The Case for Decriminalizing Sex Work
Researchers and advocates say criminally penalizing prostitution can lead to dangerous health outcomes.
MORE RESEARCHERS ARE making the case to decriminalize sex work, joining calls by other advocates who say doing so might improve public health outcomes.
In December, health experts, legal scholars and advocates released a report that focused on decriminalizing sex work in Washington, D.C., where sex work is punishable by fines or jail time. It's some of the latest research suggesting that criminalizing prostitution can lead to dangerous health outcomes for sex workers.
There is "considerable evidence from public health researchers that criminalization of sex work contributes to community violence, propagates crime, blocks access to public health resources, is an ineffective deterrent to participation in sex work, and is deeply harmful to sex workers," according to an executive summary of the report, an effort by the Whitman-Walker Institute, an LGBTQ-focused community health center in Washington, the Georgetown University O'Neill Institute of National and Global Health Law and HIPS, a nonprofit working to advance the health rights of sex workers.
Advocates of decriminalization argue that criminalizing sex work puts workers in constant fear of the police, making them less likely to ask for help if they face danger from a client – workers may worry about being arrested, or about facing violence or solicitation from law enforcement officers themselves. They also say it makes it harder for sex workers to access social services, welfare benefits and health care.
When sex work is decriminalized, advocates say, it improves the safety of sex workers by allowing them to organize themselves and operate more freely. It also may help prevent the spread of HIV, removing sex workers' concern they could be arrested merely for carrying condoms and giving them more power to set rules with clients about contraceptives.
It additionally can empower sex workers to see health and social services providers without fear of police or judgment, advocates say.
Sex workers "will be seen first as criminals," says Joanne Csete, an associate professor of population and family health at Columbia University's Irving Medical Center. "There are many places in the world where health workers feel the obligation to actually turn them over to the police or somehow to report them as criminals."
Advocates say there is a clear example of how the approach can improve the health of sex workers: Rhode Island.
That's because from 2003 through 2009, indoor prostitution taking place in massage parlors, strip clubs and through online escorts was effectively decriminalized in the state, thanks to a legal loophole that provided a snapshot of what loosening restrictions on sex work could look like for public health. To that end, an analysis by researchers at Baylor University and UCLA indicates that Rhode Island saw a 31% decrease in reported rapes and a nearly 40% decrease in cases of female gonorrhea from 2004 to 2009 among the overall population. Arrests for prostitution also decreased; in a separate report, the ACLU notes arrests themselves can "involve extreme violence and lead to the violence of imprisonment."
Rhode Island's decriminalization policy is why Bella Robinson ended up there.
Robinson has been in sex work since her teens, starting in Florida and later moving to New Jersey. It was there she was arrested and incarcerated on prostitution charges in 2007. After leaving prison – her second stint after serving time in 1989 – Robinson heard from a client that sex work was legal in Rhode Island. "I Googled it. I packed my house, and I moved to Rhode Island," says Robinson, who uses that name instead of her legal name for work.
However, in 2009, sex work was recriminalized by the state. The same year, Robinson founded the Rhode Island chapter of Call Off Your Old Tired Ethics (COYOTE), a national grassroots network calling for the end of the criminalization of sex work. Robinson's advocacy for decriminalization was only strengthened the next year when police on Long Island, New York, found the bodies of four women who were sex workers and began hunting for their killer. The news was chilling to Robinson, who believes that criminalization was forcing workers to operate in unsafe conditions.
Robinson believes shame and stigma prevent sex workers from accessing crucial health care, such as substance use services or mental health treatment. "When you shame people who were poor for engaging in sex work … it's psychologically damaging," she says.
She also thinks decriminalization would lead to more condom use, saying many sex workers are scared to carry condoms out of fear police will search and arrest them for carrying the contraceptive. In California and New York City, sex workers have won major victories after officials banned the use of condoms found on a person as evidence of sex work.
