Sex Work Criminalization Is Barking Up the Wrong Tree

"It's Like Doctor Jekyll and Mister Hyde": The Construction of Moral Identity by Israeli Men Who Pay Women for Sex

This study examined how Israeli men who pay women for sex (MPWS) construct and sustain a moral identity within the social context that often portrays them as deviants, perpetrators, and abusers, thereby challenging their ability to maintain a respectful and dignified image. Twenty-three Israeli MPWS participated in in-depth semi-structured interviews, which were then analyzed using constructivist grounded theory method. Using the theoretical framework moral reflexivity, we conceptualize three central dynamics of constructing and sustaining a moral identity in the context of paying for sex: Maintaining an intact moral self by resisting the moral conflict; presenting a reflexive agonizing moral self; and constructing a moral self through identity fragmentation. The findings reveal that these facets of the moral reflexivity process can overlap, coexist, and circulate in a messy manner, thus promoting an ecological understanding of how morality is shaped by various societal forces, rather than discovering what a moral identity is. We therefore call for a morally sensitive approach in studies in the field of MPWS and sex work. Such an approach encourages researchers to be aware of moral issues, moral questions, and moral processes, and to treat morality as a socially context-dependent trait that is highly relevant to the study of the sex industry.

Trafficking in the child and adolescent: Application of SAFETY and CARE for a global crisis of exploitation

Human trafficking in the child and adolescent is a global public health crisis that can be divided into sex trafficking, labor trafficking and organ trafficking. This discussion considers basic terminology in this area, sociodemographic information on these victims, negative effects or repercussions from such egregious actions forced on the victims, issues of screening for healthcare providers based on specific risk factors/indicators, and information regarding screening tools as well as management principles for healthcare professionals. These trafficked persons are seen in varied practice settings such as primary care offices, emergency departments, street medicine operations, and others. Clinicians can approach these victims with targeted training that encourages these pediatric persons to feel safe in healthcare settings, empowering them to help with healing (i.e., trauma-informed care). It is important that those involved in the care of trafficked victims understand the rights of these persons who are essentially hostages that need rescuing, and thus, employ a rights-based approach in dealing with these vulnerable children and youth. Culturally-sensitive concepts of prevention are considered as well to reduce this illegal, inhumane exploitation of our children and adolescents ubiquitously existing throughout the United States and the world. Indeed, there is much that clinicians and society can do to help these unfortunate minors who often feel hopeless and trapped in chaotic circumstances.

Exploring or Floundering in the Sex Industry? Understanding Sex Work as Job Explorations for Emerging Adult Sex Workers

Based on in-depth interviews with 40 men involved in the Chinese sex industry, this study compared how engagement in sex work impacts, whether positively or negatively, the career development and transition to adulthood of middle-class and lower-class emerging adults. Most middle-class sex workers had concrete career goals outside of the sex industry and were on track to achieve those goals using their educational credentials and social and cultural capital. In contrast, most lower-class male sex workers relied on the lucrative nature of sex work to accumulate capital for their long-term goals, such as starting small businesses. Lower-class sex workers without career goals often spent their income on addictive habits, such as video games, and their engagement in sex work was not conducive to their long-term career development. Extending the literature on emerging adulthood to the context of sex work, I argue that for emerging adults who engage in sex work consciously with career goals, sex work could be viewed as a form of job exploration, while for those who engage in sex work without clear career goals, their engagement could be better described as floundering.

A practical approach to meeting national obligations for sustainable trade under CITES

Reconciling conservation goals with sustainable resource use requires adaptive management strategies. The Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) regulates global trade for species listed on Appendix II, partly by requiring member countries (parties) to ensure exports do not damage wild populations (called making positive "nondetriment findings" [NDFs]). Unfortunately, when parties find NDFs difficult, they often suspend legal trade, imposing economic costs and driving trade underground. To make it easier for parties to examine the detrimental nature of exports, we devised a spatial approach and applied it to seahorses (Hippocampus spp.) in Tamil Nadu, India, as an example. Our approach involves mapping answers to 5 key questions on species distribution (QA), pressures (QB), management measures (QC), management implementation (QD), and species' population status (QE). We gathered data from fisher interviews and published literature. Seahorse abundance was greatest in southern Palk Bay and the northern Gulf of Mannar, primarily in seagrasses and coral reefs (QA). Fishing pressure was highest in Palk Bay, primarily from bottom trawlers and dragnetters operating in shallow seahorse habitats near the coastline (QB). Management measures including a marine protected area (MPA), bottom trawl exclusion zone, and closed season were theoretically in place (QC), but their implementation was poor (QD). Fishers reported seahorse catches in 85% of the area covered by the MPA and the exclusion zone; bottom trawlers were responsible for most violations. Seahorses were also captured in Sri Lankan waters, where bottom trawling is banned. Fisher reports indicated declining seahorse catches and reduced body sizes (QE), highlighting unsustainable exploitation. Our results highlight the need for better implementation of existing management measures before a positive NDF can be made and suggest mitigation beyond bans. Such pragmatic spatial analyses can help regulate exports at sustainable levels, supporting CITES implementation for its vast range of species.

The Legality of Labor and Perceptions of Deservingness of Rights and Services for Sex Workers

Access to social services like healthcare, education, housing, and welfare are integral to creating an equitable society. While many populations inherently benefit from these services, sex workers are often denied these rights and services because of the nature of their work. The purpose of this study was to examine perceptions of deservingness of sex workers for a wide range of rights and services. This study distinguished those attitudes across legal and illegal forms of sex work, identified attitudinal and demographic correlates associated with those perceptions, and examined potential interactions between respondents' gender and age. Participants included a nationwide sample of adults from the USA (n = 549). Results indicated that participants perceived legal sex work as more deserving of rights and services compared to illegal sex work. Perceptions of deservingness were associated with attitudes toward abortion, LGBTQ+ rights, and perceptions of government legitimacy. Overall, older individuals were less willing to extend rights and services to sex workers and women were more likely to perceive sex workers as deserving of rights and services. There was an interaction between gender and age. For illegal sex work, gender differences in perceptions converged as participants aged, whereas for legal sex work, gender differences were exacerbated with age, with men reporting particularly restrictive perceptions of deservingness.

The Role of Moral Foundations in Support for Sex Work Decriminalization by Venue

The criminal status of prostitution has received greater attention from policymakers and advocates in recent years, but systematic policy change has yet to take root in the United States. These efforts have been both motivated and challenged by a strong moral discourse, resulting in policies that are more reflective of ideology than efficacy. While the popularization of sex work through online avenues like social media has altered the traditional concept of sex work, there is an incomplete understanding of public attitudes toward decriminalization in this modern market. Using national data from 519 U.S. adults, the present study applied Moral Foundations Theory to investigate support for sex work decriminalization in three venues (brothel, online, street). Overall, results show lower support for decriminalization of street sex work compared to brothel and online sex work, and that the effects of moral foundations on support for decriminalization are consistent across all venues. Individualizing foundations (i.e. harm, fairness) do not predict support for decriminalization, while binding and liberty foundations explain some variation in support. Implications of the findings speak to the potential barriers to criminal justice reform in this area and the role of moral arguments in this dispute.

The Question of Moral Worth in a Controversial Market: Moral Justification Regimes and Boundary Work Among Israeli Men Who Pay for Sex Abroad

This study examined the internal moral debate that takes place among Israeli men who pay for sex (MWPS) while traveling abroad. We explored how they construct their sense of moral worth and present themselves as moral subjects in light of the intensified stigmatization of their actions. Using the theoretical frameworks of pragmatic morality and boundary work, we conceptualize four main moral justification regimes that MWPS use to construct themselves as moral subjects: Cultural normalization; Conditional freedom of choice; The altruistic act of charity; and Unpacking the Stigma Discourse. The findings highlight how these justification regimes are anchored in three intersecting fields - cultural, spatial, and power relations - which produce various matrices of conflict, compromise, or collaboration in different situations. Thus, the flexible switching between various justification regimes reveals how MWPS define themselves and their activities and negotiate various moral dispositions - akin to various cultural logics - in the context of moral taint and stigma.

