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Stigmatising sex work
- Josef Decosas (13 April 2007)
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Demythologising and destigmatising sex work
- Michael DE Goodyear (14 April 2007)
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Sex workers and STIs in Birmingham
- Dr Jacky Chambers, Dr Penny Goold , Ms Sharon Myring , GUM Consultants at Whittall Street Clinic, Birmingham (17 April 2007)
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Josef Decosas, Regional Health Adviser for West Africa, Plan International Accra, Ghana
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That public health officials do not always have the highest level of sensitivity when confronted with complex social institutions such as sex work is a given, and Chris Spencer Jones is no exception.
Accusing him of "stigmatising sex workers", however, is ridiculous. Stigma is a social phenomenon, it is not done by any one person to any group.
I do not know what evidence Spencer Jones cites for Birmingham. But wherever I have worked, in West Africa, Asia, and Canada, unregulated and clandestine sex work has been a major contributor to epidemics of sexually transmitted infections. I would be surprised if this was not the case in the UK.
Spencer Jones asks for legalisation and regulation of sex work. All the sex worker activist groups I have ever met are asking for the same thing.
Some of the details of his recommendations reflect the authoritarian heritage of public health. We can talk about those. And maybe he needs to have a bit of training on making his language more acceptable. But I find that the main core of his proposals makes a lot of sense.
Josef Decosas, Accra, Ghana
Competing interests: None declared |
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Michael DE Goodyear, Asistant professor Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada B3H 2Y9
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With reference to the comments by Josef Decosas (13 April 2007), it is correct to state that stigma is a complex social process, however stigmatisation and marginalisation amongst sex workers is an issue that is of major concern to international agencies, (1) has been identified as the major cause of morbidity amongst sex workers, (2) and is something I have commented on more extensively in these pages, both in general (3, 4) and in reference to this specific issue (5). To clarify the issue at hand, the concerns expressed by researchers and care givers relates not to the opinion of one person, but to the fact that Dr Spencer-Jones states “As chairman of the BMA public health committee I have a duty”. At the very least this implies that his statements are the official view not only of his committee but of the BMA itself. I and many of my colleagues working in this field would dispute that. It is correct to state that one person does not stigmatise a single group of people, for stigma relates more to the way that an individual or group perceive their role in society and the value that society places on them. (6) The issue is one of unjustified blame by perceived authority resulting in not only decreased self esteem but increased violence towards them by other sectors of society. Sex work comes with increased risks, one of which is related to multiple sexual partners and hence potential transmission of sexually related diseases (STI), but one must be careful about generalisability, since these are both geographically and temporally dependent. I would challenge the evidence for the statement here that sex work “has been a major contributor to epidemics of sexually transmitted infections” in the contemporary context of the UK. In fact women sex workers are at a slightly increased risk when compared with population rates, but at lower risk than other women attending genitourinary clinics. (7, 8) Good sexual health practices have actually led to decreasing rates of STI at a time when these are increasing in the general female population. The Center for Disease Control in the USA estimates that the source of STIs is 75% high school and college age non-commercial sex, 20% other casual non-commercial sex and only 5% from commercial sexual activity. Therefore it is very unfair to make statements like this about a group who have tried very hard to practice high standards. There is some understandable confusion here about what is meant by legalisation. This is not what either sex workers, researchers or service providers are demanding. Legalisation and licensing as described here are quite different from decriminalisation which is the recommended best practice. (9) Under decriminalisation regulation is largely self regulating and outside of the criminal law, being seen as a health and safety and employment standard