Risk and risk management in sex work post-Prostitution Reform Act: a public health perspective

In the sex-worker population, the priority of harm minimisation has been to minimise disease transmission through educating the workers on safe-sex practices. This harm-minimisation approach assumes that by educating the sex workers on HIV/AIDS and informing them of their responsibility in preventing transmission, they would make rational choices to protect themselves and others. However, the assumption that sex workers are vectors of diseases marginalises and blames them without considering the implications of poverty, gender, public fear, and law. For a more effective health approach in the sex industry, it is hence vital to consider structural and political issues such as poverty and law. Within this context, public-health workers have been challenged to take a more holistic approach to health promotion for sex workers. In addition to taking into consideration the health of the workers, their human rights and the need to create a safer working environment were also considered in the risk-management and harm-minimisation assessment of the sex industry. Within the broad context of harm minimisation commenced the advocacy for the decriminalisation of the sex industry. It was envisaged that by repealing the laws which criminalised sex-work activities, the autonomy of the sex workers and their capability to protect themselves would increase. It was theorised that under a decriminalised system, human rights and set standards for working environments would improve the health and safety of the workers. This chapter examines whether there have been gains for sex-worker health and safety in a decriminalised environment. It examines the main threats to health and safety identified by the participants: risks to sexual health, risks of violence and exploitation, and risks to emotional health