Strategies and Interventions Used to Prevent Violence Against Sex Workers in the United States: A Scoping Review Using the Social-Ecological Model

Structural factors in the United States, such as criminalization, contribute to disproportionate rates of violence against sex workers and subsequent risk of adverse health outcomes. There is a clear need for systemic interventions and risk reduction strategies to reduce violence in this population. To inform next steps in prevention, this scoping review provides an overview of the literature on violence prevention efforts targeting sex workers in the United States, mapped out according to the social-ecological model (SEM). A comprehensive search of peer-reviewed literature across five databases with no limit on publication date yielded 2,372 documents. Studies were eligible for inclusion if they focused on the U.S. population of sex workers and had a clearly defined aim or purpose of exploring, describing, or evaluating sex work violence prevention interventions or risk reduction strategies. Twelve studies met all eligibility criteria and were selected. Only two of the studies evaluated sexual violence prevention interventions, while the remaining 10 explored strategies sex workers use to minimize the risk of violence. Most research focused on female sex workers, violence from paying clients, and prevention at the individual level of the SEM. Our findings suggest a need for additional violence prevention interventions tailored for diverse groups of sex workers and cognizant of the overlapping forms of violence they face. This scoping review contributes to the limited body of research on the prevention of violence against sex workers in the United States by providing future directions for research and program development that span across the SEM.

The Reconsecration of the Self: A Qualitative Analysis of Sex Trafficking Survivors' Experience of the Body

The understudied bodily harm women experience after commercial sex (CS) may be partially explained by the prominence of Cartesian mind-body dualism in psychological science. Accordingly, we qualitatively explored the mind-body relationship among 79 female sex trafficking survivors. Survivors reported long-term negative alterations in feelings about the body, sex, and physical touch posttrafficking and these negative outcomes did not differ across women who self-perceived as consenting and women who self-perceived as forced. Implications for future research are presented, particularly on measuring dehumanization in CS which contributes to extensive harm even in the absence of physical aggression.

Sexual Health Needs Among Men Who Engage in Transactional Sex with Men in the UK

Men who engage in transactional sex with men (MTSM) are a high-risk population for HIV and other sexually transmitted infections. Epidemiological data have so far included them in the broad category of men who have sex with men (MSM), while research on transactional sex typically focused on female sex workers. The internet has substantially changed sex work practices and earlier findings concerning the sexual health needs of MTSM may no longer be applicable. We analyzed quantitative data from MSM based in the UK (n = 11629) taking part in the European MSM Internet Survey (EMIS-2017). Compared to non-MTSM, MTSM (n = 230; 2%) were younger, more likely to self-identify as an ethnic minority, be single, have lower education levels, struggle financially, and-controlling for age-more likely to be living with diagnosed HIV. Commonly unmet needs among all MSM were a lack of confidence in accessing HIV post-exposure prophylaxis, uncertainty about HIV status, and ignorance of where to access hepatitis vaccinations. Compared with other MSM, MTSM were notably less satisfied with the safety of their sexual practices, less confident in their ability to maintain sexual boundaries, and more likely to engage in risk because of absent precautionary resources. Given their greater opportunity for sexual risk, as well as fewer resources for negotiating safety, our findings suggest that services should prioritize MTSM in HIV prevention and sexual health promotion, including assertiveness and social skills training, in addition to knowledge-based education.

Construction and Validation of a Scale to Assess Social Judgments Toward Sex Work from the Stereotype Content Model

Sex workers (SW) are subject to social judgment and the associated attitudes, ranging from admiration to contempt. The presence of stereotypical attitudes toward SW is common and can be analyzed using the Stereotype Content Model (SCM), where the concepts of warmth and competence play a central role. The interweaving of both dimensions allows the identification of four emotions and corresponding political positions toward SW: admiration (non-interventionism), pity (abolitionism), contempt (prohibitionism), and fear (regulationism). From the SCM framework, this study offers the construction, validation and performance of a 25-item scale with a snowball sample of 1,543 participants residing in Spanish-speaking countries. The four-factor hypothesized model yielded adequate values. Internal consistency was sufficient on all factors, as was model-based reliability and convergent validity. The scale also showed measurement invariance between gender and age groups, suggesting that the measure is interpreted in a conceptually similar manner by respondents representing different genders or ages. Further analysis revealed that male participants scored significantly higher on admiration. Baby boomers showed less pity and contempt while Millennials showed more fear and less admiration. SW and those who know or work with SW showed less fear and pity and more admiration. The SCM and the process of developing social judgments offer us a way to understand the differences that underlie irreconcilable policy positions. Overcoming these differences requires mutual understanding from scientific frameworks instead of from ideological perspectives.

Prostitution in the shadow of life-long sexual abuse: Arab women's retrospective experiences

The present study uses the life-course and intersectionality perspectives to explore the meaning that aging Arab women attribute to their lived experiences of life-long sexual abuse in the shadow of engaging in prostitution. Interpretive phenomenological analysis was used to analyze the narratives of 10 older Arab women in Israel who were engaged in prostitution. Four themes emerged: experiencing childhood in the shadow of sexual abuse, becoming a prostitute, being entrapped in prostitution, and settling accounts with the native culture. Women aging in prostitution experience a harsh reality of abuse and loss. The present study points to multiple channels of abuse throughout the life course, from childhood until old age.

Access to Sexual Rights for People Living with Disabilities: Assumptions, Evidence, and Policy Outcomes

Sexuality scholars have historically understudied the link between disability, sexual exclusion, and social justice, including equal rights for people living with disabilities (PLWD) to enjoy a sexual and intimate life in adulthood. There have been some recent efforts to rectify this situation, with studies emerging concerning strategies for promoting their sexual rights. Our Target Article explores one contentious service option-the possibility of "sexual assistance" for PLWD, which ranges in meaning across countries from sex surrogacy to physical contact with paid sexual assistants. We conducted a knowledge synthesis using a scoping review methodology to identify the breadth of the academic scholarship available and assess its alignment with current ethical and moral debates and recent policies and practices surrounding the sexual scripts of PLWD as they relate to sexual assistance. We categorized the relevant articles in our scoping review into two broad classes: those that support sex-negative perspectives (i.e., framing sexuality as risky, adversarial, etc.) and those that support sex-positive perspectives (i.e., framing sexuality as normative, consensual, etc.). Our results show that sex-negative cultural scripts call for limitations of the sexual rights of PLWD due to their inherent vulnerability as having disabled sexualities and/or due to their heightened risk of exploiting sexual partners, especially cis women who sell sexual services. The sex-positive cultural scripts understand PLWD as having the same rights to sexual citizenship as non-disabled individuals and that to achieve this, equitable access to sexual health services in decriminalized and regulated service environments is needed. We conclude with limitations of our investigation and recommendations for further research on this understudied topic, including the possible integration of positive disabled sexuality and abuse prevention.

Sex workers' peer support during the COVID-19 pandemic: Lessons learned from a study of a Portuguese community-led response

To respond to the consequences felt by the COVID-19 pandemic, a community-led intervention was developed by the Portuguese national Movement of Sex Workers. With this exploratory study, we aimed to document their work and analyze their perceptions of this impact. To do so, we interviewed them individually, between May and August of 2020. Additionally, we analysed an Excel Sheet that contained the needs assessment and the support provided by the Movement. The content analysis of both suggests that the impact of the pandemic might have been exacerbated by the social inequalities caused by the prostitution stigma and characteristics such as gender, migration status, race, and socioeconomic status. This study calls for the inclusion of sex workers' voices in the design of policies and responses related to the commerce of sex. The consolidation of a Portuguese Movement of Sex Workers is also noted.

