Navigating the References: Part 1

In 2015, Jill McCracken prepared for a TEDx talk on the topic “Selling Sex: Contradicting Violence with Choice” amassing a great deal of the current research on the topic. Later in 2015 Jill joined BPPP’s research advisory committee for the Nothing About Us, Without Us Project, and these references and summaries proved to be an extremely valuable resource as we developed our work on HIV policy and sex worker rights. She has now kindly provided us with a comprehensive blog posting collating key research summaries. We are publishing her post in two parts, the first focusing on the intersections of sex work, HIV and health, and the second part will focus on references referencing trafficking in persons. Jill is an Associate Professor of Rhetoric and Writing Studies at the University of South Florida St. Petersburg and author of the book Street Sex Workers Discourse.

Navigating the References Connecting Sex Work, Criminalization, and Violence

By Jill McCracken, PhD

You may not learn a great deal of new information in this blog. I say that truthfully and also to acknowledge the incredible work that has and continues to be done and shared within the sex worker rights movement and beyond. As I was compiling these sources and writing the blog, explained more fully below, I was continually hearing myself say, “Well, this is nothing new. This is what we have been saying all along”. And yet, because sources are making this information known through case studies, sites of analysis, research methodologies, and community organizations and perspectives, it becomes extremely helpful to reiterate this information and put it in one place for easy reference; at least it has been helpful for me.

When I found out I was going to give a TEDx talk at the University of South Florida, I was instantly terrified. My terror is usually linked to not only my high expectations for myself, but also my fear of disappointing my audience. And when I considered my fear in relationship to this project (working through my fear has become my new way of being of late), I realized the audience I was most afraid of disappointing was my sex worker and sex worker rights colleagues and organizations. I also knew that in order to give a talk that was worthy of the subject matter: A World Beyond Ourselves, I would need to, once again, rely on my sex worker and sex worker rights colleagues and friends. I therefore went to my many online lists and organizations and asked for help. I also did a great deal of research. Ironically, most, if not all, of this research did not actually make it into the talk, because I later found out that TEDx talks were not meant to include lots of statistics and facts, but rather stories and information the audience can relate to. But what I did find in doing all of that research was that I became even more convinced of my (and many others’) central idea for this talk: that sex work must be decriminalized if we are to reduce violence against sex workers, sex workers must be at the forefront of any discussions about these policies, and that we must focus on a rights-based approach rather than a prosecution or criminal-based approach.

One of my central beliefs and practices when doing research about sex work is that I must give back to these communities because they are the foundation of my work, and they continue to provide me with knowledge, experience, friendship, and power, for which I will forever be grateful. One way of giving back to these groups of scholars, activists, and just generally incredible individuals is to share the research I did so that others can draw on it when and if useful. Which is the purpose of this blog. Of course this short piece cannot include all of the excellent research out there on this subject, but it includes the research I found as well as what was shared with me while preparing for my talk. My goal was to locate sources that draw on evidence-based research in relationship to criminalization and violence. In short, I was looking for research that was based in sex-worker led organizations, and their findings overwhelmingly showed that criminalization creates violence or the conditions that allow for violence against sex workers.

The articles can be divided into two areas fairly neatly: those that focused on sex work and those that focused on trafficking in the sex industry, although of course there was always overlap. They also ranged from academic and community-based studies to more popular press articles.

Sex Work Articles


Many sources focused on violence and in its prevalence in relationship to sex work. Overall, these reports advocate for legislation to change based on their findings.

The American Journal of Public Health provided A Systematic Review of the Correlates of Violence Against Sex Workers, May 2014. Their goal was “to examine the prevalence and factors shaping sexual or physical violence against sex workers globally” (p. 42). Based on 1536 unique articles, they found “lifetime prevalence of any or combined workplace violence ranged from 45% to 75% and over the past year, 32% to 55%” (p. e42). They state that “despite a substantial human rights and public health concern, there are major gaps in documentation of violence against sex workers in most parts of the world” (p. 50). They further identify the following risk context of violence: legal policies and the regulation of sex work; work environments; gender inequality, power, and social stigmatization of sex work; population movement and sexual coercion of women and girls; and interpersonal, individual, and psychosocial associations (pp. 44-50). One useful finding was their identification of the deficit of studies on perpetrators of violence against sex workers.  This lack of perspective poses a substantial limitation to understanding how violence against sex workers can be mitigated and prevented (p. 51). They advocate partnership with sex worker communities as critical to the end goal of reducing violence against sex workers (p. 52).

In Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers, the authors found an extremely high occurrence of both sexual and physical violence against female sex workers that persists due to large scale structural inequities (p. 7). Their results identify these structural factors as criminalization, homelessness, and the poor availability of drug treatment as independently correlated with gender-based violence again street-based female sex workers. They argue for socio-legal policy reforms, improved access to housing and drug treatment, and a scale up of violence prevention efforts including police-sex worker partnerships as crucial to stemming this violence (p. 1). Their “research provides important empirical evidence demonstrating the adverse public health effects of enforcement based policing approaches to sex work and drug use, and supports global calls to remove criminal sanctions targeting sex workers” (p. 7).

Given the ongoing emphasis on the Swedish model or End Demand strategies that criminalize the purchase of sex rather than the selling of it, Criminalization of clients: reproducing vulnerabilities for violence and poor health among street-based sex workers in Canada—a qualitative study, 2014, explores how the criminalization and policing of sex buyers or clients shapes sex workers’ working conditions and exchanges of sex, including their risk of violence and HIV/sexually transmitted infections. A qualitative and ethnographic study based in Vancouver, Canada, the authors triangulated their findings with sex work-related violence prevalence date and publicly available police statistics. Their  work suggests that “criminalization and policing strategies that target clients reproduce the harms created by the criminalization of sex work, in particular vulnerability to violence and HIV/STIs” (p. 1). Decriminalizing sex work in order to create conditions that support the health and safety of sex workers in Canada and globally is the logical and healthy response they suggest would change these circumstances.

In addition to academic articles about violence and criminalization, I also accessed studies created by community organizations. For instance, The Right(s) Evidence: Sex Work, Violence, and HIV in Asia, 2015, is a study comprised of 123 peer-to-peer in-depth qualitative interviews with female male and transgender sex workers and key informants in Indonesia (Jakarta), Myanmar (Yangon), Nepal (Kathmandu) and Sri Lanka (Colombo). The article highlights facts that both increase and decrease participants’ exposure to violence and HIV. Those that decreased this exposure included safe workplaces, collectivization of strong sex-worker led networks, and access to knowledge, skills, and non-discriminatory and non-stigmatizing health care services. Those that increased this exposure include the criminalization of sex work, law enforcement practices, a culture of impunity about these offenses, the stigma and discrimination associated with sex work, and gender inequality because this form of violence is used to reinforce these norms and maintain existing power relations (p. 12).

They recommend the “reform of punitive laws, policies and law enforcement practices to protect sex workers’ rights, including the right be free from violence”; to “strengthen sex workers’ access to justice and empower them with knowledge of their rights”; to “recognize sex work as legitimate work”; and to “improve sex workers’ access to sexual and reproductive health, HIV, and gender-based violence services” (p. 12-16).

A community report from the International Committee on the Rights of Sex Workers in Europe, Structural Violence: Social and institutional oppression experienced by sex workers in Europe is useful because it articulates what structural violence is and how it influences and affects sex workers’ lives. As they define it, structural violence “concerns situations in which some individuals or populations are harmed and their needs are impaired due to the oppressive and unjust social conditions in which they live. Structural violence is a form of violence resulting from and perpetuated by broader social arrangements, such as historically rooted social structures and relationships, political organization, and the logic of the economic system” (p. 1). As they emphasize, “structural violence—unlike direct violence—often remains invisible and unquestioned” because it is “so deeply ingrained in the fabric of social and everyday life that it becomes commonly accepted as ‘the way things are’, or even considered a necessary condition of the social, political and economic order as we know it” (p. 2). They find misrepresentation and silencing (p. 3-4) to be the trap of criminalisation (p. 5-6) and violent institutions (p. 7). The report argues for sex workers’ access to justice, labour rights and welfare services, health, and security of family life (p. 7-10). In order to challenge this structural violence, the authors outline strategies that could help sex workers overcome structural oppression. These include community building and collective mobilization, challenging stigma, advocating for legal reform, raising awareness around discrimination and violence against sex workers, supporting sex workers’ access to justice, engaging with representatives of institutions, forging alliances with other oppressed communities, and engaging with worker’s movements and unions (p. 10-14).

