Submission to South African Law Reform Commission on Discussion Paper on Adult Prostitution: 29 June 2009
The SALRC’s full Discussion Paper seems to be biased towards views that favour the decriminalization of prostitution. The research that seems to have received prominence in the Discussion Paper favours decriminalization. Both empirical and qualitative research by academics such as Melissa Farley and Gunilla Eckberg that have shown the legalisation of prostitution to be detrimental to society and to prostituting women in several different countries has largely been ignored. Research on the results of legalising prostitution in Sydney and New South Wales, Australia also seems to have been neglected. This bias is concerning because the SALRC, as an objective body, needs to examine all the available research in order to make the best possible recommendation to the Minister of Justice and Constitutional Development.
In response to the South African Law Reform Commissions (SALRC) questionnaire on Adult Prostitution, the Christian Action Network proposes the following policy option:
The entire sex industry must be criminalised with particular attention being focused on procurers (men who solicit and buy sex), pimps, brothel owners, gangs, crime syndicates & sex traffickers by police and the prosecuting authorities.
However, women & girls trapped in prostitution must be diverted via the justice system into exit programs (run by NGOs) to help women & girls escape prostitution.
The Christian Action Network believes the policy option that best serves South Africa’s current social reality is the total criminalisation of the sex industry. Partial decriminalisation (criminalisation of the demand side of the sex industry but not the prostitutes themselves) would legitimise prostitution as an acceptable form of work and draw more women and girls into prostitution.
If the legislature makes a policy decision to use the total criminalisation option the Commission proposes a new Adult Prostitution Act to criminalise
• buying of voluntary adult prostitution
• voluntary selling of adult prostitution
• all prostitution related acts.
SALRC QUESTIONS ON THE TOTAL CRIMINALISATION OPTION
1. How must prostitution (currently 'unlawful carnal intercourse') be defined in the new Adult Prostitution Act?
Prostitution is the unlawful exchange of sexual favours for financial or material gain.
2. How will this option reduce the demand for prostitution?
Pornography is one of the forces that drive the demand. When men use pornography, in that process they are trained as “johns”. Pornography is men’s rehearsal for prostitution. Pornography is cultural propaganda which drives home the notion that women are prostitutes.
Pornography should be recognised as prostitution filmed. By criminalizing pornography along with clamping down on the procurers (customers, pimps, brothel owners, sex traffickers etc) the demand would be significantly reduced.
CAN believes that the entire sex industry should be criminalized with prostitutes diverted via the justice system into exit programmes.
Strip clubs and massage parlours (etc) act as fronts for prostitution. By criminalizing them as well, the demand would also be reduced.
In Sweden, where the “buyers” have been criminalized, and where prostitution is regarded as an aspect of male violence against women and children, the number of prostitutes has been effectively reduced.
Street prostitution has all but disappeared in many Swedish cities and in Stockholm the number of women in street prostitution has been reduced by two thirds, with the number of “Johns” down by 80%. .
Gone too, for the most part, are the renowned Swedish brothels and massage parlours which proliferated during the last three decades of the twentieth century when prostitution in Sweden was legal.
The number of foreign women now being trafficked into Sweden for sex is very small. The Swedish government estimates that in the last few years only 200 to 400 women and girls have been annually sex trafficked into Sweden, a figure that's negligible compared to the 15,000 to 17,000 females yearly sex trafficked into neighbouring Finland. No other country or social experiment has duplicated Sweden's promising results.
What ultimately drives the demand and what is the ultimate solution?
R.J Rushdoony in his book, Noble Savages: Exposing the Worldview of Pornographers and their war against Christian Civilization, writes:
(All references to pornography also apply to prostitution).
Pornography is more than what you see, it propagates a specific view of man, morality and life. It is not, at its root about titillation, though that is how peddlers market it to consumers. There are intellectual props on which pornography rests, a philosophy of perversion, the worldview of man freed from God and His Law. The real horror of pornography is its positive declaration of a new moral ethic.
Pornography cannot be dealt with in isolation from its concomitant worldview, one that seeks not simply to excuse rebellion from God, but to defend it as true freedom.
Pornography is a symptom, a particular manifestation of the humanistic, evolutionary worldview. It is one aspect of a worldview that sees power as coming from below. In the case of pornography, it sees a vital aspect of sex as its aggression and exploitation. People are used as objects, but exploitation and manipulation prove insufficiently satisfying. Violence is a purer exercise of raw power.
Pornography involves “paper sexuality”, wherein people desire to voyeuristically observe more than they capable of practicing. Pornography prefers the inner world of the imagination. Pornographic images are intended to satisfy the inner world of the imagination, a fantasy world where people can be manipulated and violated without consequences.
The modern mind resists all attempts to control evil, particularly evils that that it characterizes as “self-expression.” It is ready to oppose all censorship as a matter of principle and defend such opposition to standards as a moral stand in itself. All forms of sexuality are considered natural and therefore normal and good. Whatever man imagines or desires is seen as natural and therefore permissible.
The Christian worldview however, is based on a supernatural perspective and cannot be defended by naturalistic argument. Truth and ethics must be grounded on God’s revealed Word, not on man’s perspective of what is normative. Neither can we oppose evil by tradition or community standards.
We cannot stop pornography merely by opposing it, or removing it from the Internet, shops or television. The worldview that justifies evil and demands the right to debase and pollute must be opposed by its sole antithesis, the Biblical Worldview.
The modern faith in man and the ultimacy of his urges must be countered with the claims of God as the Sovereign dispenser of law and grace. Man must approach God in faith and respond to Him in faithful obedience. The choice for both God and man and his culture is life or death, the Kingdom of God and His Christ or the kingdom of man.
3. How will this option reduce harm and vulnerability to abuse and exploitation of prostitutes?
Sexual intercourse in prostitution as well as the entire exploitative shady underworld of gangs, drugs, crime and trafficking associated with prostitution intrinsically involves harm for the prostitute.