Using social practice theory in measuring perceived stigma among female sex workers in Mombasa, Kenya

BACKGROUND

Perceived stigma is a complex societal phenomenon that is harboured especially by female sex workers because of the interplay of a myriad of factors. As such, a precise measure of the contribution of different social practices and characteristics is necessary for both understanding and intervening in matters related to perceived stigma. We developed a Perceived Stigma Index that measures the factors that greatly contribute to the stigma among sex workers in Kenya, and thereby inform a framework for future interventions.

METHODS

Social Practice Theory was adopted in the development of the Perceived Stigma Index in which three social domains were extracted from data collected in the WHISPER or SHOUT study conducted among female sex workers (FSW), aged 16-35 years in Mombasa, Kenya. The three domains included: Social demographics, Relationship Control and Sexual and Gender-based Violence, and Society awareness of sexual and reproductive history. The factor assessment entailed Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and the internal consistency of the index was measured using Cronbach's alpha coefficient.

RESULTS

We developed a perceived stigma index to measure perceived stigma among 882 FSWs with a median age of 26 years. A Cronbach's alpha coefficient of 0.86 (95% confidence interval (CI) 0.85-0.88) was obtained as a measure of the internal consistency of our index using the Social Practice Theory. In regression analysis, we identified three major factors that contribute to the perceived stigma and consists of : (i) income and family support (β = 1.69; 95% CI); (ii) society's awareness of the sex workers' sexual and reproductive history (β = 3.54; 95% CI); and (iii) different forms of relationship control e.g. physical abuse (β = 1.48; 95%CI that propagate the perceived stigma among the FSWs.

CONCLUSION

Social practice theory has solid properties that support and capture the multi-dimensional nature of perceived stigma. The findings support the fact that social practices contribute or provoke this fear of being discriminated against. Thus, in offering interventions to curb perceived stigma, focus should fall on the education of the society on the importance of acceptance and integration of the FSWs as part of the society and the eradication of sexual and gender based violence meted out on them.

TRIAL REGISTRATION

The trial was registered in the Australian New Zealand Clinical Trials Registry, ACTRN12616000852459.

Assessing program fidelity to critically reflect on the suitability of Critical Time Intervention to facilitate exiting sex work

An emerging approach to facilitating exiting sex work is through applying the Critical Time Intervention [CTI] model. CTI represents a time-limited approach that supports marginalized individuals during periods of transition. We performed a fidelity assessment as part of a process evaluation of Exit Doors Here [EDH], a program supporting women who wish to exit sex work. We reflect on the appropriateness of the CTI model for supporting these women, and highlight contextual and population specificities which might need to be considered for effective scaling up of similar programs. First, we applied an existing fidelity assessment tool to the EDH program. Program staff highlighted areas for adaptation. We then adapted the tool based on this feedback and assessed program fidelity by analyzing data from eight participants' CTI charts. Fidelity ratings were computed and interpreted according to established guidelines. Consultations with program staff resulted in adaptations to seven of the 12 fidelity assessment tool items. The majority of adaptations surrounded the time-limited nature of CTI and unique needs of the program participants such as their experiences with violence and substance use. The fidelity assessment of the adapted tool demonstrated that even after adaptations were made, certain items were still not appropriate for this study population. Difficulties in implementing selected program components with high fidelity can be attributed to contextual and population specificities of the study population. This study reiterates the importance of considering such factors when developing and implementing programs aimed at improving the health and livelihoods of marginalized women such as those who engage in sex work.

HIV- and sex work-related stigmas and quality of life of female sex workers living with HIV in South Africa: a cross-sectional study

BACKGROUND

Environmental quality of life (QoL) assesses individually perceived factors such as physical safety and security, accessibility, quality of healthcare, and physical environment. These factors are particularly relevant in the context of sex work and HIV, where stigma has been identified as an important barrier across several prevention and treatment domains. This study aims to examine the association between different types of HIV- and sex work-related stigmas and environmental QoL among female sex workers (FSW) living with HIV in Durban, South Africa.

METHODS

We conducted cross-sectional analyses using baseline data from the Siyaphambili randomized controlled trial. FSW who reported sex work as their primary source of income and had been diagnosed with HIV for ≥ 6 months were enrolled from June 2018-March 2020, in eThekwini, South Africa. We evaluated the association between environmental QoL, dichotomizing the environmental domain score collected by the WHO Quality of Life HIV Brief (WHOQOL-HIV BREF) questionnaire at the median, and stigma using modified robust Poisson regression models. Five stigma subscales were assessed: sex work-related (anticipated, enacted, or internalized stigma) and HIV-related (anticipated or enacted stigma).

RESULTS

Among 1373 FSW, the median environmental QoL was 10.5 out of 20 [IQR: 9.0-12.5; range 4.0-19.0], while the median overall QoL was 3 out of 5 [IQR: 2-4; range 1-5]. One-third of FSW (n = 456) fell above the median environmental QoL score, while 67% were above the median overall QoL (n = 917). Reporting anticipated sex work stigma was associated with lower environmental QoL (adjusted prevalence ratio [aPR] 0.74 [95% CI 0.61, 0.90]), as was severe internalized sex work stigma (aPR: 0.64, 95% CI 0.48, 0.86). Reporting enacted HIV stigma versus none was similarly associated with lower environmental QoL (aPR: 0.65, 95% CI 0.49, 0.87). Enacted sex work stigma and anticipated HIV stigma were not statistically associated with environmental QoL.

CONCLUSIONS

This study highlights the need to consider the impact of multiple stigmas on FSW's non-HIV related clinical outcomes, including safety and physical well-being. Moreover, these results suggest that addressing underlying structural risks may support the impact of more proximal HIV prevention and treatment interventions. Trial registration NCT03500172 (April 17, 2018).

"What will we do if we get infected?": An interview-based study of the COVID-19 pandemic and its effects on the health and safety of sex workers in the United States

Emerging evidence suggests that sex workers face unique and profound risks arising from the COVID-19 pandemic. To illuminate the pandemic's effects on sex worker health and safety and identify intervention opportunities, from May-August 2020 in-depth interviews were conducted with a purposive sample of 15 sex workers, four service providers and two individuals who were both. Sampled sex workers included eight people of color, eight cisgender women, five cisgender men, three non-binary people, and one transgender woman. Using Conservation of Resources Theory to define impacts on sex worker resources and resulting health and safety implications, a deductive thematic analysis was conducted. Seven resources were threatened due to the pandemic: work opportunity, sex work venues, social support, health services, money, food, and housing. The loss of these resources was exacerbated by stigma - notably sex work criminalization - and significantly undermined health and safety by increasing food and housing instability, increasing risks of violence, and diminishing safer sex negotiation. Six resources were activated in response: social support, digital skills, health knowledge, non-sex work employment, money, and resilience. While social support had numerous benefits, investing digital skills and non-sex work employment were generally of limited impact. The pandemic's negative health and safety effects were most profound at the intersections of race, gender, class, and migration status. These findings suggest sex workers need urgent and ongoing support, with investments in social support and sex work decriminalization likely to have the greatest effects on health and safety relative to and beyond the COVID-19 pandemic.

Understanding the longitudinal relationship between substance use and violent victimization among street-based women who exchange sex in Baltimore, Maryland

BACKGROUND

Women who exchange sex (WES) experience extensive interpersonal violence from multiple perpetrators. Violence towards WES contributes to poor mental and behavioral health outcomes, including high rates of drug use. However, it is difficult to disentangle the temporal relationship between drug use and violence among WES.