A report based on research in Vancouver, Canada, My Work Should Not Cost Me My Life: The Case against Criminalizing the Purchase of Sex in Canada, 2014, emerged from the combined efforts of Pivot Legal Society, an organization that uses the law to address root causes of poverty and social exclusion, Sex Workers United Against Violence, a peer-based organization of active and forced sex workers who live and/or work in the Downtown Eastside of Vancouver, and, Gender and Sexual Health Initiative, a core program of the CB Centre for Excellence in HIV/AIDS.  In response to the Supreme Court of Canada’s 2013 decision in the case of Bedford v. Canada, and Canada’s subsequent interest in the approach taken by Sweden which prohibits the purchase of sexual services, these organizations felt it was an important time to “examine and evaluate the evidence regarding the impact of this model” (p. v). Their goal was to evaluate the effects of law enforcement targeting purchases of sexual services. For the five years prior to this report, the police departments had gradually shifted away from arresting street-based sex workers, while still actively arresting clients. The report concludes, “criminalization of clients impacts sex workers’ safety by exposing them to significant safety and health risks, including: displacement to isolated spaces; inability to screen clients or safety negotiate terms of transactions; and inability to access police protection” (p. v). The report provides four recommendations that “would lay the groundwork for sex workers to have access to healthy and safe working conditions, to address law enforcement concerns about violence and abuse in the sex industry and to ensure that sex workers’ choices and autonomy are respected” (p. vi).

Their recommendations:

  • Canada’s law should not prohibit the purchase or sale of sexual services by adults
  • Ensure sex workers are in a leadership position in all future law and policy development
  • Use existing criminal laws to target violence and abuse in the sex industry
  • Invest in government programs that support sex workers’ rights and safety and alleviate poverty and discrimination.  (p. vi)

In February 2015, an open letter to Ontario Attorney General was published titled, Stop the Enforcement of Dangerous New Sex Work Legislation and Meet with Sex Work Advocates, written by Maggie’s and STRUT, who both represent and advocate for sex work communities. They wrote in response to the Protection of Communities and Exploited Persons Act (PCEPA), an amendment to the Bedford v. Canada decision that went into effect in November 2014. This amendment made it an offense to purchase sexual services and to communicate for that purpose. The letter calls on the Honorable Madeleine Meilleur to advise against these laws as well as prosecuting these charges, and requests a meeting with advocates of people currently in the sex industry. The letter outlines many of the local concerns about this new legislation as well as responses to it, all of which focus primarily on sex workers safety and livelihood.


The Lancet HIV and sex workers series (2015) argues for the decriminalization of sex work as central to their findings. In their opening to the series, Bringing sex workers to the centre of the HIV response, 2015, Pamela Das and Richard Horton summarize by saying, “this Series calls on governments to decriminalize sex work. There is no alternative if we wish to reduce the environment of risk faced by women, men, and transgender people worldwide” (p. 4). In Combination HIV prevention for female sex workers: what is the evidence?, 2015, the series delves into the benefits of combining biomedical approaches with prevention to include “behavioural and structural components as part of a community-driven approach, [that] will help to reduce HIV infection in sex workers in different settings worldwide” (p. 72). They argue the “evidence indicates that effective HIV prevention packages for sex workers should include combinations of biomedical, behavioural, and structural interventions tailored to local contexts, and be led and implemented by sex worker communities” (p. 72). In their literature review of the available published data for HIV prevalence and incidence, in addition to their findings that eliminating sexual violence and scaling up access to antiretroviral therapy reduces the spread of HIV, they project that modest coverage of sex-worker led outreach to reduce HIV infections in the next decade would also be highly beneficial. The authors of Global Epidemiology of HIV female sex workers: influence of structural determinants, 2015, emphasize that combined with all of these methods, “decriminalization of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33-46% of HIV infections in the next decade” (p. 55). This study relied on a deterministic transmission model to simulate potential HIV infections averted through structural changes with high HIV prevalence among female sex workers. They applied these models to Vancouver, Canada; Mombasa, Kenya; and Bellary, India.  These case studies included a description of the work environments, as well as an overview of criminalization, policing, and violence.