Sexual acts in prostitution by the “john” towards the women involve humiliation, degrading verbal abuse, physical abuse, and exploitation. There is rarely any love, mutual affection or mutual respect. Prostitution is therefore all too often paid rape.
The illusion that prostitution is mostly a choice is manipulative and deceptive. It allows the buyers and the pimps to obscure the abuse involved and to confer a form of right on the abuser. The fact that money is exchanged cannot disguise the fact that what occurs in prostitution, the bodily and psychological violations involved are in fact sexual abuse and harassment and would be seen as such in any so-called ordinary workplace or social setting.
Andrea Dworkin wrote about prostitution in 1983:
“Her mind is hurt by rape and other physical assault on her body, it fades and shrinks and seeks silence as refuge; it becomes the prison cell inside her...Every invasion of the body is marked in the brain: contusions, abrasions, cuts, swellings, bleeding, mutilation, breaking, burning. Each capacity of the brain: memory, imagination, intellect, creation, consciousness itself is distressed and deformed, distorted by the sexualized physical injuries that girls and women sustain.”
“Psychologists are usually not that specific, and certainly not that eloquent, regarding the harms of prostitution and pornography. Post-traumatic stress disorder, or PTSD, is a crude measure of the overall level of emotional harm against women in prostitution. The psychiatric diagnosis of PTSD describes mental and physical avoidance behaviors, psychological numbing, social distancing, flashbacks, and anxious physiologic hyper-arousal. Some of the PTSD suffered by women in prostitution results from the ways that men use pornography on them and against them.
Of 854 women, men and children in prostitution, across 9 countries, we found that 68 percent had PTSD. 8 This is an extremely high prevalence of PTSD, and it tells us, like Andrea Dworkin did, that prostitution causes great psychological harm to those in it.
As Melissa Farley et al analyzed their data, they investigated factors that might indicate what exactly it was about prostitution that was causing such high rates of PTSD. They wondered: did childhood sexual abuse, childhood physical abuse, or rape or other physical assault in prostitution cause particularly high levels of PTSD in the people we interviewed? They found that so many of our respondents had all of those types of violence in their lives that we couldn’t differentiate how much each type of violence contributed to their overall distress. This is called a statistical ceiling effect. Others have found ceiling effects for certain phenomena. For example, two studies failed to find race differences in PTSD symptoms among combat veterans. In these studies, combat, like prostitution, was the overwhelmingly traumatic event that mitigated differences in PTSD based on race. Their PTSD was already so high from the trauma of combat that the traumatic effects of racism could not be statistically demonstrated.
They mention these statistical effects because, frankly, they thought that prostituted women’s PTSD was so high that it could not go up any higher. They did not expect to show that the making of pornography or the coercion to imitate it had a statistically significant effect on the PTSD suffered by the women we interviewed in prostitution.
But in fact their results showed that when women had pornography made of them, it hurt them even more. It is data that causes you to weep. Women in prostitution whose tricks or pimps made pornography of them in prostitution had significantly more severe symptoms of PTSD than did women who did not have pornography was made of them.”
By recognizing prostitution as “paid rape” and therefore a violation of the right to dignity of women, government and civil society should do their utmost to help women escape this slavery and abuse.
If prostitutes are being harmed by the police in any way – that should be dealt with separately by police officials.
4. How will this option assist prostitutes to enforce their rights to equality and access to health?
The act of prostitution by its very nature, entrenches inequality –the view that women have less value then men .
What word should we use in English to describe men who buy or rent women in prostitution? Melissa Farley uses the word “trick” because that is what women in prostitution call the men who buy them. The word trick refers to the multitude of ways that men trick women into performing more or different acts of sexual exploitation than the men pay for, or the way that men sexually exploit women in prostitution and then refuse to pay, cheating or tricking the women. Other words for them might be sex predators.
There is a massive power imbalance in prostitution, where johns have the social and economic power to hire women, adolescents, girls or boys to act out their masturbation fantasies. Prostitution Research &
Education, a San Francisco nonprofit organization, has begun an international study of customers of prostitutes. Although some research on customers of prostitutes interviewed men in diversion programs who had been arrested for soliciting a police decoy, Melissa Farley et al interviewed men who had not been arrested in part because they wanted to interview men who bought women in indoor prostitution. They ran advertisements in local newspapers seeking interviews with customers of prostitutes. The tricks they interviewed confirmed that the relationship in prostitution is one of dominance and subordination. One man told them, “Prostitution says that women have less value than men.” In prostitution, another trick explained, “She gives up the right to say no” during the time that he has paid for. Another man told them that he clarifies the nature of his relationship to the women he buys, “I paid for this. You have no rights. You’re with me now.” Another trick explained to them:
“Guys get off on controlling women, they use physical power to control women, really. If you look at it, it’s paid rape. You’re making them subservient during that time, so you’re the dominant person. She has to do what you want.”
Many of the tricks expressed unveiled hostility toward women. “I think about getting even [during prostitution]. It’s like a kid’s game, you’re scoring points,” one man told them. Another trick said, “Prostitution is an act of force, not of love. She gives up the right to say no.”
Access to Health Care
There is no evidence to suggest that prostitutes are prevented from gaining access to health facilities. Women in prostitution have the right to access health facilities such as clinics, state or private hospitals and private physicians without having to admit they are prostitutes.
Rather, as research from Greece has shown, even where prostitution is legal prostitutes avoid going for mandatory health check ups because they want to retain anonymity and are often involved in other illegal activities such as crime and drugs.
Greece, has the most strict regulations regarding registered prostitutes with mandatory medical screening twice a week. As a result, most sex workers avoided registration, which made them liable for prosecution. All health care facilities and HIV prevention activities for prostitutes were limited to those who are registered. This is ineffective in public health terms: in Athens approximately 400 women are registered, while an estimated 5 000 more prostitutes are not registered.