A Changing Tide
Internationally, there's been a growing movement to decriminalize sex work. Sweden, where prostitution technically was not prohibited, took a novel approach in 1999 by penalizing buyers of sex but not those selling it. New Zealand in 2003 allowed both aspects – an approach Amnesty International, the largest human rights group in the world, called for in 2016. Guidelines from The World Health Organization also recommend that countries work toward decriminalization.
Momentum has also picked up in the U.S., where progressives on Capitol Hill have taken up the cause. Rep. Ro Khanna, a Democrat from California, spearheaded a bill in late 2019 to require the Department of Health and Human Services to conduct a federal study on the health and safety of sex workers in connection with what some consider a flawed anti-sex trafficking law and to "build the case for decriminalization." That same year, Rep. Ayanna Pressley, a Democrat from Massachusetts, proposed a resolution calling to decriminalize sex work. Neither measure moved forward to the floor.
Without concrete federal action, efforts to decriminalize sex work have fallen to community activists. In New York, state legislation was introduced in 2019 to decriminalize sex work, but ultimately failed. In Washington in 2019, the D.C. Council failed to advance a decriminalization bill.
Calls to decriminalize sex work have been controversial both in the U.S. and abroad – with some arguing that the industry is innately oppressive to women – and even those who agree that prostitution should be without penalty have disagreements over how to handle the people who pay for the services. Some advocates believe paying for sex should still be a crime, embracing what is often called "the Nordic model," an approach enacted in Sweden, Norway and Iceland.
But others, including many sex workers and the authors of the D.C.-focused report, believe that partial decriminalization only pushes sex workers to take greater risks to protect clients, makes them increasingly vulnerable to violence from buyers and does little to combat the stigma associated with the work.
"Women who worked on the street used to have safe spots where they would tell the client to drive," Pye Jakobsson, a Swedish sex worker, told The New York Times in 2016. "Now clients say no, because of the police. They want to go someplace else remote. How can the woman be safe there?"
Sex Work in the Nation's Capital: A Local Spotlight on National Trends
Through focusing on the stories of sex workers in the district, the report from Whitman-Walker, Georgetown and HIPS shines a light on the specific health challenges facing many sex workers.
Co-authors Benjamin Brooks and Sean Bland relied on interviews with three focus groups of 27 sex workers who were mostly Black and either transgender women or gay or bisexual men. Among young gay and bisexual American men, Black men accounted for 42% of new HIV cases in 2018 in the U.S. A D.C. needs asssesment published in 2015, meanwhile, found that 20% of transgender survey respondents reported living with HIV and that transgender respondents who had engaged in sex work were more likely to have HIV than those who had not.
For the report, sex workers described their experiences with incarceration and violence from both police and clients. Participants recognized they were at risk of contracting HIV or other sexually transmitted infections, but said they encountered barriers to prevention, including discomfort among some with disclosing their sex work to providers, a potential barrier to preventative services.
"They look at you kind of funny," one anonymous sex worker said when describing visiting a health care provider. "Because of all the stigma and bias are related to sex work. … You may not go. You may not mention that you do sex work."
Sex workers also can face challenges in storing or taking HIV medications, with one participant noting that unstable housing due to legal troubles may mean people are less inclined to carry their pills with them but have nowhere to put them. Another discussed the issue of losing access to medication after being incarcerated in connection with sex work.
In the district, minority and LGBTQ people face higher rates of bias-motivated crimes, with 61% of suspected hate crimes classified as motivated by sexual orientation and 39% classified as motivated by race in 2018, according to a Washington Post analysis cited in the D.C.-focused report.
Yet interactions with law enforcement are also a concern.
Tamika Spellman, a policy and advocacy associate with HIPS, says her worst interactions while she was a sex worker were with the police.
"Everywhere that I have been across the country I have been sexually assaulted by the police," says Spellman, who is Black and transgender. "It was more frequent here in the District of Columbia."
"Sex work needs to be decriminalized," she says. Without doing so, she adds, "violence flourishes."
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