Public Health Impact of Sex Work
Review the impact of sex work on public health, including HIV/STIs epidemiology, the potential effects of decriminalization, disparities faced by sex workers, and the risks associated with repressive policies. Explore the overlap between HIV/STIs and sex work, addressing issues like violence, condomless sex, and inequalities exacerbated by criminalization.
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Update on Sexually Transmitted Infections The Rhode Island Department of Health March 21, 2022
The Public Health Impact of Sex Work Objective #1: Objective #1: Review the public health impact of sex work. Review the public health impact of sex work. Objective #2: Objective #2: Review the epidemiology of HIV and other sexually Review the epidemiology of HIV and other sexually transmitted infections (STIs). transmitted infections (STIs). Objective #3: Objective #3: Discuss the potential impact of decriminalizing sex Discuss the potential impact of decriminalizing sex work from a public health perspective. work from a public health perspective. 2 Rhode Island Department of Health Rhode Island Department of Health
The Public Health Impact of Sex Work Lack of Lack of Housing Housing Poverty Poverty Sex Workers Sex Workers Face Many Face Many Disparities Disparities Mental Mental Health Health Substance Substance Use Use Racism Racism Discrimination Discrimination 3 Rhode Island Department of Health Rhode Island Department of Health
The Public Health Impact of Sex Work Repressive policies including criminalization of sex work has Repressive policies including criminalization of sex work has been associated with increased risk of been associated with increased risk of Sexual/Physical Sexual/Physical Violence Violence Condomless Condomless Sex Sex HIV/STIs HIV/STIs Other Other Increased risk of Increased risk of violence (Odds violence (Odds ratio 2.99); ratio 2.99); Increased risk Increased risk condomless sex condomless sex (Odds ratio (Odds ratio 1.42); 1.42); Increased risk of Increased risk of HIV and other HIV and other STIs (Odds ratio STIs (Odds ratio 1.87). 1.87). Disruption of Disruption of support networks support networks and access to and access to services; services; Displacement of Displacement of sex workers into sex workers into unsafe unsafe situations. situations. Discourages sex Discourages sex workers carrying workers carrying condoms. condoms. Exacerbation of Exacerbation of existing existing inequalities. inequalities. 4 Platt et al., 2018 Platt et al., 2018 Rhode Island Department of Health Rhode Island Department of Health
The Public Health Impact of Sex Work There is a significant overlap between HIV/STIs and sex work. There is a significant overlap between HIV/STIs and sex work. Sexual/Physical Sexual/Physical Violence Violence Condomless Condomless Sex Sex HIV/STIs HIV/STIs Other Other Increased of Increased of violence (Odds violence (Odds Ratio 2.99); Ratio 2.99); Increased risk of Increased risk of condomless sex condomless sex (Odds ratio (Odds ratio 1.42); 1.42); Increased risk of Increased risk of HIV and other HIV and other STIs (Odds ratio STIs (Odds ratio 1.87). 1.87). Disruption of Disruption of support networks support networks and access to and access to services; services; Displacement of Displacement of sex workers into sex workers into unsafe unsafe situations. situations. Discourages sex Discourages sex workers carrying workers carrying condoms. condoms. Exacerbation of Exacerbation of existing existing inequalities. inequalities. 5 Platt et al., 2018 Platt et al., 2018 Rhode Island Department of Health Rhode Island Department of Health
Number of New HIV Diagnoses by Year, Rhode Island, 2012-2021 Source: Source: Rhode Island Department of Health 6 Rhode Island Department of Health Rhode Island Department of Health
Number of Chlamydia Diagnoses, Rhode Island, 1998-2021 Source: Source: Rhode Island Department of Health 7 Rhode Island Department of Health Rhode Island Department of Health
Number of Gonorrhea Diagnoses, Rhode Island, 1998-2021 Source: Source: Rhode Island Department of Health 8 Rhode Island Department of Health Rhode Island Department of Health
Number of Infectious Syphilis Diagnoses, Rhode Island, 1998-2021 Source: Source: Rhode Island Department of Health 9 Rhode Island Department of Health Rhode Island Department of Health
Disparities and HIV/STIs African African- -American/Black individuals have 5 American/Black individuals have 5- -8x higher rates of STIs. STIs. 8x higher rates of Hispanic/Latino individuals have 1 Hispanic/Latino individuals have 1- -2x higher rates of STIs. 2x higher rates of STIs. Gay and bisexual men comprise almost 50% of infectious syphilis Gay and bisexual men comprise almost 50% of infectious syphilis cases and have gonorrhea rates 42x that of heterosexual men. cases and have gonorrhea rates 42x that of heterosexual men. Young people aged 15 Young people aged 15- -24 years make up >60% of chlamydia 24 years make up >60% of chlamydia cases and >40% of gonorrhea cases. cases and >40% of gonorrhea cases. www.cdc.gov/media/releases/2021/p0413-stds.html 10 Rhode Island Department of Health Rhode Island Department of Health
Why are STIs increasing? Increased condomless sex (due to effective contraception and Increased condomless sex (due to effective contraception and PrEP and HIV treatment); PrEP and HIV treatment); Riskier sex associated with substance use and addiction; Riskier sex associated with substance use and addiction; Less awareness and concern about other STIs (compared to Less awareness and concern about other STIs (compared to HIV); HIV); Limited investment in clinical and public health infrastructure to Limited investment in clinical and public health infrastructure to address STIs. address STIs. 11 Rhode Island Department of Health Rhode Island Department of Health
The Public Health Impact of Sex Work STIs are significantly increasing across Rhode Island. STIs are significantly increasing across Rhode Island. Evidence demonstrates that repressive policies and Evidence demonstrates that repressive policies and criminalization of sex work leads to adverse health outcomes criminalization of sex work leads to adverse health outcomes among sex workers, including a higher risk of HIV/STIs. among sex workers, including a higher risk of HIV/STIs. Removal of criminal and administrative sanctions for sex work Removal of criminal and administrative sanctions for sex work can improve the health of sex workers and access to care. can improve the health of sex workers and access to care. We should work to improve linkage and access to healthcare and We should work to improve linkage and access to healthcare and other support services for sex workers. other support services for sex workers. 12 Rhode Island Department of Health Rhode Island Department of Health
Contact Information Philip A. Chan, MD Consultant Medical Director Rhode Island Department of Health Philip.Chan@health.ri.gov
