British policy makes sex workers vulnerable

We welcome the timely call for decriminalisation of sex work in the editorial by Goodyear and Cusick (BMJ 2007;334:52-3). The murders of sex workers in Ipswich have led to the repetition of stereotypes that only serve to dehumanise women in the sex industry and make them more vulnerable. We wish to highlight some further flaws in the evidence used by the government and others in justification of their demonising of sex workers.

There is no evidence that 90% of UK sex workers are addicted to heroin or crack or that 45% were abused as children. These data, along with numerous alternative versions in the media, are attributed to the Home Office consultation exercise Paying the Price (2004), but we have heard nothing about the many responses that refuted these stereotypes in detail. Our research in London has followed sex workers from the mid-1980s to 2000, and our study is, to our knowledge, the only one to provide evidence of the impact of prostitution on women's lives over time.

We have shown that drug use is widespread and that problem drug use is associated with multiply disadvantaged women. Injecting drug use was uncommon in our studies (for example, 7% of women attending our project from 1998 to 2002 reported ever injecting drugs), and crack use declined towards the end of the 1990s. Alcohol use, however, is a condition of work in some sectors, such as clubs, and “addiction” has become more common, as indeed it has among the rest of the UK population.

Violence is found throughout the industry. In our study two women were murdered, and both worked indoors. One murder was never resolved; the other woman was murdered by her boyfriend, who then killed himself. Research participants across all sectors of the industry described assaults, but experiences of violence outside work, when their children were taken into care or when they suffered domestic violence, were the most harrowing.

Street workers do not form a discrete workforce: they also work indoors and in jobs outside the industry. In our follow-up of sex workers to 2000, street workers had greater occupational mobility than women working in other sectors of the industry.

Among the women we followed to the year 2000, 37% (31/84) undertook further, higher, or vocational education, which they funded through their own earnings. However, only half of these women then left the sex industry, despite the occupational choices this training had presented—and, of course, it is always assumed that sex workers would never continue their work if they had any other options.

The most significant health problems reported in our studies related to stigma and criminalisation. Reports in the press and other media this week about drug abused victims from broken families forced to expose themselves to madmen on the streets—without any reference to the laws, policies, or damaging stereotypes about “bad women” that put sex workers at risk—simply exacerbate their problems. Reports about regulation elsewhere have been misleading about the possible solutions. Thus, the so called failure of street toleration zones in the Netherlands has nothing to do with “drug abuse”: it is impossible for the great majority to work legally, as they are undocumented migrants.

Similarly, the recent reforms in New Zealand have provided an important model, since these reforms were the first to allow women to work together indoors freelance without requiring them to raise substantial capital, acquire a licence, and manage the business (through which employees are commonly exploited heavily in “legal” businesses elsewhere). Similar changes have been recommended, but not acted on, in the United Kingdom.

It is British policy that makes sex workers vulnerable, whether they work outdoors or indoors. In the last 10 years these policies have become more punitive through the arbitrary use of antisocial behaviour orders (ASBOs), street “cleaning” purges, fines, imprisonment, and deportation. We endorse calls for decriminalisation and amnesty from those who organise and work closely with prostitutes, including the International Union of Sex Workers and the English Collective of Prostitutes. These will be key measures towards stopping the violence. They will also be central to wider advocacy for health and health care. Criminalisation and stigma are associated with significant mental health problems; they make workers vulnerable to violence; they foster misinformation about the industry and workers' health needs; and they also make contact with health professionals difficult. Without decriminalisation and amnesty, how are we to provide substantial sectors of the UK workforce with basic services, including health promotion, screening, and treatment?