The safety of migrant and local sex workers: preparing for London 2012
- Correspondence to Professor Helen Ward, Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK;
- Accepted 14 June 2011
See page 377
In the run up to the 2012 Olympics in London, there has been talk of the potential influx of vulnerable sex workers from other countries. Newspapers report that ‘vice girls hope to strike gold’ and the Metropolitan Police received an extra £600 000 in 2009 to ‘rescue young women sold into prostitution’ to meet the demand from the construction workers and visitors to the games, but have admitted that they have not actually noticed any increase in trafficking.1 2
In recent years, the discussion of sex work has been dominated by the topic of trafficking, which appears to drive out any need for a rational debate in favour of an abolitionist agenda.3 Trafficking in people, whether for sex work or other forms of labour or exploitation including construction, agriculture and domestic services, is abhorrent, involving the denial of human rights and often extreme abuse of the individuals involved. But the majority of foreign-born sex workers are not trafficked, and the conflation of the two is making it increasingly difficult to argue for evidence-based harm-reduction policies.4 So while initiatives and funds are made available to raid brothels, curb demand, catch the traffickers and cut off mobile phone numbers, there has been little investment in services to provide practical support for sex workers and many have had their funding cut, which will increase the risk to health and human rights.5 6 The prioritisation of public policies in this sphere is not based on evidence of harm—to sex workers or others—but rather on beliefs about the morality of making profit out of sex in contrast to other forms of trade.7 8
An article published in this issue is a welcome addition to the evidence base for harm reduction9 and provides another rebuttal to the charge that all migrant sex workers are trafficked. In this London study, a team of 15 fieldworkers recruited 268 women in a range of settings to try and obtain an inclusive sample of indoor sex workers. They compared women born in the UK with those who were born in Eastern Europe or the former Soviet Union (migrants). Using the UN definition, they found that 7% of migrants and 3% of UK-born women reported being coerced into sex work, consistent with other research in the UK. The most common reasons given by migrant women for starting sex work were to support themselves of their family, to fund studies or to save. UK-born women cited similar reasons except that fewer cited education and more reported needing money for drugs.
The study explored various harms that might be associated with sex work including HIV and sexually transmitted infection (STI, measured through testing) and the experience of violence. The most commonly reported harm was violence, with 25% of women reporting physical violence from clients—being robbed, hit, beaten, threatened, attacked with a weapon or kidnapped—in the past 12 months. Reducing this level of violence should clearly be a priority in terms of policy, as it is in New Zealand, for example, where a new law decriminalised prostitution in 2003 and promoted safety of sex workers. By contrast, UK policies and enforcement may actually increase vulnerability: in this study, women who had been arrested or imprisoned were 2.6 times more likely to report violence from clients.
The prevalence of HIV was 1%, which appears to have been remarkably stable over the past 25 years despite variations in sampling methods and settings and is consistent with studies in other parts of Europe.10–13 The prevalence of HIV may not have changed, but it is still higher than in the general population. It was therefore alarming that there was such poor uptake of routine HIV testing: 78% of the women had not had an HIV test in the previous 12 months despite the fact that 82% reported having had an STI screen. This indicates that specialist services are failing to advocate HIV testing and perhaps that the women themselves are reluctant to have tests. This could lead to late diagnosis and avoidable ongoing transmission, particularly to regular partners and family.
As with HIV, the risks of other STI remain relatively low and less than in other clinical attendees.14 Grouped together, 10% of women had one or more infection (antibodies to HIV or syphilis from an oral fluid sample, chlamydia or gonorrhoea based on self-collected swab); these women were more likely to have a non-paying partner and less likely to have been in contact with an outreach team. This latter finding is consistent with international research that has shown the protective impact of outreach work and specialist health projects working with sex workers.15 16
This study was of indoor sex workers; other recent studies have shown that there are areas of sex work in London where women remain highly vulnerable to STI, violence and other harms. These women are even more in need of effective policies and services to reduce their risks and offer opportunities to address problems such as addiction.17 18
As we move closer to the Olympic Games in London, we need to prioritise the needs of sex workers through the expansion of projects and outreach that deliver key support and services in relation to sexual health, violence and rights rather than stepping up police raids, deportations and prosecutions that often increase their vulnerability.19 20 Outreach projects can reach wider populations with new testing methods21 and can link to broader support services helping with language skills and advocacy.6 These projects, including sex worker organisations and sex workers, can then also work to oppose trafficking and forced prostitution while no longer fearing that it is they who will be prosecuted if they go to the authorities.
Linked article 049544.
Competing interests None.
Provenance and peer review Commissioned; not externally peer reviewed.