This Lancet series also includes studies about male sex workers. In Male sex workers: practices, contexts, and vulnerabilities for HIV acquisition and transmission, 2015, the authors define this group “as a key population underserved by current HIV prevention, treatment, and care services” (p 260). They direct attention to the interrelationships of access and stigma that lead to this status: “Criminalization and intersectional stigmas of same-sex practices, commercial sex, and HIV all augment risk for HIV and sexually transmitted infections among male sex workers and reduce the likelihood of these people accessing essential services” (p. 260).  In HIV risk and preventive interventions in transgender women sex workers, 2015, it is argued that “worldwide, transgender women who engage in sex work have a disproportionate risk for HIV compared with natal male and female sex workers” (p. 274).  This argument is based on the review of recent epidemiological research on HIV in transgender women. Like male sex workers, they find “that transgender women sex workers (TSW) face unique structural, interpersonal, and individual vulnerabilities that contribute to risk of HIV” (p.274). Incredibly, they found only six studies of “evidence-based prevention interventions”, none of which focused exclusively on TSWs. In response to this absence of research, they developed a deterministic model centered on findings related to HIV risks and interventions that examine HIV prevention approaches in TSW in Lima, Peru and San Francisco, CA, USA. The purpose was to identify which interventions would most likely achieve the United Nations goal of 50% reduction in HIV incidence in 10 years. They found that using a combination of interventions was promising in both settings (Peru and USA) and include case studies of six countries (India, Kyrgyzstan, Peru, South Africa, Thailand, and the USA) that show how context-specific issues should inform the development and implementation of these interventions. They also propose a research agenda to improve HIV services and policies for transgender sex workers. This piece includes community voices from a peer educator with SWEAT (Sex Workers Education and Advocacy Task Force in South Africa) and “the President of Somporker, Noya Setu, a national community based organization (CBO) that works for the rights of sexual minorities in Dhaka, Bangladesh” (p. 282). They also pointed out that “an analysis of funding patterns at NIH showed that only 0.1% of all NIH-funded studies addressed lesbian, gay, bisexual, and transgender health concerns and, of that 0.1%, less than 7% studied transgender populations. The near absence of NIH-funded research helps to perpetuate health disparities” (p. 283).

Two community-based research reports were released in December 2015 that both focus on transgender and sex worker communities. Meaningful Work: Transgender Experiences in the Sex Trade, is a report that utilizes the data collected through the National Transgender Discrimination Survey (NTDS) conducted and published by the National Center for Transgender Equality (NCTE) and the National LGBTQ Task Force. Their project surveyed and examined the experiences of 6,400 transgender adults in 2008-2009 reporting on their experiences of discrimination and abuse. Their report, Injustice at Every Turn: A Report of the National Transgender Discrimination Survey was released in 2011 and remains the largest reported survey of transgender people in the US. Meaningful Work is based on a “more thorough quantitative analysis of the raw data set that focuses on respondents’ involvement in the sex trade” (p. 13).  The authors found that “694 NTDS respondents—10.8% of the overall survey—reported having participated in sex work and 135 NTDS respondents (an additional 2.3%) indicated that they had traded sex for rent or a place to stay” (p. 4). Their detailed report provides information demographics, including participation in the sex trade based on gender identity and race and ethnicity (p. 13-14). They also cover areas such as education, employment and income; police and incarceration; and physical and mental health; all within the context of sex work. They include policy recommendations as well as suggestions for community and advocacy groups.  This report finds:

Transgender people who struggle to support themselves and their families are placed in an extremely challenging situation due to the stigma, violence, and discrimination they face, which is often compounded by racism, poverty, and other factors. Many turn to sex work to sustain themselves, and become vulnerable to harassment, assault, and arrest. […]The stigmatizing and criminalizing of sex work deepens the marginalization that transgender people face. NTDS respondents who had participated in the sex trade had many of the same negative experiences as other transgender people, often at higher rates—particularly transgender women and trans people of color. (p. 25)

The second report, Nothing About Us Without Us: Sex Work, HIV, Policy, Organizing, the first in a series, was produced as part of the Nothing About Us, Without Us: HIV/AIDS-related Community and Policy Organizing by US Sex Workers project. The project led by both sex workers and transgender people is grounded in long-term community organizing. It is a joint project of Best Practices Policy Project and Desiree Alliance and is funded by a grant from the Elton John AIDS Foundation. The goal is to end the silencing of transgender and sex working communities written into existing policies.

