria since 1999. Therefore prevention and intervention programs need to be comprehensive covering provision of health information particularly sexually transmitted diseases and use of contraceptives, providing access to contraceptives, test programmes/facilities within their areas of work, counseling services, as well as, rehabilitation programmes. It will also include encouraging peer education among sex workers where they are able to inform one another of STIs and their consequences, as well as, safe sex practices.

By implementing these programs the state will achieve increase use of condoms and safer sex practices among sex workers and their clients. Making condoms available to sex workers especially in their areas of work and in their testing facilities will encourage them to protect themselves. Sex education will also enable them better understand the risks and consequences associated with lack of usage of contraceptives

15. 15. M Shahmanesh, & S Wayal, ‘Targeting commercial sex-workers in Goa, India: time for a strategic rethink’, The Lancet, Vol. 364, no. 9441, 2004, p1298 or unsafe sex. As a result, they empowered to get involved in their health care and take control over their working as well as social conditions.

Counseling services and rehabilitation programmes will enable them overcome drug and alcohol abuse which makes them more vulnerable to STIs infection. Sex workers are always stigmatised in every society and Victoria community is not left out. They have therefore felt uncomfortable acquiring health services such as tests, treatment and counseling due to the attitude that the general society has towards them, and therefore, they sometimes continue spreading the diseases because they are afraid of obtaining such services from public health facilities. Providing them with health facilities especially for dealing with STDs testing, prevention and treatment could help control the spread of STIs significantly. Counseling services will enable them rise above just the need for more money without giving much concern to their health. Sex workers who understand the importance of maintaining their health will always give much priority to their health.

Sex workers have often used drugs to help them endure the emotional physical pain that they experience in their work, as well as, the stigma that the society attaches to them. However, they have not been able to clearly understand the consequences of being unable to have mental control over what they do while offering sexual services. Thus rehabilitation and counseling programmes would help them avoid use of drugs, and as a result, empower them take control of their lives. As a result, the Victorian community is likely to experience significant reduction in the level of STIs among sex workers and hence a decrease in HIV and other STIs prevalence in Victoria.