“End demand” laws are being adopted or considered in a growing number of countries. Typically, under these laws, sex workers themselves commit no crime, but clients and any third parties are criminalized. Supporters of “end demand” laws have argued that this approach will increase sex workers’ access to essential services, including HIV prevention and care.
But two studies presented at today’s press conference at the 22nd International AIDS Conference (AIDS 2018) poked holes in this assertion, citing evidence from Canada and France.
“Given the importance of sex workers in the global response to HIV, I think these studies deserve careful consideration,” Linda-Gail Bekker, President of the International AIDS Society and International Chair of AIDS 2018, said. “If ‘end demand’ laws create new barriers to HIV prevention and care, that is a very significant concern.”
Canada’s law did not lead to increased access to HIV care for sex workers
Elena Argento of the University of British Columbia presented an analysis of the Protection of Communities and Exploited Persons Act (PCEPA), a policy adopted by Canada in 2014 that criminalises sex work clients and third-party advertising. The analysis revealed substantial evidence that criminalisation impedes access to services and support for sex workers, even though an explicit goal of “end demand” approaches is to increase access.
The authors aimed to longitudinally evaluate the impact of the PCEPA on sex workers’ access to HIV care, primary care and community-led and sex worker-led services in Vancouver, Canada.
They looked at a group of women sex workers over time, and found independently verified evidence of significantly reduced odds of utilization of community-driven services and supports after the law came into effect. These include services led by sex workers and indigenous-, migrant/refugee-, women- or youth-specific services.
There was no evidence of increased access to HIV-specific services among sex workers living with HIV following implementation of the new laws. The post-policy period was also correlated with significantly reduced odds of accessing health services when needed.
The study concluded that “end demand” approaches may, in fact, exacerbate barriers to healthcare and community-led services.
A second study dealt with a 2016 French law criminaliasing sex workers’ clients. Opponents of the law cite the risk of increased vulnerability among sex workers and exposure to stigma and violence, which hinders their access to health and legal services and increases risks of exploitation in the sex industry.
Based on these arguments, Médecins du Monde (Doctors of the World) fielded a survey aimed at evaluating the impact of the law on sex workers’ health, rights and well-being. Between April 2016 and January 2018, researchers conducted qualitative semi-directive interviews and a questionnaire-based quantitative survey.
An analysis presented by Hélène Lebail, of CNRS – Sciences Po, Centre de Recherches Internationales, showed that the law’s most direct effect has been an acute increase in the socio-economic vulnerability of sex workers, including: an increase in experienced violence; degrading working conditions; and negative health consequences.
The authors also found a decrease in condom use and increased difficulty for sex workers to negotiate safe-sex practices after the law took effect. Additionally, HIV-positive sex workers faced difficulty accessing services.
While it is still too early to evaluate the impact in terms of HIV infections, the research pointed to an increase in some sexually transmitted infections, notably of syphilis, among sex workers in France. The authors concluded that policy makers should consider these findings when designing new laws to mitigate harmful health effects.