issue. Legalisation, for instance as was commonly practiced in nineteenth century Europe does not make much sense, and has repeatedly been a failure. With regard to the other proposals briefly mentioned here, subjecting sex workers to regular testing does not make sense in view of the above, has been shown not to be cost effective, (10) has serious human rights implications and will result in negative social consequences. The data presented simply cannot be substantiated, nor the theory justified, and the BMA has some explaining to do about how this came about, and a duty to correct the situation. What is necessary is to remove sex work from the criminal law and to ensure that adequate access to appropriate health and social services is provided. 1. United Nations Population Fund. Resource pack on gender and HIV/AIDS 2006. Fact Sheet 9: HIV/AIDS, Gender and Sex Work. http://www.unfpa.org/publications/detail.cfm?ID=279&filterListType 2. Ward H, Day S. What happens to women who sell sex? Report of a unique occupational cohort. Sex Transm Infect. 2006 Oct;82(5):413-7 3. Goodyear M, Cusick L. Protection of sex workers: Protection of sex workers Decriminalisation could restore public health priorities and human rights BMJ 2007; 334: 52-53 4. Goodyear M. Remembering Ipswich:.The Case for Decriminalisation of Prostitution. January 2007 http://myweb.dal.ca/mgoodyea/files/rememberingipswich.doc 5. Goodyear M. Public health policy must be based on sound evidence, not opinion BMJ 6 April 2007 http://www.bmj.com/cgi/eletters/334/7586/187 6. Parker R, Aggleton P et al. Horizons. HIV/AIDS-related stigma and discrimination: A conceptual framework and an agenda for action. Population Council, Horizons Program, Washington D.C. 2002 http://pdf.dec.org/pdf_docs/pnacq832.pdf 7. Ward H, Day S, Weber JN. Risky business: health and safety in the sex industry over a nine year period. Sexually Transmitted Infections 1999;75(5):340-343 8. Ward H, Day S, Green A, Cooper K, Weber J. Declining prevalence of STI in the London sex industry, 1985 to 2002. Sex Transm Inf 2004;80:374-379 9. Harcourt C, Egger S, Donovan B. Sex work and the law. Sex Health. 2005;2(3):121-8. 10. Lee DM, Binger A, Hocking J, Fairley CK. The incidence of sexually transmitted infections among frequently screened sex workers in a decriminalised and regulated system in Melbourne. Sex Transm Infect. 2005 Oct;81(5):434-6. Competing interests: None declared |
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Dr Jacky Chambers, director of public health Heart of BirminghamtPCT , Bartholomew House , 142 , Hagley road , Edgbaston , B16 9PA, Dr Penny Goold , Ms Sharon Myring , GUM Consultants at Whittall Street Clinic, Birmingham
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There is no epidemiological evidence to support the recent statement (1) by Dr Chris Spencer Jones that 70% of all STIs in Birmingham are circulating in a pool of prostitutes and their clients. Surveillance data routinely collected by GUM clinics and analysed by the Health Protection Agency do not include the proportion of Sexually Transmitted infections (STIs) diagnosed in sex workers (SW) or their clients. Furthermore , data from the ‘Safe Project’ a dedicated sexual health promotion service for Birmingham’s Sex Workers indicates that , over the last year , the prevalence of STI’s amongst the 208 Sex workers attending this targeted service was low - Chlamydia (1.9%) and HIV (0) Gonorrhoea (2.9%) and syphilis (1%) More recently a local Enhanced Surveillance Programme introduced for Syphilis indicated that although commercial sex work or reported use of Sex Workers was identified amongst those found to be infected with syphilis, just 5% of the total number of syphilis diagnoses were attributable to this group. Trends in HIV infections in Birmingham are similar to those seen nationally and there is no evidence that contact with commercial sex workers is a significant risk factor in those newly diagnosed with HIV infection (2, 3). Overall the claims made by the Chairman of the BMA public health committee appear to be without substance. We feel that as a public health doctor he has a duty not only to ensure that important public health issues are discussed but also to check out the facts before going public. 1. News BMJ 2007; 334: 767 [Full text] 2. Sexually Transmitted Infections in Residents of Birmingham and Solihull Jan- Dec 2005 . Health Protection Agency , West Midlands 3 The UK Collaborative Group for HIV and STI Surveillance. A Complex Picture. HIV and other Sexually Transmitted Infections in the United Kingdom: 2006. London: Health Protection Agency Centre for Infections. November 2006 http://www.hpa.org.uk/publications/2006/hiv_sti_2006/pdf/a_complex_Picture_ Authors:
Competing interests: None declared |
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