METHODS

We used data from 251 WES, who completed baseline and 6-month follow up surveys. WES reported baseline sociodemographic characteristics, including homelessness and hunger. Participants reported their drug use by type and violent experiences by perpetrator at each time point. We conducted a path analysis examining the associations between drug use and violent victimization over time.

RESULTS

Participants were on average 37.8 years old, non-Hispanic White (57.4%) and experiencing high levels of structural vulnerability (59.4% homelessness; 58.6% weekly hunger). Drug use and violence were significantly correlated within each time point. Prospectively, baseline violent victimization was significantly associated with drug use (ß (SE) = 0.13 (0.06)) and violence (ß (SE) = 0.47 (0.05)) at follow up. Baseline drug use was associated with drug use at follow up (ß (SE) = 0.45 (0.05)) but was not significantly associated with violence at follow up (ß (SE) = 0.10 (0.06)).

CONCLUSIONS

Violence and drug use are closely linked in this population; and violence appears to facilitate sustained drug use. Interventions to address the dual epidemics of violence and substance use in this population should address underlying trauma as well as socio-structural drivers of violence as well as tailored harm reduction services for this population.

Challenges and Benefits of Disclosure of Sex Work to Intimate Partners

Sex workers' noncommercial intimate partnerships are marginalized on two counts - they are non-monogamous and at least one partner is in sex work, an occupation with much stigma. We asked a heterogeneous sample of Canadian sex workers (N = 218) about their decisions to reveal/not reveal their sex work to intimate partners, and the resulting challenges and benefits. A minority (58/183) of participants who had been or were currently involved in an intimate relationship kept their work secret from at least one partner or disclosed limited information, shielding them from stigma but resulting in a burden of secrecy. The majority of participants (151/183) who had been/were currently involved in an intimate relationship chose to disclose their sex work to at least one partner, which for most, had one or more negative consequences. A small group of participants related that disclosure resulted in acceptance, support, and understanding from their intimate partner. Some participants avoided the disclosure dilemma by forming intimate relationships from social connections where sex work status was already known. These relationships were generally supportive. We conclude that intimate relationships provide positive experiences for many people who sell sexual services and that these relationships could be stronger if societal stigma was reduced.

Perceived Stigma and Stigma Management Strategies Among Online Male Sex Workers

Technological advances like the Internet and Internet-enabled devices, such as smartphones, and the dating and hookup websites and apps available to the users of them, have transformed the nature, organization, and practice of sex work in fundamental ways. Some scholars have argued that these changes have contributed to a normalization of male exchange sex (i.e., providing sex in exchange for money, drugs, shelter, or goods), and in so doing, have diminished the stigma historically associated with it. However, little empirical research has focused on how male sex workers (MSWs), including those engaged in what might be called informal or incidental or casual sex work and primarily use dating/hookup websites and apps not designed for commercial to meet clients experience and manage stigma. To help fill this gap, we analyzed interview data from 180 MSWs who engaged in exchange sex and met their client on dating/hookup websites and apps. Most participants felt that sex work was still highly stigmatized in society at large, but many also felt it was generally accepted-if not completely normalized-within the gay community. Nevertheless, many struggled with the emotional impact of engaging in a stigmatized practice and most employed one or more of the following stigma management strategies: information management, distancing, discrediting the discreditors, asserting no other option existed, and challenging or reframing stereotypes and narratives. These findings indicate that MSWs, even those engaged in informal or incidental sex work, who meet clients on dating/hookup websites and apps are still strongly affected by sex work-related stigma and seek to manage it in various ways. Future research should investigate the sources of internalized stigma among this under-studied population of sex workers.

Co-occurring Threats to Agency Among Female Sex Workers in Baltimore, Maryland

Driven largely by the unequal distribution of power, female sex workers (FSW) globally bear a disproportionately high burden of HIV, sexually transmitted infections, and interpersonal violence. Prior literature has identified a number of multi-level factors that may serve to constrain FSWs' agency, or their ability to define and take action to realize goals. Among these are work-based violence and substance use, which are potentiated by the criminalization of sex work and structural vulnerability. Quantitative research related to U.S.-based FSWs' own sense of agency, as well as the barriers that may impede it, is sparse. We sought to identify patterns of various threats to agency and explore to what extent they were associated with perceived agency among a cohort of 381 FSW in Baltimore, Maryland, United States, using latent class analysis. Latent class indictors were past-six-month experience of client-perpetrated sexual violence, client-perpetrated physical violence, homelessness, food insecurity, arrest, daily crack-cocaine use, and daily heroin use. Perceived agency was measured using the short form of the Pearlin Mastery Scale. We identified three typologies of threatened agency among women in our sample: a "threatened by structural factors, drug use, and violence" class, a "threatened by structural factors and drug use" class, and a "less threatened" class. Mean perceived agency score was significantly lower for the class characterized by client-perpetrated violence than for either of the other classes. This suggests violence, in the context of deeper, structural power imbalances embedded in hunger, homelessness, and drug use, may dramatically reduce one's sense of agency and operate as a critical barrier to empowerment. Our study adds important insights to the broader FSW community empowerment literature and supports the need for interventions to bolster both individual and collective agency among U.S.-based FSW, including interventions to prevent sex work-related violence.

Sex Workers' Everyday Security in the Netherlands and the Impact of COVID-19

Introduction

The COVID-19 pandemic has laid bare and exacerbates the existing insecurities of sex workers. This paper asks: What are sex workers' everyday experiences of (in)security? And: How has the COVID-19 pandemic influenced these?

Methods

We engage with these questions through collaborative research based on semi-structured interviews carried out in 2019 and 2020 with sex workers in The Hague, the Netherlands.

Results

Revealing a stark mismatch between the insecurities that sex workers' experience and the concerns enshrined in regulation, our analysis shows that sex workers' everyday insecurities involve diverse concerns regarding their occupational safety and health, highlighting that work insecurity is more multi-faceted than sexually transmitted infections (STIs). Widespread employment and income insecurities for sex workers are exacerbated for transwomen and male sex workers. Their legal liminality is enabled not only by the opaque legal status of sex work in the Netherlands, but also by the gendering of official regulation. The COVID-19 pandemic made visible how the sexual and gender norms that informally govern sex workers' working conditions intersect with hierarchies of citizenship, complicating access to COVID-19 support, particularly for migrant sex workers.

Conclusions

Sex work regulation in the Netherlands leaves workers in a limbo-not without obligations and surveillance, yet, without the full guarantee of their labour rights.

Policy Implications

To effectively address sex workers' insecurities, a shift in regulation from its current biopolitical focus to a labour approach is necessary. Besides, public policy and civil society actors alike need to address the sex industry's harmful social regulation through hierarchies of gender, sexuality and race.

Mercer C, Wiessner C, Matthiesen S, Briken P. Men Who Pay For Sex: Prevalence and Sexual Health

BACKGROUND

Men who pay for sex (MPS) are a vulnerable bridging population for spreading sexually transmitted infections (STI). However, their prevalence and sexual health are unknown in Germany.

METHODS

We analyzed data from 2336 men aged 18-75 years resident in Germany who completed the German Health and Sexuality Survey (GeSiD), a populationbased probability sample survey undertaken 2018-2019, using face-to-face interviews (participation rate: 30.2%).

RESULTS

26.9% (95% confidence interval [24.7; 29.2]) of all men reported ever paying for sex. On average, MPS had M = 19.9 [16.8; 22.9] lifetime sexual partners, among them M = 7.3 [5.3; 9.4] paid partners. MPS described their paid sex predominantly as vaginal intercourse in domestic brothels. Regarding socio - demographic characteristics, MPS differed from men not paying for sex (MNPS) in terms of age, immigration status, and sex education. Compared to MNPS, MPS reported significantly more HIV/STI risk-taking, including multiple sex partners in the past year (OR adjusted for age, immigration status, sex education; AOR 3.55) and STI diagnosis in the past 5 years (AOR 1.96) as well as more prevention behaviors (e.g., condom use in the past year: AOR 3.13).