In Germany The Protection Against Infection Act entered into force on 1 January 2001. The German Federal government’s Report on the Prostitution Act states, “ Those cities where prostitutes had to undergo check-ups have observed less contact since the Protection Against Infection Act was introduced. During the survey of experts (SoFFiK I), answers provided by the ministries of health of Saxony, Baden-Württemberg and Bavaria indicated that the Protection Against Infection Act had had an impact on health services provided to prostitutes. The frequency of check-ups had decreased dramatically; in particular the situation of immigrants had worsened. Prostitutes working illegally in Germany, or those with drug addictions, can hardly benefit from the improved legal situation.”
South Africa already has an incredibly high HIV infection rate. Legalising prostitution offers the tantalizing hope of controlling sexually transmitted diseases. However, South Africa’s privacy provisions will make mandatory checks difficult to apply. Even if these can be applied, prostitutes who are already infected (for example, 74 % of the prostitutes servicing truck drivers in Warden are HIV positive) will not easily leave the trade.
In South Africa, prostitution is currently a seller’s market. Because the supply is restricted by the fear of prosecution, those who sell themselves are able to command higher prices. Legalising prostitution in a country like South Africa creates a buyer’s market, as many impoverished and desperate women flock to the streets encouraged by the impunity and moral endorsement of legality.
Because there will be more competition for customers, prices will drop and more, or unsafe acts, will be required for prostitutes to retain their standard of living. This has been the experience in the relatively wealthy countries of Australia and New Zealand.
Poor mental health and drug dependence amongst prostitutes may actually undermine the motivation and ability of these sex traders to adopt safer sex behaviour. In Costa Rica it was also found that a national educational campaign, radio and television programs and other preventive actions apparently did not influence the rate of receptive anal intercourse without a condom (about 80%) during nine years of the epidemic.
In the case of male prostitutes, it was found that, when psychologically compared with non-patient normals male prostitutes exhibited significantly higher levels of psychopathology.
In Australia there is a recorded case in New South Wales where the government had to invoke a turn-of-the-century public health provision to detain a female prostitute who is HIV positive. She admitted on television that she still had unprotected sex with her clients. Another study in the United States showed that STD's were common amongst a group of heterosexuals, including a group of whom the majority of the women were prostitutes and the majority of men were their clients.
This study shows that, despite regularly participating in a HIV study in which consistent condom use was promoted, STD's were common. Also in Thailand and in Northern Ireland the same trend was found.
We reiterate the views of Family Policy Institute here.
A legalized/decriminalised system of prostitution that mandates health checks and certification only for women and not for clients is blatantly discriminatory to women. "Women only" health checks make no public health sense because monitoring prostituted women does not protect them from HIV/AIDS or STDs, since male "clients" can and do originally transmit disease to the women (Raymond:2003)
Neither do so-called enforceable condom policies. In one of Coalition against Women in Trafficking’s (CATW) studies, U.S. women in prostitution interviewed reported the following: 47% stated that men expected sex without a condom; 73% reported that men offered to pay more for sex without a condom; 45% of women said they were abused if they insisted that men use condoms. Some women said that certain establishments may have rules that men wear condoms but, in reality, men still try to have sex without them.
In reality, the enforcement of condom policy was left to the individual women in prostitution, and the offer of extra money was an insistent pressure. One woman stated: "I'd be one of those liars if I said 'Oh I always used a condom.' If there was extra money coming in, then the condom would be out the window. I was looking for the extra money."
Many factors militate against condom use: the need of women to make money; older women's decline in attractiveness to men; competition from places that do not require condoms; pimp pressure on women to have sex with no condom for more money; money needed for a drug habit or to pay off the pimp; and the general lack of control that prostituted women have over their bodies in prostitution venues. (Raymond 2003)
So called "safety policies" in brothels did not protect women from harm. Even where brothels supposedly monitored the "customers" and utilised "bouncers," women stated that they were injured by buyers and, at times, by brothel owners and their friends. Even when someone intervened to control buyers' abuse, women lived in a climate of fear. Although 60 percent of women reported that buyers had sometimes been prevented from abusing them, half of those women answered that, nonetheless, they thought that they might be killed by one of their "customers" (Raymond et al: 2002).
Again, only by leaving prostitution will prostitutes’ health risks be reduced.
5.How will this option avoid the stigmatisation and discrimination of prostitutes?
All illegal acts should have a negative connotation or “stigma” in the minds of the public in order to discourage people from going into these harmful, exploitative acts. If something is damaging to individuals and society, it should remain illegal.
"What are the effects of prostitution on the women in prostitution as well as society at large? Prostitution doesn’t just have individual impacts on women in prostitution. It impacts all women in that society. If you have a country that thinks it’s appropriate and acceptable that women are to be for sale then you normalize the idea that men have the right to buy and sexually exploit not just a particularly marginalized subclass of women, but all of us," Abolishing Prostitution: The Swedish Solution by Gunilla Ekberg.
We reiterate the views of Family Policy Institute here.
Most of our research show that in nations that have either decriminalised or legalised prostitution the social stigma associated with prostitution remained. This is mainly due to the fact that the legal status of women in prostitution does not alter or reduce the negative perceptions associated with prostitution.
Stigma and prejudice against prostitution and the shame associated with that, continued after decriminalization of prostitution in New Zealand. The New Zealand Prostitution Review Committee stated, “Despite decriminalization, the social stigma surrounding involvement in the sex industry continues.” (Page 154)
The authors of the Netherlands report (WODC, Research and Documentation Centre of the Dutch Ministry of Justice) point out: “Because of the more stringent police-control the new regulations also resulted in the relocation of activities within the prostitution sector: criminal forms of prostitution moved to places where there are fewer or less stringent checks.” In other words, the criticism often levelled at those advocating removing prostitution from particular localities – that it will be displaced – seem to also apply to legalisation.