This report focuses on the experiences of transgender people who are also sex workers or are profiled as sex workers and reveals how current HIV policies impact groups of people who are often silenced and excluded from policy debates, in particular: sex workers, transgender individuals, people from low income communities, people of color, youth, drug users, and people who have experienced incarceration. This report documents the findings based on 25 survey responses and over 40 in-depth interviews and includes the perspectives of direct service providers, service organizations, advocates, policy makers, and sex worker and transgender community members. The outline their findings and reveal the legal and socially sanctioned violence of stigma, incarceration, and transphobia and then offer alternatives and best practices to reduce and remove this violence through the leadership of transgender people, especially people of color and leaders with sex trade experience, in all policy discussions pertaining to HIV and sex work.

A community empowerment approach to the HIV response among sex workers: effectiveness, challenges, and considerations for implementation and scale-up, 2015, is devoted to exploring a community empowerment approach to the HIV response among sex workers. They define this approach as “a process by which sex workers take collective ownership of programs to achieve the most effective HIV outcomes and address social and structural barriers to their overall health and human rights” (p. 172). They note that large-scale implementation of community empowerment-based approaches have been scarce. Their systematic review analyzes the effectiveness of “community empowerment in sex workers in low-income and middle-income countries”. These approaches were associated with reductions in HIV and other sexually transmitted infections and with increases in constant condom use with clients. The four case studies include Kenya, Burma, India, and Brazil. They describe the process, barriers and facilitators in reducing HIV transmission, and the sustainability of community empowerment. The authors identified formidable structural barriers to implementation of empowerment-based approaches that include “regressive international discourses and funding constraints; national laws criminalizing sex work; and intersecting social stigmas, discrimination, and violence” (p. 172). Despite these barriers, they find “sex-worker organisations have developed innovative and effective strategies to address the multi-level challenges they face in the implementation of community empowerment initiatives to promote their health and human rights” (p. 182). The authors call for increased financial and political support of these efforts by sex worker organizations, as well as for a strengthened and diversified evidence base for community empowerment in sex workers.

In Human rights violations against sex workers: burden and effect on HIV (2014), detailed evidence from more than 800 studies documents the “widespread abuses of human rights perpetuated by state and non-state actors” (p. 186). The authors of this article called for an end to impunity for sexual violence and other human rights violations stating “the failure to investigate and prosecute these violations, is a state failure” (p. 196). Their directive to human rights organizations acknowledges the duty to move beyond debates about the morality of sex work and to work directly with sex workers’ to document, denounce, and redress these violations. And perhaps equally importantly, they find that “sex worker organizing generates some of the most crucial and effective work on health and human rights, yet is severely underfunded. Less than 1% of funding on HIV prevention is spent on HIV and sex work, and even less is directed toward sex workers’ organisations” (p. 196). These calls toward the intellectual and financial support of community organizing by sex worker led organizations is paramount and cannot be understated.

Their calls to action include the functional role of structural measures. For example, the decriminalization of sex work and addressing migration and stigma, reducing or eliminating police violence and harassment, and implementing supportive venue-based policies and practices, are crucial structural fixes that would stem HIV epidemics in sex workers and clients.  An Action Agenda for HIV and sex workers, 2015, reviews specific calls to action for stakeholders in the HIV response for sex workers directed at communities, governments, donors, implementers and providers, and researchers. In addition, they highlight “Dutch pragmatism in policing sex work” (p. 296) based on an Amsterdam police inspector’s account.

Many community and umbrella organizations are featured in these articles, including HOYMAS (Healthy Options for Young Men on HIV, AIDS, and Sexually transmitted infections), a community organization for both male sex workers and men who have sex with men living with HIV, AIDS, and sexually transmitted infections; STAR-STAR (Start Together for Art and Romance), an Association for Support of Marginalized Workers based in Skopje, Macedonia; the Sex Workers Rights Advocacy Network (SWAN), which operates in central and eastern Europe and central Asia; and Sonagachi/Durbar Mahila Samanwaya Committee, a collective and forum of female, male and transgender sex workers in India. Umbrella organizations such as ICRSE, NSWP, and HOOK are included and their work highlighted. They created an Action Agenda in this piece I have included in full.