CONCLUSION

The prevalence of MPS suggests physicians should address the topic with their patients to protect and improve the sexual health of MPS and their paid and unpaid partners.

Understanding Sexual Agency. Implications for Sexual Health Programming

Debates on human agency, especially female and sexual agency, have permeated the social scientific literature and health educational practice for multiple decades now. This article provides a review of recent agency debates illustrating how criticisms of traditional conceptions of (sexual) agency have led to a notable diversification of the concept. A comprehensive, inclusive description of sexual agency is proposed, focusing on the navigation of goals and desires in the wider structural context, and acknowledging the many forms sexual agency may take. We argue there is no simple relation between sexual agency and sexual health. Next, we describe the implications of such an understanding of sexual agency for Comprehensive Sexuality Education (CSE) and for sexual health and rights (SHR) programming more generally. We put forward validation of agentic variety, gender transformative approaches, meaningful youth participation, and multicomponent strategies as essential in building young peoples’ sexual agency and their role as agents of wider societal change. We also show that these essential conditions, wherever they have been studied, are far from being realized. With this review and connected recommendations, we hope to set the stage for ongoing, well-focused research and development in the area.

Support for Prostitution Legalization in Romania: Individual, Household, and Socio-cultural Determinants

Romania is a major source country of labor migration to other EU countries, being commonly perceived as a source country for sex workers operating in more prosperous economies. However, very little is known about population attitudes in relation to prostitution in Romania. Based on nationally representative data from the Romanian Gender Barometer (2018) survey, we analyzed data on 860 individuals to examine the predictors of policy preferences for legalizing prostitution. We considered individual-level socio-demographics and household-level indicators such as the presence of children and migrants, as well as socio-cultural beliefs and behaviors related to social liberalism and religiosity. The findings suggest that male gender and higher education are strong predictors of preferences for the legalization of prostitution. However, living in a household with migrants and attending church regularly were negatively associated with the legalizing policy option. Moreover, social liberalism-expressed as both favorable attitudes toward the introduction of sex education in school curriculum, and as a rejection of traditional gender roles-increased the odds of supporting the legalization of prostitution. The interaction between presence of children under 18 in the household and respondents' occupational status also revealed a significant effect. Such findings are relevant in order to correctly develop and orient prostitution policy in a way that works for citizens.

Sex workers as mothers: Correlates of engagement in sex work to support children

BACKGROUND

Globally, most female sex workers (FSW) are mothers but are rarely considered as such in public health and social service programs and research. We aimed to quantitatively describe FSW who are mothers and to examine correlates of current engagement in sex work to support children among a cohort of FSW in Baltimore, Maryland, United States (U.S.).

METHODS

The study utilized baseline survey and HIV/STI testing data from the Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study of women engaged in street-based sex work in Baltimore, Maryland. Variable selection and interpretation were guided by Connell's theory of Gender and Power. We used bivariate and multivariate logistic regression analyses to examine correlates of engagement in sex work to support children among FSW mothers.

RESULTS

Our sample included 214 FSW with children, of whom 27% reported supporting children as a reason for the current engagement in sex work. Median age was 36 years, and mean number of children was 2.88. 20.6% were currently living with any of their minor aged children, and this was significantly more common among mothers engaged in sex work to support children (57.9% vs. 7%; p<0.001). 38.7% had ever lost legal custody of children, which was significantly less common among those supporting children through sex work (26.8% vs. 42.9%; p=0.033). In multivariate analyses, the following were independently associated with engaging in sex work to support children: African-American versus white race (aOR=2.62; 95% CI:1.18-5.82; p=0.018); less housing instability (aOR=0.42; 95% CI:0.20-0.89; p=0.024); initiating sex work at age <23 (aOR=2.59; 95% CI:1.23-5.46; p=0.012); less frequent intoxication during sex with clients (aOR=0.31; 95% CI:0.14-0.67; p=0.003); and reporting mental health as most important health concern (aOR=2.37; 95% CI:1.09-5.17; p=0.029).

CONCLUSIONS

FSW mothers who report engagement in sex work to support children are distinct from their counterparts in key areas related to HIV and other health outcomes. Neglecting to account for this important social role may lead to missed opportunities to meaningfully promote physical and mental health and to engage women on their own terms. Future research and interventions should seek to address FSW as whole social beings and center their experiences and needs as mothers.

Prostitution Policies and Attitudes Toward Prostitutes

The present study examined whether regulatory attitudes toward prostitution are related to agency attributed to prostitutes and moral outrage. A Spanish sample (N = 391, aged 18-53 years old) completed a questionnaire that included two separate parts. In the first part, participants answered a scale on regulatory attitudes toward prostitution; in the second part, after reading one of two scenarios, participants answered questions about agency and moral outrage. Results showed a different pattern in the link between regulatory attitudes and social perception when participants perceived prostitutes as victims of sexual slavery (Scenario 1) or as women who freely choose to sell sexual services (Scenario 2). This study provides empirical evidence of how some regulatory attitudes toward prostitution are linked to mind attributions and negative feelings toward sex workers, and how it depends on the type of prostitute who practices it. These findings contribute to our knowledge of attitudes toward prostitution, which could inform future policy-making.

Identity Construction of Men Who Pay Women for Sex: A Qualitative Meta-Synthesis

This interpretive qualitative meta-synthesis (QMS) aims to systematically review what we know about identity construction of men who pay women for sex (MPWS). A corpus of 54 qualitative studies about the experiences and perceptions of MPWS was synthesized, using the theoretical framework of symbolic interaction and QMS guidelines. This synthesis yielded novel insights into the meanings that MPWS attribute to their involvement in the sex industry, within a range of interpersonal interactions and social discourses. We identified and expanded on six social discourses that affect the identity construction of MPWS: sexuality; intimacy; consumerism; power; deviancy and normativity; and masculinity. The findings demonstrate that paying for sex (and in particular, the stigma associated with it) permeates many life spheres of MPWS, and affects their gendered, sexual, cultural, intimate, consumerist and social identities, and self-perceptions. The discussion centers on four major understandings derived from the QMS: paying for sex is central to the lives of MPWS; paying for sex generates conflict in the identities of MPWS; discourses of masculinity are prominent in the identity construction processes of MPWS; and the literature on MPWS needs further social and cultural contextualization. These understandings have profound implications for sex-industry-related policy and social interventions.

The "Sociological Equation": Intersections Between Street Sex Workers' Agency and Their Theories about Their Customers

Street sex work is deeply stratified, embedded in power imbalances and inequities; workers are multiply marginalized, relative to customers, in terms of race, class and gender. At the same time, these imbalances should not be equated with worker powerlessness. In this paper, we seek to counter the existing limited and polarized conceptualizations of agency that dominate the sex work literature by providing an assessment of the ways in which female street sex workers seek to realize and exercise agency and enact strategies of resistance despite the violence ubiquitous in their work. We draw from worker narratives collected through individual and focus group interviews in five Canadian cities to highlight the nuanced and layered ways in which workers, collectively and individually, apply reasoning and argumentation to the risks represented by customers, as well as to other aspects of their working environment. Workers offered three significant theories related to which men buy sex on the street and why (some) men buy sex; we describe how they employ these to negotiate the conditions of their work, nesting our findings within a broader socio-cultural analysis of the risks workers experience as they navigate complex, highly politicized working environments. Finally, we show how workers appropriate hegemonic masculinity discourses as well as intersecting race, class and gender discourses to inform their rationales for choosing some customers over others, setting our discussion within existing literature on male sex work customers.