6. How will this option address concerns regarding prostitution and crime?
We reiterate the views of Family Policy Institute here.
Clamping down on the demand side of prostitution with particular focus on pimps, gangs, crime syndicates, brothel owners and sex traffickers is the only way to break the long established links between crime and prostitution.
The links between organised crime, prostitution and trafficking are well established. The traffickers are often highly organised entrepreneurs that earn huge profits from the exploitation of women and children. But international and local trafficking in women and children cannot flourish without the local prostitution markets. If a local prostitution market decreases substantially, organised crime networks are likely to relocate to a more profitable location (Bindel 2004)
Legalisation/decriminalisation is a gift to pimps, traffickers and the sex industry. People often don’t realize that decriminalisation means decriminalisation of the whole sex industry and not only the women. They haven’t thought through the consequences of legalizing pimps as legitimate sex entrepreneurs (Raymond 2003)
In South Africa, in addition to local criminal crime groups, foreign organised criminal groups from Russia, Bulgaria, Thailand, China and Nigeria are already established in the local sex industry. Strip clubs in particular have been used as not only fronts for prostitution but also to traffic in women for sexual exploitation on work permits as “exotic dancers”(Noseweek Dec 2008). Traffickers would similarly be able to bring in foreign women on work permits under the guise that they are “migrant sex workers”.
As conceded by the South African Law Reform Commission in Chapter 4 of the Discussion Papers re Trafficking released in 2006, curtailment of trafficking in persons for prostitution seems to go hand in hand with strong measures to eliminate the demand for prostituted women and children.
On 3 June 2009 in an article by Alet Rademeyer and Philip de Bruin the Beeld reports that there are about 10 000 child prostitutes in Johannesburg alone, a group concerned with child abuse said that Bloemfontein is one of the biggest focal points of syndicates as far as trafficking in children for sex and drug trading are concerned. A founding member of Sapsac, a body investigating child abuse, Retha Meintjes, who is also the deputy director of public prosecution, says even though similar figures are not available for other cities, all the available information indicates that the situation in Cape Town, Durban and Port Elizabeth are “equally grave”. According to Sapsac, girls in South Africa are sold for between R2 500 and R12 000. Countrywide networks of syndicates who are involved in child abuse include “prominent and wealthy” people, even some from the medical field. Children as young as 10 “are recruited and sexually abused by adults who pay the syndicates”. Children who work in Port Elizabeth as prostitutes and/or drug dealers, earn between R1 500 and R5 000 per day for the coffers of their “handlers”. SAPSAC said the children who disobeyed the syndicates’ instructions were punished with “extreme physical abuse, or by withholding drugs and food from them or even death”. The group said it will make an urgent plea to the government to enforce effective measures to protect children, especially with a view to the huge international sporting events which will soon take place in South Africa.
Significantly, the links between adult prostitution, child prostitution, sex trafficking and organised crime are indisputable.
In terms of article 9.5 of the Palermo Protocol (SA are signatories) States Parties must go further than discouraging the demand for trafficked persons per se but must take measures to discourage the demand that fosters all forms of exploitation of persons, especially women and children that leads to trafficking.
Decriminalising/legalising prostitution, and thereby creating large sex markets that act as a pull factor for sex traffickers, would not fulfill our obligations in this regard. Drugs, crime and violence are intrinsic to the prostitution industry.
No country has managed to break the link between prostitution, crime, drugs and violence. J P Smith, Council representative for Sea Point, a well-known prostitution “hot spot”, and Chairperson for the Cape Town City Safety and Security Portfolio Committee, has stated that the City has found a definite link between prostitution and general crime.
7. How will this option address concerns regarding public health and HIV?
Researchers have estimated that if a prostitute would for instance have 10 clients a day, working 5 days a week, over the three months while infection is not detected by routine testing he/she will put 650 people directly at risk. Clients of prostitutes usually are married or cohabiting. This automatically doubles this figure to 1 300 people being put at risk of HIV before the infection is being detected.
This is despite two weekly health checks. Even if her clients would use condoms, she would still infect a possible 130 people (studies have indicated a 20% failure rate for condoms to protect against AIDS), and put another 130 at risk.
We reiterate the submission of Family Policy Institute here.
The alarmingly high infection rates of prostitutes with HIV/AIDS and the risk they present to the general public health have been well documented. The following are extracts from a research document compiled by Doctors for Life, an association of more than 1500 medical doctors across South Africa and the world. DFL is actively engaged in safe exit programs for people in prostitution and has rendered expert evidence to the Constitutional Court, Law Reform Commission and Parliament regarding the social and psychological consequences of prostitution.
Prostitution’s role in the world-wide AIDS/STD pandemic:
The likelihood of contracting an STD, including HIV/AIDS, is positively associated with the number of sexual partners a person has. That is a proven scientific fact. Prostitution, by its very nature, will increase the number of sexual partners of the prostitutes, and also their clients. Prostitutes and their clients are therefore both high-risk populations for HIV/AIDS.
In a study done in South Africa at a popular truck stop midway between Johannesburg and Durban, 10 of the 12 prostitutes interviewed reported working 7 days a week. (12) In another study done in Glasgow, prostitutes reported working 5.2 nights per week and servicing 7.1 clients per night. 72% of them were also involved in private non-commercial relationships. (13)
A second Glasgow study among female street worker prostitutes showed that they typically worked 5.5 evenings per week and provided sexual services to 6.4 clients per night. (14) A study done among male prostitutes in the Netherlands showed that street and home prostitutes work an average of 26 and 7 hours per week respectively. (15) A study among heterosexual commercial sex workers showed the following results: of the 193 women interviewed 136 worked as prostitutes and had on the average 115 customers per month. 99 of the men interviewed had visited on the average 8 prostitutes in the past 4 months. The data revealed that prostitutes had unprotected vaginal intercourse with an estimated average of 160 persons in 4 months. (16)
Risk factors for HIV infection amongst prostitutes:
Johnson and Aschkenasy found that the most frequently reported risk factor was a history of prostitution. (17) Male CSW's (commercial sex workers) were significantly of a higher risk group than female heterosexual CSW's. (18) Other risk factors include intravenous drug use, history of STD's, (19) blood transfusions, a history of multiple sex partners (20) or having a sex partner who used IV drugs. (21) Also noted as risk factors were the number of years in prostitution, seromarkers for HBV (hepatitis B virus) and syphilis, mean percentage of encounters involving receptive anal intercourse, and the presence of other STD's (22) sexual contact with those at increased risk, (23) seropositivity for HIV and penal/anal (24) intercourse, (25) for HBV (hepatitis B virus). It is obvious that more than one of the above risk factors are often present with prostitutes.