(An action agenda for HIV and sex workers Chris Beyrer et al. The Lancet

Volume 385, Issue 9964, 17–23 January 2015, Pages 287–301).


In addition to the issues covered above, there were Comments, or short pieces, included in this special series. One comment focused on Trafficking, sex work, and HIV: efforts to resolve conflicts, 2015. This comment emphasizes: “the issue of trafficking in sex work has been singled out, its scale and potential for harm frequently mis-stated or exaggerated to bolster anti-prostitution arguments, inflame public opinion, and justify repressive and counterproductive police action” (p. 94). The authors emphasize that “it is the official response to trafficking, particularly police actions, which is most likely to increase vulnerability to violence or HIV acquisition” (p. 95). They specifically mention the self-regulatory board developed by the Durbar Mahila Samanwaya Committee and its replication by Ashodaya Samithi in Mysore, India, stating both report better anti-trafficking and anti-violence results at every stage of the process compared with the raid and rescue model (p. 95). The authors also emphasize a significant level of conflict that lies in “deep-seated contradictions in the attitudes and dealings of societies towards and with sex work. Intergovernmental and donor policies on sex work, HIV, and human trafficking often stratify and separate substantially, leading to situations in which activities in one area set back efforts in another” (p. 95). They cite specific examples of these cases in Goa, India, and in Cambodia. The authors find, again, that “it is feasible to address both HIV and human trafficking positively in sex work settings if prevention efforts are aligned with and committed to sex worker participation”. The emphasis on the potential both offered and realized by self-regulatory boards’ experiences that build on sex workers’ commitment to improve their living and working conditions shows substantial advantages that can result from building an anti-trafficking response on a strong community platform with developed networks. Identification of trafficking cases becomes vastly improved as “sex workers are best able to identify underaged or coerced people in sex work areas” (p. 96). The authors emphasize that conflicts must be resolved at the policy level, and at the very least, policy should do no harm. They argue for the support and inclusion of sex worker communities as partners in human trafficking prevention specifically because it fits well with HIV program priorities and improves anti-trafficking outcomes. They state again that “the decriminalisation of sex work and its recognition as legitimate work would arguably set the stage for more comprehensive programs to protect workers—whether migrant or local—support their human rights, and improve workplace safety” (p. 96).

Another comment addresses Responses to HIV in sexually exploited children or adolescents who sell sex, 2015. They site international law in defining children younger than 18 years who sell sex as considered to be sexually exploited children. They state there are no accurate global estimates of the number of children and adolescents aged 10-17 years, nor are there accurate estimates of this subset who sell sex (p. 97). The authors find fear of police harassment and/or institutionalization prevents these children and adolescents from accessing HIV and other services. This contributes to driving them “underground, becoming invisible, excluded, and more vulnerable” (p. 98). They call for a new approach, “one which recognizes that all children and adolescents aged 10-17 years have a right to access information and rights-based health and other services which address their holistic needs” (p. 98). They argue that peer support is essential for children and adolescents to be able to discuss their issues and create their own solutions (p. 98). Policy makers, programmers, researchers, and youth organizations are asked to stop creating programs based on assumptions, but rather to “work together to ensure that adolescents are involved at all levels of programme and policy design, implementation, and evaluation, so that the response is shaped by their realities, needs, and aspirations” (p. 99).

Overall, the Lancet authors’ calls toward increased connection and involvement with sex-worker led organizations and research, as well as the need for funding for these studies and community empowerment models are clear. They clearly emphasize the ineffectiveness of punitive approaches and their role in increasing violence and risk of HIV and other sexually transmitted infections. As they state:

“The rich evidence base for community-based intervention shows that when sex workers lead in interventions, real and measurable improvements in health and rights can be achieved. Together, community engagement and new biomedical methods for HIV prevention and treatment offer the promise of substantial reductions in HIV risks and burdens for sex workers in the future, and could reduce treatment costs and save lives If these advances can be made available in policy contexts where carrying condoms is seen as a positive occurrence, where police protect sex workers from violence rather than perpetuate it, and where outcomes of policies are measured in reduced HIV infections, not increases in arrests, this component of the global HIV response could be markedly more effective” (p. 298).

