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When evidence based approaches go out the window sex workers are the casualties

April 11th, 2007

Dr Petra

You may have seen a few news stories recently claiming that legalising prostitution will save the NHS millions. News reports have revealed 70% of sexually transmitted infections (STIs) are found amongst sex workers and clients. This shocking statistic came from a British Medical Association conference presentation at the end of March – which appeared to be endorsed by a press release sent out to a number of UK papers and subsequently covered in the press.

The conference presentation by Chris Spencer Jones – Chair of the British Medical Association’s public health committee argued legalising prostitution would save the NHS money.

Media coverage quotes Jones as saying “If prostitution was legalised and regulated, you wouldn’t get an exactly 70 per cent drop in STIs, but I would be confident in saying that you would get a 50 per cent drop. What I am told is that this is a widespread picture, so I would be happy to say that you would get the same results anywhere else in the country. Nationally, sexual health services cost around £700 million a year. While regulating prostitution would probably cost £20 – 25 million a year to staff, we’re still looking at a saving of £330 million every year if the industry was regulated.”

He went on to claim there had been an ‘explosion’ in HIV cases within the Birmingham area linked to immigrants from HIV endemic countries settling in the region “In Birmingham we have got women from places like Somalia offering sex at very low prices. They will agree to unprotected sex for as little as £5”.

Whilst it is well known sex work can pose physical and emotional health risks to workers, prostitutes report often finding it difficult to access safe and non-judgemental health care. Clients most certainly can carry and infect prostitutes with STIs and sex workers who are more vulnerable may well find it difficult to enforce condom use – putting them at risk of infection. And sex workers are often put at risk by other problems posed by clients and wider communities including physical violence and verbal abuse. However, evidence does not support the idea that 70% of our STIs in the Birmingham area (or the rest of the UK) are confined to sex workers and their clients. We do know that the majority of STIs are contracted and spread amongst the 18-25 year old age group.

It is unclear exactly where the data that underpinned this conference presentation came from – it does not appear to be supported by routinely collected local sexual health data for the region – nor is it endorsed by those working closely with sex workers within sexual health. It does not fit within wider research on prevalence of STIs in UK sex workers and nor does it compliment the view taken by the British Medical Journal on the health needs of prostitutes. Worryingly health groups within the UK claim they are not aware of Somali or other African prostitutes working in large numbers – or charging such small fees.

What this conference presentation and subsequent media coverage does do is hark back to past approaches to the management of prostitution where sex workers, not clients or wider society, were blamed for spreading infection and aggressively targeted. And it certainly makes some very uncomfortable claims that expose already stigmatised community members to further racial prejudice.

It seems that an individual, for reasons best known to themselves, quoted a misleading statistic at a conference presentation and misrepresented not only a body of scientific evidence, but also undermined the work of local initiatives actively assisting sex workers. Sadly the media missed this scandal completely in a chance to pair the NHS with prostitution.

Michael Goodyear has written a useful response to this story in the BMJ.

What will happen to the practitioner who made these inaccurate and arguably prejudicial claims has yet to be seen – whether it’s a disciplinary or sacking offence is unclear. What certainly needs to happen is those working in public positions within healthcare must have their epidemiological data correct before going to the press – particularly if they are talking about vulnerable groups who are already targets of public hatred.

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