Men Who Pay for Sex Once, More than Once, or Not at All: The Associations between Attitudes toward Paying for Sex, Socio-Demographic Characteristics, and Frequency of Sex Payment

In an attempt to characterize men who pay women for sex (MPWS), theory and research generally divides men into two groups: men who pay for sex and those who never paid for sex. However, this dichotomy may lack sufficient detail to understand sex payment accurately, and with regard to attitudes toward paying for sex and frequency of sex payment. The present study set out to explore the associations between views toward MPWS; socio-demographic characteristics and frequency of paying for sex. A sample of 632 Israeli men, ages 18-75, were recruited via Facebook ads. Participants completed an anonymous, online questionnaire on their attitudes toward MPWS. Men who paid for sex once were more similar in their attitudes to men who did not pay for sex than to those who paid more than once. In addition, favorable views on MPWS predicted paying for sex only among men who paid for sex more than once, but not among men who paid for sex once. These findings may require new programmatic attention in public policy considerations and therapeutic strategies, taking into consideration both attitudes of men who pay for sex toward, and frequency of, this behavior.

'I Can Lead the Life That I Want to Lead': Social Harm, Human Needs and the Decriminalisation of Sex Work in Aotearoa/New Zealand

BACKGROUND

Sex work is commonly understood to be a risky occupation. Sex work law debates coalesce around the issue of harm, with differing perspectives regarding what constitutes harm, how harm is produced and what needs to change to mitigate it. While sex work is often portrayed as inherently harmful, sex workers and researchers have challenged this assumption, calling attention to the relationship between harm and policies in place. Criminalisation, in its many and varied forms, is thought to exacerbate harms that can occur in sex work, while decriminalisation is understood as creating conditions conducive to minimising harm. However, the decriminalisation of sex work remains rare, and more research which examines how decriminalisation works in relation to harms is critical. This paper uses the concept of social harm to unpack the implications of sex work policies and examine the experiences of sex workers in New Zealand, where sex work is decriminalised.

METHODS

Semi-structured in-depth interviews were conducted with 46 sex workers in New Zealand in 2018 and 2020 across two studies focused on examining experiences and perceptions of stigma and discrimination in this context. The interviews were thematically analysed using NVivo data analysis software.

RESULTS

The experiences of participants demonstrate how involvement in sex work had improved their lives in multiple ways. Participants described the importance of sex work in improving their quality of life by ensuring that they could better meet their everyday needs, the autonomy this afforded them and how decriminalisation helped to enable this. The validating impact of decriminalisation in acknowledging sex workers as people with rights is also evident in participant's experiences.

CONCLUSIONS

Social harm is a framework that can help illuminate socio-economic harms which influence pathways into sex work for some people and the compounding harms of criminalising regimes. The benefits of engaging in sex work are often overlooked in policy debates. Although sex work is not easy work, engaging in sex work can have positive impacts on the lives of people who pursue it. Full decriminalisation of sex work is the only responsible option for societies seeking to reduce harm.

The Double-Edged Sword of Health and Safety: COVID-19 and the Policing and Exclusion of Migrant Asian Massage Workers in North America

Migrant Asian massage workers in North America first experienced the impacts of COVID-19 in the final weeks of January 2020, when business dropped drastically due to widespread xenophobic fears that the virus was concentrated in Chinese diasporic communities. The sustained economic devastation, which began at least 8 weeks prior to the first social distancing and shelter in place orders issued in the U.S. and Canada, has been further complicated by a history of aggressive policing of migrant massage workers in the wake of the war against human trafficking. Migrant Asian massage businesses are increasingly policed as locales of potential illicit sex work and human trafficking, as police and anti-trafficking initiatives target migrant Asian massage workers despite the fact that most do not provide sexual services. The scapegoating of migrant Asian massage workers and criminalization of sex work have led to devastating systemic and interpersonal violence, including numerous deportations, arrests, and deaths, most notably the recent murder of eight people at three Atlanta-based spas. The policing of sex workers has historically been mobilized along fears of sexually transmitted disease and infection, and more recently, within the past two decades, around a moral panic against sex trafficking. New racial anxieties around the coronavirus as an Asian disease have been mobilized by the state to further cement the justification of policing Asian migrant workers along the axes of health, migration, and sexual labor. These justifications also solidify discriminatory social welfare regimes that exclude Asian migrant massage workers from accessing services on the basis of the informality and illegality of their work mixed with their precarious citizenship status. This paper draws from ethnographic participant observation and survey data collected by two sex worker organizations that work primarily with massage workers in Toronto and New York City to examine the double-edged sword of policing during the pandemic in the name of anti-trafficking coupled with exclusionary policies regarding emergency relief and social welfare, and its effects on migrant Asian massage workers in North America. Although not all migrant Asian massage workers, including those surveyed in this paper, provide sexual services, they are conflated, targeted, and treated as such by the state and therefore face similar barriers of criminalization, discrimination, and exclusion. This paper recognizes that most migrant Asian massage workers do not identify as sex workers and does not intend to label them as such or reproduce the scapegoating rhetoric used by law enforcement. Rather, it seeks to analyze how exclusionary attitudes and policies towards sex workers are transferred onto migrant Asian massage workers as well whether or not they provide sexual services.

Changing Minds and Changing Laws: How New Zealand Sex Workers and Their Allies Shaped Decriminalisation in New Zealand

INTRODUCTION

This article provides insight into a rare instance of a collaborative governance approach to sex work that led to the decriminalisation, design and implementation of the sex work policy governance framework in New Zealand with the Prostitution Reform Act 2003.

METHODS

Drawing on a sample of 17 interviews conducted between the years 2012 and 2019 in addition to associated archival material originating from government and non-government sectors including sex worker representative organisations.

RESULTS

It finds that non-sex workers' endorsement for the decriminalisation of sex work was motivated by the New Zealand Prostitutes Collective (NZPC) and occurred primarily within a human rights and harm minimisation framework. But that during the lobbying and parliamentary process, amendments to the Bill emerged that contradicted the NZPC's main goal which was for sex work to be recognised as a legitimate labour activity and for all sex workers to benefit from decriminalisation and policy reform.

CONCLUSIONS

As such, this article broadens the scope of analysis related to the sex worker rights movement by examining how and why sex workers and their allies came to communicate and act on the impetus for sex work law reform and how it affected policy outcomes.

POLICY IMPLICATIONS

Those involved in collaborative governance sex work law reform projects could consider adopting Östegren's typology of repressive, restrictive or integrative approaches to sex work law reform in negotiations that concern regulation and policies.

Multiplicity of stigma: cultural barriers in anti-trafficking response

Purpose

The purpose of this study is to contribute to the social understanding of stigma as a societal and cultural barrier in the life of a survivor of human trafficking. The findings illustrate several ways where stigma is internal, interpersonal and societal and impacts survivors’ lives, including the care they receive.

Design/methodology/approach

This study used qualitative methods. Data collection occurred during 2018 with efforts such as an online survey (n=45), focus groups (two focus groups of seven participants each) and phone interviews (n=6). This study used thematic analysis of qualitative data.

Findings

The research team found that a multiplicity of stigma occurred for the survivors of human trafficking, where stigma occurred across three levels from micro to meso to macro contexts. Using interpretive analysis, the researchers conceptualized how stigma is not singular; rather, it comprises the following: bias in access to care; barriers of shaming, shunning and othering; misidentification and mislabeling; multiple levels of furthering how survivors are deeply misunderstood and a culture of mistrust.

Research limitations/implications

While this study was conducted in a single US city, it provides an opportunity to create dialogue and appeal for more research that will contend with a lens of seeing a multiplicity of stigma regardless of the political climate of the context. It was a challenge to recruit survivors to participate in the study. However, survivor voices are present in this study and the impetus of the study’s focus was informed by survivors themselves. Finally, this study is informed by the perspectives of researchers who are not survivors; moreover, collaborating with survivor researchers at the local level was impossible because there were no known survivor researchers available to the team.