An older and yet useful study was also included in my research, HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action, 2003. This article is useful specifically because it takes stigma, or a “significantly discrediting” attribute, as its starting point and works to “conceptualize stigma and stigmatization as intimately linked to the reproduction of social difference” (p. 13). They offer a new framework through which to understand HIV and AIDs-related stigma and its effects that aims to break down this barrier. This framework “highlights the manner in which stigma feeds upon, strengthens and reproduces existing inequalities of class, race, gender and sexuality” (p. 13). This article offers some excellent suggestions for lines of inquiry that include stressing the “concepts, ideas and new understandings of greatest relevance to national and international programs and activities focusing on HIV and AIDS-related stigma” (p. 20). Their article is one example of emphasis whereby “existing knowledge is constantly reviewed for its adequacy and appropriateness in the light of changing needs and circumstances” (p. 20). They clearly focus on “community mobilization aimed at unleashing resistance to stigmatization and discrimination, structural interventions aimed at developing a rights-based approach to reducing HIV and AIDS-related stigmatization and discrimination should be a high priority in order to create a transformed social climate in which stigmatization and discrimination themselves will no longer be tolerated” (p. 22).


There were many sources that honed in primarily on health with regard to the criminalization of sex work. For example, The decriminalization of prostitution is associated with better coverage of health promotion programs for sex workers was published in the Australian and New Zealand Journal of Public Health in 2010. In order to determine if law has any impact on the delivery of health promotion services to sex workers, the authors compared health promotion programs in three Australian cities with different prostitution laws (Melbourne, Perth, and Sydney). Despite variations in criminalization of sex work, they noted there was a thriving and diverse sex industry in each location. Sydney, the only location where sex work is largely decriminalized (without licensing as compared to the other two locations) had the only government-funded sex worker health promotion program that was run by a community-based organization, and the only program that contained a multi-lingual staff. Overall, they found the “legal context appeared to affect the conduct of health promotion programs targeting the sex industry” (p. 482), and notably, that “the programs in Perth and Melbourne had a limited capacity for advocacy because they were not community based. Brothel licensing systems and police-controlled illegal brothels are associated with reduced access to peer-education and support services for sex workers” (p. 486).

The Women’s Network for Human Rights Advocacy (WONETHA) in Uganda sent me their Annual Performance Evaluation Final Report for 2014 to assist me in creating my presentation. Sex work is criminalized in Uganda, and WONETHA was established in 2008 in response to the human rights abuses and violence that emerges from this criminalization. The goal of this report was to appraise the organization’s performance and guide decisions for their program delivery. Their participants totaled 74 people, 60.8% of which were sex workers’, and 6.1% of which were sex workers and peer educators. Their goal was to ascertain knowledge about WONETHA and its role, the perceived value of the organization, and their relevance in addressing their target group. They found that condom distribution and health care services were the most met need in 2014, whereas the least met need was support toward education of sex workers’ children. According to their evaluation, their objective to promote sexual and health rights was their greatest achievement. They found that “92.2 % of sex workers received enough condoms during 2014 [… and a] majority (86.3 %), that is a total of 1,205 individuals (sex workers and other members of their communities) that needed counseling and testing services received the service during 2014” (p. 9). Their other objectives include influencing change in policy, creating laws and practices that encourage violation of sex workers’ rights, strengthening the capacity of sex workers’ groups and promoting economic empowerment of sex workers in Uganda, and strengthening the capacity of WONETHA to deliver on its mandate (p. 9-11).

Our Lives Matter: Sex Workers Unite for Health and Rights is another helpful source. This report draws from eight very different organizations: Durjoy Nari Shongho in Bangladesh, Humanitarian Action in Russia, Stella in Canada, Durbar Mahila Samanwaya Committee (DMSC) in India, Sex Workers Project of the Urban Justice Center in the United States, Odysseus in Slovakia, Davida in Brazil, and Sex Worker Education and Advocacy Taskforce (SWEAT) in South Africa. This report highlights a variety of organizations work to fight for sex workers’ rights and provide health-based organization and services. In this report, Anna-Louise Crago highlights innovative action and lasting change for each organization. She includes information about the law in each country. Crago concludes, “Sex workers and sex worker rights organizations have become leaders in the fight against HIV; outspoken advocates to end violence against women and the persecution of transgender people; and strong voices for the rights of migrants and people in prison” (p. 64). She then goes on to provide recommendations to policymakers and funders (p. 65-68).

