To protect women and minors, prohibit prostitution…

…But use the law to drive down demand, say experts in public health and culture.

A vote at Amnesty International’s decision-making forum earlier this month has committed the human rights organization to promoting the full decriminalization of prostitution – a step, it claims, that will protect “sex workers” human rights and prevent trafficking and the exploitation of minors.

While such weighty authorities as the World Health Organisation and other UN agencies agree with Amnesty, women’s rights and anti-trafficking groups vehemently disagree. They say that coercion and abuse are inherent in prostitution and they want to see it abolished, following the approach of a Swedish law which prosecutes those who buy sex but not those who sell, the latter being helped to exit prostitution.

What is the best approach to this individual and social problem? For an independent view MercatorNet asked experts at the University of Navarre’s Institute for Culture and Society, who published their own report on the issue last year as part of the project Education of Human Affectivity and Sexuality. In the following interview Dr Jokin de Irala and Dr Cristina Lopez answer our questions.

From what perspective does your report approach the issue of prostitution?

In our report we approach the issue of prostitution from different perspectives. It is difficult to address prostitution without taking into account the social vulnerability of women and minors who are mostly victims of human trafficking, issues pertaining to criminal law, equality between males and females, or the need to educate both victims of exploitation and the so-called “clients”, who can be unaware of the human drama behind prostitution.

We also consider how affective and sexual education centered on preparing youth for love, rather than promoting so called “safe sex” programs, also plays an important role in the prevention of prostitution. We are aware that an array of influential and international organizations, global authorities as well as powerful and diffuse associations and/or donor agencies that, collectively, we call the “Sex Education Establishment”, are keen to promote the decriminalization of prostitution. They use the argument that this is the best way of preventing trafficking and problems such as the spread of sexually transmitted infections (STI´s). These institutions create policy guidelines and fund initiatives worldwide to carry out their strategic priorities. Sometimes called “best practices”, these priority interventions are presented as neutral, factual information but their track record is often questionable. For this reason we also believe it is essential to approach prostitution using evidence based criteria, whenever possible.

What is the best solution to the problems of prostitution – some form of legalisation to limit the harms, or complete prohibition? 

The debate about prostitution is usually approached from these two perspectives. The first argues that legalization of the “commercial sex” would end human trafficking for that purpose, while the second proposes that the most effective measure against human trafficking for purposes of sexual exploitation is the outlawing of prostitution.

Those who defend the first approach argue that we should distinguish between prostitution (also called “voluntary exchange of sex for money”) and trafficking and that both activities are not necessarily related. According to this approach, banning prostitution is state interference in private affairs, and even a factor that worsens the living conditions of persons who prostitute themselves. They also argue that the State should not criminalize “the entire sector” because of a minority that commits abuses. In summary, this perspective tends to not relate prostitution with the abuse of persons and therefore argues that prohibition is inappropriate.

The second approach, abolition, is based on the finding that prostitution and human trafficking are both directly and intrinsically related, and not due to the prohibition of prostitution. According to the International Labour Organization, there are 2.4 million people victims of trafficking: 98% are women and half are minors. Also, the Office of the United Nations on Drugs and Crime states that 79% of human trafficking is for the purpose of sexual exploitation.

Prostitution is considered the most important and profitable type of sex trade. In a study on prostitution and trafficking in nine countries (developed and developing), Melissa Farley finds that between 70% and 90% of prostitutes suffer physical violence; between 60% and 75% of them have been raped in the environment of prostitution, and 89% of the prostitutes in those countries want to leave prostitution.

If abolition is the goal, which type of law seems most effective? 

Sweden has laws prohibiting the “purchase” of sexual services, considered as “a criminal offense”. This law criminalizes the person who pays for the “service”, not the one who provides “her/his body”, because it is part of a prevention program of violence against women, and because its objective is to help more people to leave prostitution. Studies show that such laws do not cause increases in rape or violence against women. Moreover, it reduces street prostitution, and up to 90% of affected women have managed to leave this activity thanks to the help facilitated by the law.

It is important to remember that laws prohibiting prostitution seek, ultimately, to protect equality, protect women and minors and prevent serious abuses of human rights. We must remember a basic principle: the global business of prostitution thrives because of the “clients” seeking “sexual services” and the “inexpensive” victims who are exploited. Therefore, it is crucial to strongly act at this initial point of the demand: “points of sale” of “sexual services”.

The Lancet says that “decriminalisation 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.” – How do you respond to that claim? 

Well, we believe that those who make such claims would do better to describe what evidence they have to prove them. As noted above, international experiences of “intelligent” forms of prohibition such as Swedish law have a higher public health achievement compared to other experiences such as the legalization in Germany. Swedish law focuses on the criminalization of clients and the empowerment of women and minors that could be victims of human trafficking.

