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HIV prevalence among sex workers lessens with fair legislation
Recent findings in Europe suggest that the legislation of several aspects of sex work can help reduce HIV prevalence in this high-risk group, especially in countries with effective and fair judiciary enforcement, according to a study published in The Lancet HIV.
“The effect of structural determinants of HIV risk on sex workers is unclear, partly because most existing studies have not explicitly investigated structural drivers, instead focusing on individual-level predictors of HIV risk, such as knowledge about HIV transmission,” Aaron Reeves, PhD, from the international inequalities institute at the London School of Economics and Political Science and the department of sociology at University of Oxford, and colleagues wrote. “Legal structures might only affect health outcomes if they are effectively and fairly implemented, suggesting enforcement can moderate the relation between sex work policy and HIV prevalence.”
In this ecological regression analysis of 27 European countries, researchers assessed the association between criminal laws around sex work and HIV prevalence among women who exchange sex for money. They used data from the European CDC; sex-legislation from the US State Department’s Country Reports on Human Rights Practices; legal documents specific to each country; the rule of law and gross-domestic product per capita once making adjustment for purchasing power from the World Bank, and the prevalence of sex workers who inject drugs (-1.93; P = .026).
Out of the 17 countries that have legalized some aspects of sex work, Reeves and colleagues observed that there was significantly lower HIV prevalence among sex workers compared with countries that criminalized all aspects of sex work (–2.09, 95% CI −0.80 to −3.37; P = .003). Notably, the investigators found that the HIV prevalence among sex workers was also significantly lower after controlling for the level of economic development (–1.86; P = .038) and the proportion who are injecting drug users (−1.93; P = .026).
“The legalization of aspects of sex work could reduce HIV prevalence among sex workers… however, the legalization of sex work alone might be insufficient if these laws are not administered effectively and fairly,” Reeves and colleagues wrote. “Crucially, legal reform might not solve these issues on its own, but our data suggest that legalization could be one important part of a robust and effective response to HIV among sex workers.”
In an accompanying commentary, Marie-Claude Boily, PhD, from the infectious disease epidemiology department at Imperial College London, and Kate Shannon, PhD, director of the gender and sexual health initiative at the University of British Columbia’s Center for Excellance in HIV/AIDS, wrote that more work still needs to be done to understand how criminalization affects HIV risk in sex workers at different settings. They suggest, “Future research should consider careful monitoring of municipal-level enforcement and arrest data alongside violence and sex worker–level evidence to disentangle fully how and whether laws translate to enforcement on the ground and how this in turn affects violence outcomes and HIV prevalence for female sex workers.” – by Savannah Demko
Disclosure: Reeves, Boily and Shannon report no relevant financial disclosures.