An RH Reality Check piece published in 2014, The Evidence is In: Decriminalizing Sex Work is Critical to Public Health, draws on The Lancet medical journal research as well as Amnesty International, Human Rights Watch, and the UN Global Commission on HIV and the Law. Authors Anna Forbes and Sarah Elspeth Patterson draw on these sources to argue that sex work must be decriminalized in order to create better access to health care and reduce violence.

Nothing about us without us: sex work, HIV, policy, organizing, 2015, is an article outlining the transgender empowerment research conducted by Best Practices Policy Project and Desiree Alliance. This community based research in the United States focuses on how direct profiling of transgender people and sex workers leads to dehumanizing social attitudes and structures that upend the health of individuals and communities, creating barriers to well-being and spreading HIV.

“Federal U.S. anti-trafficking policies undermine the health and rights of sex workers by requiring that many organizations seeking funding adopt a policy against sex work (“Anti-Prostitution Loyalty Oath”). This requirement is applied to organizations worldwide seeking funds from the President’s Emergency Plan for AIDS Relief (PEPFAR). Organizations within the U.S. have also been subject to the pledge under the Trafficking Victims Protection Reauthorization Act. These restrictions cause confusion amongst organizations about what kinds of services can be provided to sex workers and have, in some situations, led to the closure of excellent harm reduction services” (p. 7).

These practices are taken a step further when used as a justification for confiscating condoms and using them as proof of selling sex, or when law enforcement violates the privacy rights of transgender people by rifling through their possessions and checking to see if they are carrying any HIV medications. These practices are in direct conflict with reducing the spread of HIV. Community based research exposes the flawed underpinnings of current policy and shows how prevention and understanding work to reduce the spread of HIV and other health related issues faced disproportionately by the transgender community.

Meaningful Work: Transgender experiences in the sex trade, 2015, conducted a statistical analysis of data from the National Transgender Discrimination Survey. One of their findings was that the rejection of transgender people by their families and by society greatly increases the likelihood that they will participate in the sex industry/sex work. This rejection was shown to undermine both their physical and mental health. “Sixty percent (60.4%) of survey respondents who were involved in the sex trade reported that they had attempted suicide, a rate 37 times that of the general population” (p. 25). This study breaks down the disproportionate struggle faced by Transgender people which is rooted in stigma and fear. Violence, discrimination, racism, poverty, and other factors further alienate this segment of the population.



Although many of the reports I read addressed legislation in relationship to violence, HIV, and health, there are a few articles where it is the primary focus. In Why It’s Time to Legalize Prostitution, 2014, Cathy Reisenwitz draws on many reports and academic studies (including Ireland, Germany, New Zealand, Rhode Island, USA; the World Health Organization report, The Lancet, and a glimpse into the leaked Amnesty International document) to better understand existing legislation surrounding sex work. Reisenwitz doesn’t make a distinction between decriminalization and legalization, rather, she focuses primarily on the problems with criminalization of prostitution as well as the arguments used against decriminalizing it. She concludes with her analysis of the moral framework driving the argument and explores sex-positive feminists’ argument that the choice should be up to the individual. [stay tuned for PART 2 of this post coming soon]


Thank you to those who offered such great resources, feedback, and assistance for my TEDx talk and this project.

Kate D’Adamo, National Policy Advocate at Sex Workers Project

Derek Demeri, South Jersey Regional Director of the New Jersey Red Umbrella Alliance

Ms. Kyomukama Flavia, Programme Manager WONETHA

Kari Lerum, PhD, Associate Professor, Cultural Studies; Gender, Women, & Sexuality Studies

Erica Magenta , Peer Educator, Respect, Inc.

Penelope Saunders, Best Practices Policy Project

Michelle Sonnenberg, Research Assistant, University of South Florida St. Petersburg