The reduction of HIV epidemics argued in the Lancet article assumes the achievement of more hygiene, and condom use, in a setting where prostitution would be legal, but two issues have to be taken into account. Firstly, it is well known that clients and commercial sex workers rarely have an equal status in that “commercial transaction” and thus condom use would still ultimately depend on what “clients” want. Secondly, the large epidemics of HIV infection in areas such as those in Sub Saharan Africa have not solved their problems thanks to condom promotion. The largest reductions of HIV transmission have resulted more from the reduction of the number of sexual partners.

We are afraid “commercial sex” businesses “need” a large number of clients rather than a reduced number. Since condoms are not 100% effective in avoiding STI’s, the phenomenon of “risk compensation” will surely be the cause of new infections in spite of the legalization of prostitution.

Germany is one country which has opted for legalisation, treating prostitution as “work” but regulating the conditions under which it is practised. How is that working out? 

In Germany, prostitution is legal since 2002 and “sex workers” have access to retirement benefits because they pay social security contributions. However, studies show that the legalization has failed to reduce the cases of sexual exploitation and human trafficking, and that hygiene and other conditions of these “workers” have not improved as expected.

For prohibition to work, what sorts of social policies and other initiatives are necessary?

Obviously, it is always necessary to consider bans in an international and global context of measures, taking into account to all the complex aspects related to the problem of human trafficking. For example: by combating the demand from customers and pimps (adapting prohibitionist laws to international needs, enforcing them, prosecuting those who traffic within criminal networks, identifying facilitators and exploiters); by reducing the “supply” (achieving the goal that no one perceives the “need” to engage in prostitution, promoting assertiveness, resilience and other life skills in young people, and finally by rehabilitating and reintegrating victims); as well, by strengthening communities (increasing their economic opportunities, encouraging equality between men and women, promoting interdisciplinary collaboration of professionals and improving the training of advocates of the law). And in this context of “global action”, the affective and sexual education of youth is crucial.

Both the Lancet and Amnesty International, among others, refer to prostitution as “sex work” and suggest that it can exist as a freely chosen service to meet the needs of particular people.  – Is it just traditional morality that stands in the way of this “profession” or is there something in the realm of human values that makes it unacceptable? 

It does not seem reasonable to believe that “a client” can be always totally sure of engaging in sex with a person that is not a minor, or that this person “offers his/her services” without being pressured or abused to engage in this activity. To distinguish between a “commercial transaction” that is free from pressure and abuse is complicated in practice when the one that pays for commercial sex does not go much further than that sexual act that was paid for.

Experts such as Joanna Niemi (professor of Law at Helsinki University) affirm that the use of terms such as “commercial sex”, “sexual service”, “provider”, “client” are used by some with the intention to increase respect towards the people involved. However she is worried by the unwanted collateral effects of the use of such terms. She is concerned because such terms ultimately facilitate human trafficking. It is more difficult to perceive an abuse if we speak of “economic transactions to pay for a service”. The terms lead us to interpret what is happening in brothels as “leisure and sexual consumption”. The “client”, usually a male, does not necessarily identify himself as an abuser and he can easily be unaware that the persons who are “providing a service” are in fact doing that against their will, due to economic or other pressures, or even that they are minors.

How can prostitution be abolished in societies which allow pornography to flourish? What is the educational task here? 

Pornography is a real social problem, with a clear impact on public health as more and more young people are developing problematic and addictive uses of pornography. Furthermore there is also a link between pornography and sexual abuse of women and minors. Pornography can be considered a trigger and/or fuel of the problem of the “perceived need” of prostitution that we mentioned previously.

We mentioned affective and sexual education of youth as part of the global action against prostitution. Some proposals, for example those from the sex education establishment worldwide, are centered on safe sex messages or on biological aspects of human sexuality. However, our affectivity, or emotional responsiveness, is part of our sexuality. Therefore, character education should precede education concerning the more biological aspects of sexuality. Some programs also teach the biological aspects of sexuality but concentrate more on preparing youth to become loving adults as opposed to “sexual experts” that constantly have condoms in mind.

The more biologically-centered approaches to sex education seldom help youth to be real and empowered masters of their own sexuality; they rather lead them into emotional and affective dependencies, with possessive ideas concerning romantic relationships. This in turn increases the frequency of abusive relationships and, when “needed”, the use of prostitution.

Jokin de Irala MD, MPH, PhD, is the former Vice Dean of the School of Medicine of the University of Navarre. He has a Master of Public Health (University of Dundee) and doctorates in Medicine (University of Navarre) and Biostatistics and Epidemiology (University of Massachusetts). He is the Senior researcher of the project Education of Affectivity and Human Sexuality from the Institute of Culture and Society of the University of Navarre. 

Cristina Lopez-del Burgo MD, PhD, is Associate Professor of the Department of Preventive Medicine and Public Health at the University of Navarre, Spain. She has also specialized in Family and Community Medicine.