Practical implications

There are clinical responses to the narratives of stigma that impact survivors’ lives, but anti-trafficking response must move beyond individualized expectations to include macro responses that diminish multiple stigmas. The multiplicity in stigmas has meant that, in practice, survivors are invisible at all levels of response from micro, meso to macro contexts. Therefore, this study offers recommendations for how anti-trafficking responders may move beyond a culture of stigma towards a response that addresses how stigma occurs in micro, meso and macro contexts.

Social implications

The social implications of examining stigma as a multiplicity is central to addressing how stigma continues to be an unresolved issue in anti-trafficking response. Advancing the dynamic needs of survivors both in policy and practice necessitates responding to the multiple and overlapping forms of stigma they face in enduring and exiting exploitative conditions, accessing services and integrating back into the community.

Originality/value

This study offers original analysis of how stigma manifested for the survivors of human trafficking. Building on this dynamic genealogy of scholarship on stigma, this study offers a theory to conceptualize how survivors of human trafficking experience stigma: a multiplicity of stigma. A multiplicity of stigma extends existing research on stigma and human trafficking as occurring across three levels from micro, meso to macro contexts and creating a system of oppression. Stigma cannot be reduced to a singular form; therefore, this study argues that survivors cannot be understood as experiencing a singular form of stigma.

The Influence of Legal Brothels on Illegal Sexual Service Purchasing Habits: The U.S. Context

In this study, we use a survey of sex workers' clients to examine the relationship between having paid for services in legal brothels in Nevada and paying for criminalized sexual services among male clients. Using ordinary least squares (OLS) and generalized ordered logistic regression models, the use of legal brothels is found to be negatively related to reported purchasing of criminalized sexual services, regardless of criminal history, income, and most other demographic factors. When tested by criminalized purchase context, purchases made using the Internet, from public, outdoor contacts (such as the street) and indoor, public contacts (like bars), were less likely to occur with brothel experience. This study addresses a critical gap in scholarship on sex workers' clients purchasing choices with consideration to both market choice and frequency of purchase when having been exposed to a legal replacement for an illegal transaction. Implications and areas of further study are discussed.

Sexual Assault Survivors Who Exchange Sex: Identity, Stigma, and Informal Responses from Support Providers

It is well established in the literature that individuals who engage in sex work are more likely to experience sexual trauma/violence, but little research has examined experiences of sexual assault survivors who exchange sex from the survivor's perspective. Sexual assault survivors and their informal support providers (SP; e.g., family, friends, romantic partners) were interviewed separately about disclosure, social reactions, and help-seeking following assault. Sixteen survivors mentioned experiences exchanging sex, which comprises the sample for the current study, as well as comments from twelve SPs. Qualitative analysis revealed several themes including violence experienced engaging in sex work, navigating stigma and the identity of both sexual assault survivor and sex worker, and how survivors' social supports impact their recovery. Survivors endorsed their sex worker identities at varying levels, and others used their identity as a sexual assault survivor to explain why they engaged in sex work. Social work implications regarding service provision and advocacy work are discussed.

"It Is Important for Everyone as Humans to Feel Important, Right?" Findings from a Community-Based Participatory Needs Assessment with Street-level Sex Workers

A community-based participatory research design informed the development and conduct of a needs assessment with street-level sex workers within a mid-sized city in Ontario, Canada. The research question was: What would help street-level sex workers to live with enhanced safety and dignity within their community? Twenty-four women who accessed a peer-driven drop-in center (SafeSpace) participated in in-depth interviews. Observational data of items requested by women who accessed SafeSpace were also documented over a 6-month time period. The overarching theme of relationships was identified as vital to participants' ability to live and work with enhanced safety and dignity in their community. Subthemes included: Informal/formal surveillance: Relationships to public space(s); Nowhere to go for us: Relationships with/in community services; and You're given the time you need: Relationships in a peer-driven drop-in center for/with/by sex workers. Our findings demonstrate how central relationships are, particularly peer, to enhancing or diminishing sex workers' sense of dignity, self-worth, safety, and enhanced their access to services.

Sexually transmissible infections among female sex workers in Amsterdam between 2011 and 2016: does risk vary by work location?

Background Female sex workers (FSW) are at risk for sexually transmissible infections (STI). This study aimed to investigate whether the risk for chlamydia and gonorrhoea differs by work location among FSW in Amsterdam. Additionally, trends in STI positivity rates between 2011 and 2016 were assessed.

METHODS

This was a retrospective analysis of routinely collected clinical data during STI consultations of FSW by the Prostitution and Healthcare Centre (P&G292). Work location was categorised as window prostitution, escorts/homeworkers, clubs/brothels/private houses/massage salons and other.

RESULTS

In total, 7558 STI consultations of 2529 FSW in the period 2011-16 were included. Positivity rates for chlamydia and gonorrhoea were 6.6% and 2.0%, respectively. Infectious hepatitis B virus, syphilis and HIV were diagnosed in <0.2% of consultations. Positivity rates of chlamydia and rectal gonorrhoea differed significantly by work location (P < 0.001). Genital and rectal chlamydia and rectal gonorrhoea were significantly less likely among women working in window prostitution, except for the other-group. Risk factors for STI did not vary by work location. Among women working in window prostitution, positivity rates for oropharyngeal and genital chlamydia and genital gonorrhoea were significantly decreasing between 2011 and 2016 (P trend <0.05).

CONCLUSIONS

The higher STI positivity among escorts/homeworkers and FSW in clubs/brothels/private houses/massage salons emphasises the need for extra attention to improve condom use and STI testing in this group. Factors associated with STI did not vary by work location, thus interventions, including those used by P&G292, to reduce STI risk, can be used for women at all work locations.

"The Prostitution Problem": Claims, Evidence, and Policy Outcomes

Prostitution, payment for the exchange of sexual services, is deemed a major social problem in most countries around the world today, with little to no consensus on how to address it. In this Target Article, we unpack what we discern as the two primary positions that undergird academic thinking about the relationship between inequality and prostitution: (1) prostitution is principally an institution of hierarchal gender relations that legitimizes the sexual exploitation of women by men, and (2) prostitution is a form of exploited labor where multiple forms of social inequality (including class, gender, and race) intersect in neoliberal capitalist societies. Our main aims are to: (a) examine the key claims and empirical evidence available to support or refute each perspective; (b) outline the policy responses associated with each perspective; and (c) evaluate which responses have been the most effective in reducing social exclusion of sex workers in societal institutions and everyday practices. While the overall trend globally has been to accept the first perspective on the "prostitution problem" and enact repressive policies that aim to protect prostituted women, punish male buyers, and marginalize the sex sector, we argue that the strongest empirical evidence is for adoption of the second perspective that aims to develop integrative policies that reduce the intersecting social inequalities sex workers face in their struggle to make a living and be included as equals. We conclude with a call for more robust empirical studies that use strategic comparisons of the sex sector within and across regions and between sex work and other precarious occupations.