Male and Female prostitutes are therefore internationally considered amongst the main vectors of HIV infection in Africa, Asia, Europe and North America and Central and South America. (26) (27) (28) Men who use prostitutes have a higher risk of acquiring HIV (especially when the female sex worker has ulcerative infections). (29) (30) (31) (32) One study in Nigeria found that paying for sex with a commercial sex worker was the most significant predictor of having an STD. (33)
Thailand is a classic example of this tragedy. In Thailand, prostitution is rampant. Men from all over the world go to Thailand, because of easy access to prostitution. It is no wonder then, that Thailand also has a higher rate of HIV/AIDS than any other nation in the world. In Thailand, heterosexual contact is the main route of HIV-1 transmission and female CSW's have the highest risk of infection. An explanation of the higher prevalence of HIV-1 in spite of consistent condom use in the North may be that most HIV-1 infections had already occurred before condom use became widespread. HOWEVER, SEX WORKERS IN THE NORTH, WHO ENTERED THE PROFESSION DURING THE PREVIOUS YEAR, AND WHO REPORTED ALWAYS USING CONDOMS HAD AN HIV-1 PREVALENCE OF 36%. THIS SHOWS THAT THE INCIDENCE OF HIV-1 INFECTION IN RECENT TIMES HAS BEEN HIGH DESPITE HIGH LEVELS OF REPORTEDLY CONSISTENT CONDOM USE. (34) Another study in Thailand amongst 1 172 male commercial sex workers also showed that male CSW's in northern Thailand are at high risk of HIV despite current prevention efforts.
Other examples of countries where studies considered prostitutes to be a high risk group are: Spain, (35) mainland China, (36) Bombay, India, (37) Zaire, (38) Turkey, (39) Senegal, (40) Abidjan, where the seroprevalence amongst CSW's was 80% amongst 1 209 women tested. 23
Female sex workers (FSW's) were found to have the highest absolute and proportional rate of dual seroreactivity to HIV-1 and HIV-2 yet described in any population. (41) Another study in Abidjan found that HIV-infected men were significantly more likely than uninfected men to have had sex with FSW's in their lifetime. (42) HIV infection was independently associated with a longer duration of being a sex worker (43) (44) (45) (46) (47) and having a positive Treponema palladium agglutination test (Positive test for syphilis). (48) Kenya, (49). One study in Kenya used a cohort of 1 000 prostitutes from the lower socio-economic strata who were known to be a reservoir of STD's in 1985. (59) Nigeria, (50) (51) (52) Japan, (53) South Africa. (54) Sub-Saharan Africa in general, (55) West-Africa, (56) Bali Indonesia, (57) and Djibouti are also areas where prostitution is considered a significant risk factor in AIDS transmission. (58) Men having unprotected sex with FSW's had the greatest risk of acquiring infections and (by inference) of transmitting them to women. 85% Of these were seropositive for HIV-1. Another study reported in the New England Journal of Medicine. (60) reveals 66% of the prostitutes in Central Africa tested positive to AIDS exposure. They were in the lower economic class, did not use intravenous drugs and only practised vaginal sex.
Across the Atlantic, women prostitutes are also considered an important pool of HIV infection. In the USA approximately 33% of women entering treatment for narcotic addiction have at some time engaged in prostitution to earn money to buy drugs. These women have therefore been the cause of spread among heterosexuals in the US context. Other studies from America are from Argentina and (64) Miami Florida. (61) A study reported by the CDC in 1985 showed that 40% of 25 prostitutes tested in Miami tested positive to the disease. (62) Another study of U.S. servicemen infected with AIDS showed that 6 of 41 contracted the disease from female prostitutes. (63)
A report from Glasgow reveals that financial necessity might bolster the need for prostitutes to engage in their trade even during menstruation. During this period blood potentially tainted with HIV is more likely to affect the male client. (65) A favourite method of preventing the visible presence of bloodstained vaginal secretions from deterring potential clients is to insert absorbent material into the vagina during the menstrual period to mask the secretions. One such device was a contraceptive sponge, similar to the nonoxynol-9-impregnated "Today" sponge (Wyeth). This latter device has the merit of introducing a potential virucidal agent into the vagina, although its efficacy is doubtful.
In a congressional testimony about AIDS, W.A. Haseltine noted that infection of the prostitute population in Germany was a major problem. A figure of 20% nation-wide was estimated. (66) There was controversy whether the prostitutes were registered or not. (67) Some studies in first world countries have concluded that heterosexual transmission of HIV-1 by prostitutes to clients is limited and inefficient. (68) (69) These studies are, however, few in number. Also, this view is applicable to Western type HIV-1 disease where the incidence of AIDS is relatively low. It is not valid in the African context where heterosexual exposure to infected prostitutes with other STD's, and a much higher prevalence of HIV infection, is a different matter. (70) In Africa (as in India) the route of infection has been mainly by heterosexual intercourse with CSW's, and often involved long distance truck drivers. (71).
