Criminalization and Regulation
A constant struggle in activism and advocacy for sex workers is the criminalization of the work itself. Policing and criminalization impacts the daily lives and ability to access healthcare for sex workers, and therefore it is important to analyze the way different policies and policing practices influence the health outcomes of different communities of sex workers.
Then:
Looking directly at police documents can help to understand the impact of policing and health outcomes. In one police document (also referenced in the Stigma page), the police encourage hospitals to target women who come seeking treatment for syphilis as sex workers to help police to crack down on the practice; “A compensation of three francs will also be granted for the capture of a girl that is recognized at the clinic as having a contagious disease and is designated for the hospital, would not have returned to the prefecture by the indicated time, or who would have evaded the hospital that which she would have been treated for a contagious illness.”[1]
The hospitals are even offered compensation in exchange for turning in a suspected sex worker. From this passage we can see that healthcare professionals were in contact with the police about criminalizing sex workers, and were offered financial incentives to turn in sex workers rather than providing them care. Fear of arrest is a huge deterrent to seeking care for STIs, meaning that many sex workers were actively avoiding health care because of the relationship between health professionals and the police.
Now:
In the US today, criminalization, and policing both have a negative effect on sex workers ability to access and use healthy practices when doing their work. Criminalization policies create a risk of arrest when sex workers seek healthcare or attempt to practice safer sex in their work. For example, the police using condoms as evidence for sex work both profiles anyone who has safer sex supplies, and discourages sex workers from keeper safer sex supplies on their person. Sex workers must choose between having preventative supplies on their person or potentially facing arrest, an impossible risk calculation to make. [2]
Furthermore, a lot of policy around sex workers does not treat sex workers as autonomous members of the labor force due to the criminalization of sex work. This manifests in policies that assume sex workers cannot negotiate their own healthcare if given access to comprehensive and confidential services. For example, forced healthcare testing for STIs and other diseases comes up often in public health policy around sex work. This is both condescending and ineffective in preventing the spread of disease. This creates a climate for sex workers where a visit to a healthcare professional comes with risks of potentially being criminalized for past behavior of avoiding mandatory testing. This means that the services are ultimately less accessible and safe for sex workers and clients when they enforce mandatory standards.
HIV criminalization laws also have a disproportionate effect on sex workers. HIV criminalization manifests in laws that make it illegal to transmit HIV to a partner, legally making the HIV positive body into a weapon. These laws are written so that someone can only be criminalized if they know their HIV status, discouraging people from getting tested for fear of being legally prosecuted. Discouraging people from knowing their status has adverse public health outcomes, and for sex workers the risk is even higher for criminalization because of the illegality of their work and the stigma surrounding it. Therefore, HIV criminalization laws discourage sex workers from knowing their HIV status and seeking care for STIs generally.[3]
What is different:
Modern activism and some changes in policy means that there have been specific services created with sex workers in mind that actively support the choices of sex workers. For example, HIPS clinic in Washington DC is a center based in harm reduction philosophies, and offers comprehensive services for sex workers in the area. It is hard to fully know if these kinds of resources were available in France for sex workers at the time, however we can assume that the resources around harm reduction were not the same. In addition, there is no evidence of healthcare professionals today being offered compensation for turning in sex workers to authorities. However, stigma and criminalization still have a huge affect on health care access.[4]
What has stayed the same:
The problems associated with mandatory testing and criminalization have stayed largely stagnant. Both then and now, criminalization and policing have adverse affects on the ability for sex workers to seek comprehensive and accessible care. In France in the 1800s sex workers were being criminalized for having syphilis, and sex workers today are criminalized for HIV. In addition, the mandatory testing policies and the connection between seeking healthcare and police intervention are similar in their effect on healthcare outcomes.