Risking safety and rights: online sex work, crimes and 'blended safety repertoires'

It has been well established that those working in the sex industry are at various risks of violence and crime depending on where they sell sex and the environments in which they work. What sociological research has failed to address is how crime and safety have been affected by the dynamic changing nature of sex work given the dominance of the internet and digital technologies, including the development of new markets such as webcamming. This paper reports the most comprehensive findings on the internet-based sex market in the UK demonstrating types of crimes experienced by internet-based sex workers and the strategies of risk management that sex workers adopt, building on our article in the British Journal of Sociology in 2007. We present the concept of 'blended safety repertoires' to explain how sex workers, particularly independent escorts, are using a range of traditional techniques alongside digitally enabled strategies to keep themselves safe. We contribute a deeper understanding of why sex workers who work indoors rarely report crimes to the police, reflecting the dilemmas experienced. Our findings highlight how legal and policy changes which seek to ban online adult services advertising and sex work related content within online spaces would have direct impact on the safety strategies online sex workers employ and would further undermine their safety. These findings occur in a context where aspects of sex work are quasi-criminalized through the brothel keeping legislation. We conclude that the legal and policy failure to recognize sex work as a form of employment, contributes to the stigmatization of sex work and prevents individuals working together. Current UK policy disallows a framework for employment laws and health and safety standards to regulate sex work, leaving sex workers in the shadow economy, their safety at risk in a quasi-legal system. In light of the strong evidence that the internet makes sex work safer, we argue that decriminalisation as a rights based model of regulation is most appropriate.

Sex workers' experiences and occupational conditions post-implementation of end-demand criminalization in Metro Vancouver, Canada

OBJECTIVES

In 2014, Canada introduced end-demand criminalization (the Protection of Communities and Exploited Persons Act (PCEPA)), criminalizing purchase of sexual services while leaving the sale of sex legal. We assessed factors correlated with self-reported changes in working conditions post-PCEPA among sex workers (SWs) in Metro Vancouver.

METHODS

Post-PCEPA data for one year were drawn from a community-based cohort of SWs. We analyzed self-reported changes in working conditions among 299 participants who worked prior to PCEPA and were asked about working conditions post-PCEPA. Multivariate GEE analysis evaluated factors correlated with negative changes post-PCEPA, including reduced capacity to screen clients and reduced access to workspaces/clients.

RESULTS

Most (72.2%) experienced no change in working conditions, and 26.4% reported negative changes (e.g., reduced ability to screen clients or reduced access to workspaces/clients). Reporting negative changes was correlated with being an im/migrant to Canada (adjusted odds ratio (AOR) 2.79, 95% CI 1.59-4.92) and recent physical workplace violence (AOR 4.01, 95% CI 1.12-14.40). In sub-analysis, physical/sexual workplace violence (AOR 3.77, 95% CI 1.17-12.16) and living in the suburbs of Richmond/Burnaby (AOR 2.81, 95% CI 1.15-6.84) correlated with reduced screening capacity; incarceration (AOR 2.98, 95% CI 1.04-8.57) and being an im/migrant (AOR 2.39, 95% CI 1.14-4.99) correlated with reduced access to workspaces/clients.

CONCLUSIONS

Most SWs reported no change in working conditions and one quarter reported negative changes, suggesting that PCEPA may be failing to advance sex workers' safety. Im/migrants, women experiencing workplace violence, and those facing criminalization were most likely to report negative impacts. Decriminalization of all aspects of sex work is needed to support well-being, health, and safety.

Reaching key adolescent populations

PURPOSE OF REVIEW

Adolescents and young people who fit within key populations face some of the greatest barriers to HIV care, but are frequently overlooked. We review the recent literature on these young, vulnerable populations including HIV risk factors, barriers to care, and strategies for engagement.

RECENT FINDINGS

Common risk factors include age, risky sexual practices, poor education, and high levels of alcohol and drug abuse. Barriers to care include limited data, criminalization, and high levels of stigma. Strategies to increase engagement include incorporating adolescents into biological and behavioral surveys and the use of social media. Digital innovations for HIV prevention and testing show promise, and pre-exposure prophylaxis may be acceptable. At a policy level, decriminalizing same-sex activity and commercial sex work are priorities. Differentiated models of care including HIV self-testing, after-hour services, community-based delivery, and multimonth dispensing of antiretroviral therapy, should be combined into holistic care.

SUMMARY

There has been limited success in reaching these key adolescent populations largely because of criminalization and stigma. Accurate, generalizable data are needed to inform the development of innovative strategies for holistic care.

Associations between sex work laws and sex workers' health: A systematic review and meta-analysis of quantitative and qualitative studies

BACKGROUND

Sex workers are at disproportionate risk of violence and sexual and emotional ill health, harms that have been linked to the criminalisation of sex work. We synthesised evidence on the extent to which sex work laws and policing practices affect sex workers' safety, health, and access to services, and the pathways through which these effects occur.

METHODS AND FINDINGS

We searched bibliographic databases between 1 January 1990 and 9 May 2018 for qualitative and quantitative research involving sex workers of all genders and terms relating to legislation, police, and health. We operationalised categories of lawful and unlawful police repression of sex workers or their clients, including criminal and administrative penalties. We included quantitative studies that measured associations between policing and outcomes of violence, health, and access to services, and qualitative studies that explored related pathways. We conducted a meta-analysis to estimate the average effect of experiencing sexual/physical violence, HIV or sexually transmitted infections (STIs), and condomless sex, among individuals exposed to repressive policing compared to those unexposed. Qualitative studies were synthesised iteratively, inductively, and thematically. We reviewed 40 quantitative and 94 qualitative studies. Repressive policing of sex workers was associated with increased risk of sexual/physical violence from clients or other parties (odds ratio [OR] 2.99, 95% CI 1.96-4.57), HIV/STI (OR 1.87, 95% CI 1.60-2.19), and condomless sex (OR 1.42, 95% CI 1.03-1.94). The qualitative synthesis identified diverse forms of police violence and abuses of power, including arbitrary arrest, bribery and extortion, physical and sexual violence, failure to provide access to justice, and forced HIV testing. It showed that in contexts of criminalisation, the threat and enactment of police harassment and arrest of sex workers or their clients displaced sex workers into isolated work locations, disrupting peer support networks and service access, and limiting risk reduction opportunities. It discouraged sex workers from carrying condoms and exacerbated existing inequalities experienced by transgender, migrant, and drug-using sex workers. Evidence from decriminalised settings suggests that sex workers in these settings have greater negotiating power with clients and better access to justice. Quantitative findings were limited by high heterogeneity in the meta-analysis for some outcomes and insufficient data to conduct meta-analyses for others, as well as variable sample size and study quality. Few studies reported whether arrest was related to sex work or another offence, limiting our ability to assess the associations between sex work criminalisation and outcomes relative to other penalties or abuses of police power, and all studies were observational, prohibiting any causal inference. Few studies included trans- and cisgender male sex workers, and little evidence related to emotional health and access to healthcare beyond HIV/STI testing.

CONCLUSIONS

Together, the qualitative and quantitative evidence demonstrate the extensive harms associated with criminalisation of sex work, including laws and enforcement targeting the sale and purchase of sex, and activities relating to sex work organisation. There is an urgent need to reform sex-work-related laws and institutional practices so as to reduce harms and barriers to the realisation of health.

Usage of the Terms Prostitution, Sex Work, Transactional Sex, and Survival Sex: Their Utility in HIV Prevention Research

This article considers the terms prostitution, sex work, transactional sex, and survival sex, the logic of their deployment and utility to research concerned with people who are paid for sex, and HIV. The various names for paid sex in HIV research are invested in strategically differentiated positionings of people who receive payment and emphasize varying degrees of choice. The terminologies that seek to distinguish a range of economically motivated paid sex practices from sex work are characterized by an emphasis on the local and the particular, efforts to evade the stigma attached to the labels sex worker and prostitute, and an analytic prioritizing of culture. This works to bestow cultural legitimacy on some locally specific forms of paid sex and positions those practices as artifacts of culture rather than economy. This article contends that, in HIV research in particular, it is necessary to be cognizant of ways the deployment of alternative paid sex categories relocates and reinscribes stigma elsewhere. While local identity categories may be appropriate for program implementation, a global category is necessary for planning and funding purposes and offers a purview beyond that of isolated local phenomena. We argue that "sex work" is the most useful global term for use in research into economically motivated paid sex and HIV, primarily because it positions paid sex as a matter of labor, not culture or morality.