Some studies have even shown that women who knew their positive HIV-1 state were more likely to report the practice of anal intercourse than those who did not know that they were positive for HIV-1. (72)
12) Karim-QA; Karim-SSA; Soldan-K; et al; Reducing the Risk of HIV Infection among South African Sex Workers Socio-economic and Gender Barriers; American Journal of Public Health, Vol. 85, No. 11, pages 1521-1525, 12 references.
13) McKeganey-N; Barnard-N; Selling sex: Female Street Prostitution and HIV Risk Behaviour in Glasgow; AIDS Care, Vol. 4, No. 4, pages 395-407, 18 references.
14) Green-ST; Goldberg-DJ; Christie-PR; et al; Female sex Streetworker-Prostitutes in Glasgow: A Descriptive Study of Their Lifestyle; AIDS Care, Vol. 5, No.3, pages 321-335, 30 references.
15) de Graaf-R; Vanwesenbeeck-I; van Zessen-G; et al.; Male Prostitutes and Safe Sex: Different Settings, Different Risks; AIDS Care, Vol. 6, No. 3, pages 277-288, 19 references.
16) Hooykaas-C; van-der-Pligt-J; van-Doornum-GJJ; et al., Heterosexuals at Risk for HIV: Differences between Private and Commercial Partners in Sexual Behaviour and Condom Use; AIDS, Vol. 3, No. 8, pages 525-532, 27 references.
17) Johnson TP; Aschkenasy JR; Herbers MR; Gillenwater SA; Self-reported risk factors for AIDS among homeless youth; AIDS Educ Prev (UNITED STATES) Aug 1996 8 (4) p308-22 ISSN: 0899-9546.
18) Thomas-RM; Plant-MA; Plant-ML; et al., Risks of AIDS among Workers in the "Sex Industry": Some Initial Results from a Scottish Study; British Medical Journal, Vol.299, No. 6692, pages 148-149, 13 references.
19) Johnson TP; Aschkenasy JR; Herbers MR; Gillenwater SA; Self-reported risk factors for AIDS among homeless youth; AIDS Educ Prev (UNITED STATES) Aug 1996 8 (4) p308-22 ISSN: 0899-9546.
20) Johnson TP; Aschkenasy JR; Herbers MR; Gillenwater SA; Self-reported risk factors for AIDS among homeless youth; AIDS Educ Prev (UNITED STATES) Aug 1996 8 (4) p308-22 ISSN: 0899-9546.
21) Wenstrom-KD; Zuidenn-LJ; Determination of the Seroprevalence of Human Immunodeficiency Virus Infection in Gravidas by Non-anonymous versus Anonymous Testing; Obstetrics and Gynecology, Vol. 74, No. 4, pages 558-561, 4 references.
22) Onorato-IM; Klaskala-W; Morgan-WM; Withum-D; Prevalence, incidence, and risks for HIV-1 infection in female sex workers in Miami, Florida; J-Acquir-Immune-Defic-Syndr-Hum-Retrovirol. 1995 Aug 1; 9(4): 395-400.
23) Johnson TP; Aschkenasy JR; Herbers MR; Gillenwater SA; Self-reported risk factors for AIDS among homeless youth; AIDS Educ Prev (UNITED STATES) Aug 1996 8 (4) p308-22 ISSN: 0899-9546.
24) Johnson TP; Aschkenasy JR; Herbers MR; Gillenwater SA; Self-reported risk factors for AIDS among homeless youth; AIDS Educ Prev (UNITED STATES) Aug 1996 8 (4) p308-22 ISSN: 0899-9546.
25) Rosenblum-L; Darrow-W; Witte-J; et al., Sexual Practices in the Transmission of Hepatitis B Virus and Prevalence of Hepatitis Delta virus Infection in Female Prostitutes in the United States; Journal of the American Medical Association, Vol. 267, No. 18, pages 2477-2481, 36 references.
26) Hawkes-S; Hart-GJ; Johnson-AM; Shergold-C; Ross-E; Herbert-KM; Mortimer-P; Parry-JV; Mabey-D; Risk behaviour and HIV prevalence in international travellers; AIDS. 1995 Feb; 8(2): 247-52.
27) McKeganey-NP; Prostitution and HIV: What Do We Know and Where Might Research Be Targeted in the Future; AIDS, Vol. 8, No. 9, pages 1215-1226, 110 references.
28) B.G. Weniger, et al., "The Epidemiology of HIV Infection and AIDS in Thailand". AIDS, 1991, 5, (supp.2): 571-585.
29) The entire report can be found on the World Sex Guide at: -
30) Pham-Kanter-GB; Steinberg-MH; Ballard-RC; Sexually transmitted diseases in South Africa; Genitourin-Med. 1996 Jun; 72 (3): 160-71.
31) Kimani-J; Maclean-IW; Bwayo-JJ; MacDonald-K; Oyugi-J; Maitha-GM; Peeling-RW; Cheang-M; Nagelkerke-NJ; Plummer-FA; Brunham-RC; Risk factors for Chlamydia trachomatis pelvic inflammatory disease among sex workers in Nairobi, Kenya; J-INFECTDIS. 1996 JUN; 173(6) 1437-44.
32) Onorato-IM; Klaskala-W; Morgan-WM; Withum-D; Prevalence, incidence, and risks for HIV-1 infection in female sex workers in Miami, Florida; J-Acquir-Immune-Defic-Syndr-Hum-Retrovirol. 1995 Aug 1; 9(4): 395-400.
33) Lisa J. Messersmith, Thomas T. Kane, and Adetanwa I. Odebiyi, et Al. Patterns for Sexual Behaviour and Condom Use in Ile-Ile, Nigeria: Implications for AIDS/STDs Prevention and Control.
34) "Condom Use and Risk Factors for HIV-1 Infection among Female Commercial Sex Workers in Thailand". Letters to the Editor. Amer. Journal of Public Health, Vol. 84, No. 12, December 1994, pp. 2026-2027.
