Problem and purpose statement for Sex Work thesis
Here it goes!
Harm Reduction Strategies Focusing on Street-based Sex Workers
Problem Statement
Sex work, as defined by SJI Staff (2010) in the St. James Infirmary Occupational Health & Safety Handbook is “the provision of sexual services or performances by one person (prostitute, escort, stripper: Sex Worker) for which a second person (client or observer) provides money or other markers of economic value.” (p. 10) Sex work includes a variety of services from no physical contact to intimate contact: lingerie modeling, exotic dancing, massage, and coitus, to name a few. Survival sex is the subset of sex work that not only uses money as a medium of exchange, but also drugs, food, shelter, or security (United Nations Population Fund, 2008).
Survival sex workers may perform sex work for many reasons: famine, war, forced migration, refugee status, the sudden loss of a home, occupation, or family support (Rekart, 2005). Sex workers may be divided by location, either brothel-based or “on the street”. Brothel-based sex workers usually work in a building that is furnished for the efficient transaction of sex work. Street-level sex workers, on the other hand, meet their clients in the open, and in the United States, usually while the client is in a car. Street-level sex workers are also more likely to be engaged in survival sex.
The nature of brothel-based work decreases the risk of harm associated with sex work, as shown by studies in India, Thailand, and Australia, among other places (Decker et al., 2010; Ghose, Swendeman & George, 2011; Harcourt et al., 2010). This decrease in risk comes from several factors: brothel management maintaining security procedures to protect their investment, emergency assistance immediately at hand in case of a “bad date”, or clients are less likely to argue with sex workers about the necessity of condom use and safe sex practices (Harris, Nilan, & Kirby, 2011). Brothel-based sex workers are also less likely use drugs, especially intravenous drugs (Holroyd, 2008; Jeal, 2007).
Street-level sex work, on the other hand, is very dangerous, and sometimes lethal. The risks are intertwined in a synergy of drug use, lack of condom use, and violence (Gu et al., Jeal, Salisbury, & Turner, 2008). Street-based sex workers are more likely abuse alcohol or drugs, and while their judgement is impaired, engage in risky sex, which increased the likelihood of sexually transmitted infections (STIs) and HIV (Cohan et al., 2006; Samet et al., 2010). This impaired judgement also reduces a worker’s ability to judge the risk of violence, whether is be from a client or from a domestic partner (Panchanadeswaran et al., 2008). They are also more likely to use injectible drugs, and become prey to blood-borne pathogens (BBPs) such as hepatitis C, as well as the usual complications of injections such as phlebitis, cellulitis, and particulate contamination. They may also feel the financial pressure to forgo condom use for more money (Blankenship, Kershaw, & Biradavolu, 2008), which also increases the likelihood of STIs, BBPs and HIV. Street-based sex work is also associated with homelessness, especially that of underaged teens (Duff, 2011; National Alliance to End Homelessness, 2009) .
It is not enough to show that the presence of brothels decreases harm, but the reverse must be observed. When brothels are removed, the risks to sex workers increase, as shown by studies in the former Portuguese colony Goa (Shahmanesh et al., 2009b). If brothel-based sex work can reduce harm, why isn’t more sex work brothel-based? Due to the legal status of sex work, brothels are more likely to occur where sex work has been decriminalized, as seen in Australia, Mexico, and New Zealand (Healy, 2006; Sirotin et al., 2010; Sullivan, 2010). In the United States, the State of Nevada is famously populated with brothels, but not in counties with a population greater than 700,000 people, such as Las Vegas and Reno (Nevada Revised Statute 244.345, 2011). In Las Vegas, Reno, and the rest of the United States, street-level sex work is more common.
The purpose of this paper is to examine harm reduction strategies aimed at street-level sex workers, especially since 2006, when Rekart published a systematic review in Lancet exhaustively summarizing avenues of harm to sex workers all over the world. Much has been done since then, most of it targeted at HIV transmission, but sex workers are more than a disease vector. Sex workers are a marginalized population with specific concerns. Any patient-centered approach would address risks identified by sex workers themselves, such as lack of access to health care, drug abuse, and violence (Cohan et al., 2006).
25 references. Oy. And I have to look up how to correctly cite a statute.