35) McKeganey-N: Barnard-N; Selling sex: Female Street Prostitution and HIV Risk Behaviour in Glasgow; AIDS Care, Vol. 4, pages 395-407, 18 references.
36) Gil-VE; Wang-MS; Anderson-AF; Lin-GM; Wu-ZO; Prostitutes, prostitution and STD/HIV transmission in mainland China; Sec-Sci-Med. 1996 Jan; 42(1): 141-52.
37) Bhava-G; Lindan-CP; Hudes-ES; et al., Import of an Intervention on HIV, Sexually Transmitted Diseases, and Condom Use among Sex Workers in Bombay, India; AIDS Vol. 9, Supplement 1; pages 521-530, 34 references.
38) Alary-M; Laga-M; Vuylsteke-B; Nzila-N; Plot-P; Signs and symptoms of prevalent and incident cases of gonorrhoea and genital chlamydial infection among female prostitutes in Kinshasa, Zaire. Clin-Infect-Dis. 1996 Mar;22(3): 477-84.
39) Aral SO; Fransen L; STD/HIV prevention in Turkey: planning a sequence of interventions; AIDS Educ Prev (UNITED STATES) Dec 1995 7 (6) p544-53 ISSN: 0899-9546.
40) Langley-CL; Benga-De-E; Critchlow-CW; Ndoye-1; Mbengue-Ly-MD; Kuypers-J; Woto-Gaye-G; Mboup-S; Bergeron-C; Holmes-KK; Kiviat-NB; HIV-1, HIV-2, human papilloma virus infection and cervical neoplasia in high-risk African women: AIDS. 1996 Apr; 10(4); 413-7.
41) Ghys-PD; Diallo-MO; Ettiegne-Traore-V; et-al.; Dual seroreactivity to HIV-1 and HIV-2 in female sex workers in Abidjan, Cote d‟Ivoire. AIDS. 1995 Aug.; 9(8)" 955-8.
42) Sassan-Morokro-M; Greenberg-AE; Coulibaly-IM; et al; High-rates of sexual contact with female sex workers, sexually transmitted diseases, and condom neglect among HIV-infected and uninfected men with tuberculosis in Abidjan, Cote d‟Ivore. J-Acquir-Immune-Defic-Sundr-Hum-Retrovirol; 1996 Feb 1; 11 (2): 183-7.
43) Da Rosa-Santos OL; Goncalves Da Silva A; et al; Herpes simplex virus type 2 in Brazil: seroepidemiologic survey; Int J Dermatol (UNITED STATES) Nov 1996 35 (11) p794-6 ISSN:0011-9059.
44) Elifson-RW; Bolos-J; Sweat-M; et al; Seroprevalence of Human Immunodeficiency Virus among Male Prostitutes; New England Journal of Medicine, vol 321, NO. 12, pages 832-833, 4 references.
45) Uribe-Salas F; Del Rio-Chiriboga C; Conde-Glez CJ; Prevalence, incidence, and determinants of syphilis in female commercial sex workers in Mexico City; Sex Transm Dis (UNITED STATES) Mar-Apr 1996 23 (2) p120-6 ISSN: 0148-5717.
46) Uribe-Salas F; Del Rio-Chiriboga C; Conde-Glez CJ; et al.; Prevalence, incidence, and determinants of syphilis in female commercial sex workers in Mexico City.; Sex Transm Dis (UNITED STATES) Mar-Apr 1996 23 (2) p120-6 ISSN: 0148-5717.
47) Pal NK; Chakraborty MS; Das A; et al; Community based survey of STD/HIV infection among commercial sex workers in Calcutta (India). Part-IV: Sexually transmitted diseases and related sex factors; J Commun Dis (INDIA) Dec 1994 26 (4) p197-202 ISSN: 0019-5138.
48) Diallo MO; Ettiegne-Traore V; Yeboue KM: et al. Genital ulcers associated with human immunodeficiency virus-related munosuppression in female sex workers in Abidjan, Ivory Coast; Project Retro-CI, Bureau Central de Co-ordination du Comite National de Lu tre le SIDA, Abidjan, Ivory Coast.; Infect Dic (UNITED STATES) Nov. 1995 172 (5) p1371-4. ISSN: 0022 -1899.
49) Moses-S; Muia-E; Bradley-JE; Nagelkerke-NJ; Ngugi-EN; Njeru-EK; Eldridge-G; Olenja-J; Wotton-K; Plummer-FA; et-al. Sexual behaviour in Kenya: Implications for sexually transmitted disease transmission and control. Soc-sci-Med. 1994 DEC; 39(12): 1649-56. 27
50) Obi-CL; Ogbonna-BA; Igumbor-EO; Ndip-RN; Ajayi-AO. HIV seropositivity among female prostitutes and nonprostitutes: obstetric and perinatal implications. Viral-Immunol. 1993 Fall;6(3): 171-4.
51) Dada-AJ; Oyewole-F; Onofowokan-R; Demographic Characteristics of Retroviral Infections (HIV-1, HIV-2, and HTLV-1) among female Professional Sex Workers in Lagos, Nigeria; Journal of Acquired Immune Deficiency Syndromes, Vol. 6, No. 12, pages 1358-1363, 16 references.
52) Olaleye-OD; Bernstein-L; Ekweozor-CC; Sheng-Z; Omilabu-SA; Li-XY; Sullivan-Halley-J; Rasheed-S; Prevalence of human immunodeficiency virus types 1 and 2 infections in Nigeria; J-Infect-Dis. 1993 Mar: 167(3): 710-4.
53) Kashiwagi S; Kajiyama W; Hirata M; Hasyashi J; Noguchi A; Maeda Y; Sexual transmission of human T-lymphotropic virus type 1 among female prostitutes and among patients with sexually transmitted diseases in Fukuoka, Japan; Department of General Medicine, Kyushu University Hospital, Fukuoka, Japan, J. Epidemiol (UNITED STATES) Feb. 15 1995 141 (4) p 305-11.
54) Blecher MS; Steinberg M; Pick W; AIDS-knowledge, attitudes and practices among STD clinic attenders in the Cape Peninsula; S Afr Med J (SOUTH AFRICA) Dec 1995 85 (12) p1281-6 ISSN: 0038-2469.
55) Hunter-DJ; AIDS in sub-Saharan Africa: the epidemiology of heterosexual transmission and the prospects for prevention; Epidemiology. 1993: Jan; 4(1): 63-72.
56) Hunter-DJ; AIDS in sub-Saharan Africa: the epidemiology of heterosexual transmission and the prospects for prevention; Epidemiology. 1993: Jan; 4(1): 68-72.
57) Wirawan-D N; Fajans-P; Ford-K; AIDS and STDs: risk behaviour patterns among female sex workers in Bali, Indonesia; AIDS-Care, 1993; 5(3): 289-303.
58) Rodier-GR; Couzineau-B; Gray-CC; et al; Trends of human immunodeficiency virus type-1 infection in female prostitutes and males diagnosed with a sexually transmitted disease in Djibuti, east Africa. Am-J-Trop-Med-Hyg. 1993 May: 48(5): 682-6.
59) Cameron DW et al. Female to Male Transmission of Human Immunodeficiency Virus Type 1:Risk Factors for Seroconversion of Men. Lancet 1989;II:8660;403.
60) New England of Medicine, February 13, 1986.
61) Onorato-IM; Klaskala-W; Morgan-WM; Prevalence, incidence, and risks for HIV-1 infection in female sex workers in Miami, Florida; J-Acquir-Immune-Defic-Syndr-Hum-Retrovirol. 1995 Aug 1; 9(4): 395-400.
62) The Atlanta Journal, April 26,1986.
63) U.S.A. Today, October18,1985.
64) Zapiola I; Salomone S; Alvarez A; et al; HIV-1, HIV-2 HTLV-I/II and STDs among female prostitutes in Buenos Aires, Argentina; Eur J Epidemiol (NETHERLANDS) Feb 1996 12 (1) p27-31 ISSN: 0392-2990.
65) Green ST et al. Intercourse during Menstruation among Prostitutes, JAMA 1990; 264:3.333.
66) Haseltine WA. HTLV-II/LAV-Antibody-Positive Soldiers in Berlin. N Engl Jmed 1986; 314:1:55.
67) James JJ, Morgenstern MA & Hatten JA HTLV-III/LAV-Antibody Positive Soldiers in Berlin. N Engl Jmed 1986;314:1:55.
68) Handsfield HH. Transmission of Human Immunodeficiency Virus (HIV). N Engl JMed 1988;318:18:1202.
69) Kihara M; Ichikawa S; Kihara M; Yamasaki S; Descriptive epidemiology of HIV/AIDS in Japan, 1985-1994; 1997 14 Suppl 2 pS3-12 ISSN: 1077-9450.
70) Onorato-IM; Klaskala-W; Morgan-WM; Prevalence, incidence, and risks for HIV-1 infection in female sex workers in Miami, Florida; J-Acquir-Immune-Defic-Syndr-Hum-Retrovirol. 1995 Aug 1; 9(4): 395-400.
71) Pais P; HIV and India: looking into the abyss; Trop Med Int Health (ENGLAND) Jun 1996 1 (3) p295-304 ISSN: 1360-2276.
72) De Vincenzi I. European Study Group. Risk factors for male to female transmission of HIV. Br Med J, 1989:298-411
8. How will this option assist to create an environment for prostitutes to exit prostitution?
The total criminalisation option that clamps down on the demand side including the criminal element that exploit and abuse women and children in prostitution will significantly reduce the demand for prostitutes and break the links with organised crime.
This policy coupled with state funded exit programs supported by civil society is the only viable and responsible way to help women escape prostitution. Currently, although prostitution is criminalised there are no viable and sustainable exit programs available to help women escape this inherently harmful and exploitative trade.
As a result, and as many studies have revealed, most prostitutes will leave prostitution if provided with the necessary help and support. However, that help is not currently available or supported by government or civil society.
A zero tolerance approach to men who solicit and buy sex as well as pimps, gangs, brothel owners, crime syndicates and sex traffickers will significantly reduce the demand for prostitutes and will remove the threat of exploitation, abuse and human trafficking for sexual purposes.
Exit programs that offer real and sustainable solutions including counselling, drug and alcohol rehabilitation, job skills training, life skills training and emotional support will provide prostitutes real hope and a second chance at a life of dignity, self respect and fulfilment.
9. How must the issue of criminal record for prostitution, when leaving prostitution and seeking alternative employment, be addressed?
The only viable way women trapped in prostitution will get a fair chance of starting a new life is if their criminal records are expunged. A clean record must be used as a motivating factor for women to exit prostitution and begin a new life as a dignified member of society. Provision for the criminal offence to be expunged on completion of the programme should be an incentive.
The unfortunate circumstances that force women into prostitution should not be used to chain them to their past indefinitely. As a consequence, all recorded criminal activity associated with a woman’s life in prostitution must be rescinded when the woman agrees to the assistance offered by state funded exit programs.
In addition, women who are offered and accept assistance out of prostitution can provide authorities with intelligence about the modus operandi of crime syndicates and sex traffickers.
1. Farley, M. (in press) “Renting an Organ for Ten Minutes: What Tricks Tell us about Prostitution, Pornography, and Trafficking.”
2. Bunch, C., and Frost, S., (2000) 14 Bunch, C., and Frost, S., (2000) 15 www.hrw.org/women
3. Farley, M. “Renting an Organ for Ten Minutes: What Tricks Tell us about Prostitution, Pornography, and Trafficking.” Accepted for publication in Pornography: Driving the Demand for International Sex Trafficking. Los Angeles: Captive Daughters Media.
Christian Action Network